Is the ‘brushing technique’ recommended to release the soft tissue without vertical incisions?

This technique is not recommended.

Can soft tissue grafting be performed before bone grafting if the tissue phenotype is thin?

Soft tissue grafting can be performed in this case.

Should the flap be stretched if the MGJ is closer to the ridge, and reflection is beyond 3 millimeters?

The flap should be stretched in such case.

Can tension-free flap closure be used, or is stretching the flap with tension necessary?

With Augma bone graft cement, no horizontal releasing incision is recommended to gain a tension-free flap. The flap should be under tension during the closure. Therefore, the flap should be minimally reflected according to the protocols, while the flap closure is accomplished by stretching.

If the vertical incision is more than 3mm past the mucogingival line, is it possible to suture without engaging the muscles?

The sutures do not have any influence on muscle engagement. The flap design and the way it is reflected, together with a lack of releasing incisions, are the factors that prevent muscle engagement.

Why should sutures not be engaged with the muscles?

The flap is the part that should not be connected to the muscles; therefore, the flap is minimally reflected, as explained in the protocols. The sutures are not the issue.

Is a full periosteum release recommended to allow tension-free closure, or how much should one release?

Do not perform any periosteum-releasing incisions. The protocols for Augma bone graft cement instruct to maintain tension on the flap during the closure. In this way, the flap is minimally reflected and stretched for closure.

What type of flap is needed, partial- or full-thickness?

A full-thickness flap is necessary.

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