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Clinical Tip: The ‘Book’ Approach to Reflecting a Surgical Flap

July 2, 2019
Jack A. Hahn image
Jack A. Hahn, DDS

Course Objectives

1 CE Credit

Extraction followed by immediate implant placement is an excellent means of addressing the immediate and long-term needs of patients who present with a non-restorable tooth in the anterior. Practitioners who provide this form of treatment will inevitably encounter cases in which a facial defect is present, calling for the reflection of a surgical flap and grafting of the extraction site. In this multimedia presentation, Dr. Jack Hahn explains the “book” approach to reflecting a surgical flap, demonstrating how to identify, graft and position an implant in the presence of a facial defect. Topics include:

  • Basic protocol for extraction and immediate implant placement
  • How to identify a labial bone defect at an extraction site
  • Surgical incisions needed to execute the book approach to reflecting a flap
  • Proper implant placement in anterior extraction sites
  • Bone augmentation procedure for facial bone defects
  • Benefits of immediate tooth replacement with implant therapy
  • Techniques for optimizing esthetics in anterior implant cases


When a facial defect is present at an extraction site, clinicians can place an implant and achieve a predictable outcome by following some straightforward diagnostic and surgical procedures. A flap can be reflected using the book approach to implant surgery, exposing the site for evaluation and bone grafting. By minimizing incisions and helping to maintain hard- and soft-tissue contours, this technique can help clinicians produce esthetic results when immediate tooth replacement is desired.

CAUTION: When viewing the techniques, procedures, theories and materials that are presented, you must make your own decisions about specific treatment for patients and exercise personal professional judgment regarding the need for further clinical testing or education and your own clinical expertise before trying to implement new procedures.

Recognition & Approval

Glidewell Education Center is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

Glidewell Education Center
Nationally Approved PACE Provider for FAGD/MAGD credit
Approval does not imply acceptance by any regulatory authority, or AGD endorsement. 3/1/2021 to 2/29/2024.
Provider ID# 216789

Jack A. Hahn image
Jack A. Hahn, DDS

Dr. Jack Hahn earned his DDS from The Ohio State University College of Dentistry. A pioneer in the field of implant dentistry, Dr. Hahn has been placing and restoring dental implants for 50 years, and he developed the original tapered implant design in the 1990s. Most recently, he oversaw the design of the Hahn™ Tapered Implant, which was created to streamline treatment and improve results. Dr. Hahn is also clinical editor of Chairside® magazine. He lectures to dentists around the world and maintains a private practice in Cincinnati, Ohio.


  1. Noelken R, Neffe BA, Kunkel M, Wagner W. Maintenance of marginal bone support and soft tissue esthetics at immediately provisionalized OsseoSpeed implants placed into extraction sites: 2-year results. Clin Oral Implants Res. 2014 Feb;25(2):214-20.

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