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Vestibular deepening by periosteal fenestration and its use as a periosteal pedicle flap for root coverage.

Rajpal J, Gupta KK, Srivastava R, Arora A - J Indian Soc Periodontol (2013)

Bottom Line: Multiple techniques have been developed to obtain predictable root coverage and to increase the width of attached gingiva.The newer methods of root coverage are needed, not only to reconstruct the lost periodontal tissues but also to increase predictability, reduce the number of surgical sites, reduce the number of surgeries and improve patient comfort.Hence, this paper describes a single stage technique for increasing the width of attached gingiva and root coverage by using the periosteal pedicle flap.

View Article: PubMed Central - PubMed

Affiliation: Department of Periodontology, Subharti Dental College, Meerut, India.

ABSTRACT
Gingival recession along with reduced width of attached gingiva and inadequate vestibular depth is a very common finding. Multiple techniques have been developed to obtain predictable root coverage and to increase the width of attached gingiva. Usually, the width of gingiva is first increased and then the second surgery is caried out for root coverage. The newer methods of root coverage are needed, not only to reconstruct the lost periodontal tissues but also to increase predictability, reduce the number of surgical sites, reduce the number of surgeries and improve patient comfort. Hence, this paper describes a single stage technique for increasing the width of attached gingiva and root coverage by using the periosteal pedicle flap.

No MeSH data available.


Related in: MedlinePlus

6 mm length of recession
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Figure 2: 6 mm length of recession

Mentions: A 17-year-old girl reported to the Department of Periodontics with the chief complaint of unesthetic appearance of her front lower teeth [Figure 1]. On examination, it was found that 6 mm deep and 4 mm wide class II gingival recession (Miller, 1985) was there on the lower left central incisor [Figures 2 and 3]. The tooth was slightly labially placed and patient also gave the history of tooth brush trauma. The vestibular depth and the width of attached gingival were also inadequate in the region. There was no mobility associated with the tooth. For the root coverage, increase in width of attached gingiva and vestibular deepening the periodontal plastic surgery was planned with a single stage fenestration technique and root coverage using the periosteal pedicle graft. The patient was advised for the treatment of the isolated gingival recession defect. The patient was in good systemic health with no contraindications for periodontal surgery. She was explained about the surgery and signed informed consent was taken by the patient. A general assessment of the patient was made through her history, clinical examination and routine laboratory investigations. Before surgery, the patient received phase-I therapy, which included oral hygiene instructions and scaling and root planning with ultrasonic and hand instruments. Two weeks after phase I therapy, the patient was planned for surgical procedures. On the day of surgery, local anesthesia was first administered bilaterally by using a mental nerve block. A horizontal incision was made using a no. 15 surgical blade at the mucogingival junction retaining all of the attached gingiva [Figures 4 and 5]. A split thickness flap was reflected sharply, dissecting muscle fibers and tissue from the periosteum. This was then sutured in the depth of the vestibule using resorbable 5-0 sutures [Figure 6]. A strip of periosteum was then removed at the level of the mucogingival junction, causing a periosteal fenestration exposing the bone. The care was taken not to remove the periosteal strip completely and to leave it pedicled to the bone and the rest of the surrounding periosteum at the lateral end [Figures 7 and 8]. The recipient site preparation included two horizontal incisions. First, intracrevicular incision and a second incision made parallel and apical to the first incision [Figure 9]. The incisions were followed by split-thickness dissection of the facially located tissue up to the level of the vestibular incision so as to create a tunnel [Figures 10 and 11]. The exposed root surface was root planed with curettes to remove bacterial contamination and was biomodified using the tetracycline powder mixed with saline. The pedicled periosteal donor tissue was then moved vertically towards the recession area, passing through the tunnel [Figures 12-14]. At repositioning, the osteoperiosteal portion was closely adapted to the recipient site by pressing for 3 min and then sutured along with the overlying gingival tissue, to the recipient bed, using 5-0 resorbable sutures [Figures 15 and 16].


Vestibular deepening by periosteal fenestration and its use as a periosteal pedicle flap for root coverage.

Rajpal J, Gupta KK, Srivastava R, Arora A - J Indian Soc Periodontol (2013)

6 mm length of recession
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3713765&req=5

Figure 2: 6 mm length of recession
Mentions: A 17-year-old girl reported to the Department of Periodontics with the chief complaint of unesthetic appearance of her front lower teeth [Figure 1]. On examination, it was found that 6 mm deep and 4 mm wide class II gingival recession (Miller, 1985) was there on the lower left central incisor [Figures 2 and 3]. The tooth was slightly labially placed and patient also gave the history of tooth brush trauma. The vestibular depth and the width of attached gingival were also inadequate in the region. There was no mobility associated with the tooth. For the root coverage, increase in width of attached gingiva and vestibular deepening the periodontal plastic surgery was planned with a single stage fenestration technique and root coverage using the periosteal pedicle graft. The patient was advised for the treatment of the isolated gingival recession defect. The patient was in good systemic health with no contraindications for periodontal surgery. She was explained about the surgery and signed informed consent was taken by the patient. A general assessment of the patient was made through her history, clinical examination and routine laboratory investigations. Before surgery, the patient received phase-I therapy, which included oral hygiene instructions and scaling and root planning with ultrasonic and hand instruments. Two weeks after phase I therapy, the patient was planned for surgical procedures. On the day of surgery, local anesthesia was first administered bilaterally by using a mental nerve block. A horizontal incision was made using a no. 15 surgical blade at the mucogingival junction retaining all of the attached gingiva [Figures 4 and 5]. A split thickness flap was reflected sharply, dissecting muscle fibers and tissue from the periosteum. This was then sutured in the depth of the vestibule using resorbable 5-0 sutures [Figure 6]. A strip of periosteum was then removed at the level of the mucogingival junction, causing a periosteal fenestration exposing the bone. The care was taken not to remove the periosteal strip completely and to leave it pedicled to the bone and the rest of the surrounding periosteum at the lateral end [Figures 7 and 8]. The recipient site preparation included two horizontal incisions. First, intracrevicular incision and a second incision made parallel and apical to the first incision [Figure 9]. The incisions were followed by split-thickness dissection of the facially located tissue up to the level of the vestibular incision so as to create a tunnel [Figures 10 and 11]. The exposed root surface was root planed with curettes to remove bacterial contamination and was biomodified using the tetracycline powder mixed with saline. The pedicled periosteal donor tissue was then moved vertically towards the recession area, passing through the tunnel [Figures 12-14]. At repositioning, the osteoperiosteal portion was closely adapted to the recipient site by pressing for 3 min and then sutured along with the overlying gingival tissue, to the recipient bed, using 5-0 resorbable sutures [Figures 15 and 16].

Bottom Line: Multiple techniques have been developed to obtain predictable root coverage and to increase the width of attached gingiva.The newer methods of root coverage are needed, not only to reconstruct the lost periodontal tissues but also to increase predictability, reduce the number of surgical sites, reduce the number of surgeries and improve patient comfort.Hence, this paper describes a single stage technique for increasing the width of attached gingiva and root coverage by using the periosteal pedicle flap.

View Article: PubMed Central - PubMed

Affiliation: Department of Periodontology, Subharti Dental College, Meerut, India.

ABSTRACT
Gingival recession along with reduced width of attached gingiva and inadequate vestibular depth is a very common finding. Multiple techniques have been developed to obtain predictable root coverage and to increase the width of attached gingiva. Usually, the width of gingiva is first increased and then the second surgery is caried out for root coverage. The newer methods of root coverage are needed, not only to reconstruct the lost periodontal tissues but also to increase predictability, reduce the number of surgical sites, reduce the number of surgeries and improve patient comfort. Hence, this paper describes a single stage technique for increasing the width of attached gingiva and root coverage by using the periosteal pedicle flap.

No MeSH data available.


Related in: MedlinePlus