Alternatives in the correction of a esthetically deficient central incisor pontic site.

Combination of tissue graft, a big graft from the palate and a small one from the tuberosity. First, suture the graft from the palate in a apical coronal position, then put the small graft from the tuberosity in a only position and slide all the buccal flap on top of them. The graft from the tuberosity will give you stability and the graft from the palate will give you volume. Be sure to stabilize them well, if not both will fail.

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If implanting is not a consideration we know that 25+ year connective tissue ridge augmentation with ovate pontics are predictable -
the key in this type of complex defect is to use a wedge of dense fibrous, non fatty tissue only found tissue distal to the Upper molars.
the wedge is sutered in situ to the lingual aspect and the labial flap released sufficiently to advance and cover the graft , coapting the flaps - - wait 6 weeks and develope the ovate potic site using a round coarse diamind or a CO2 laser - - shaping with heat sources such as electrosuge or diode are a little less accurate / predictable on this large volume of tissue

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I must agree with my partner David Garber. I like your selection for this case!
Dr. S

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