Blood Supply of Human Gingiva Following Periodontal Surgery: A Fluorescein Angiographic Study

Abstract

This study demonstrates changes in the gingival vascular supply of humans following various periodontal surgical procedures. A special system was used to photograph circulatory changes following an i.v. injection of sodium fluorescein to visualize blood supply. The results of this study suggest that the following concepts are important in the design of periodontal flaps. 1. Flaps should be broad enough at their base to include major gingival vessels. 2. A flap's length to width ratio should not exceed 2:1. 3. Minimal tension should be produced by suturing techniques and the tissue should be managed gently during the surgical procedure. 4. Partial thickness flap preparations to cover avascular areas should not be too thin so that more blood vessels are included in them. 5. The apical portion of periodontal flaps should be full thickness when possible.

A Modified Surgical Flap for Root Coverage in Association with Grafting Materials

“…According to a fluorescein angiographic clinical study that investigated the microcirculation of different surgical incisions, the flaps should be broad enough at their base to include major gingival vessels and better clinical results . Thus, the displacement of the releasing incisions to the proximal line angles of the adjacent teeth favored the incorporation process of the graft as shown by Barros and colleagues in longitudinal evaluation after 12 months, not only by providing more blood vessels, more nutrients, and a better source of cells, but also by allowing easier tissue manipulation, especially in obtaining a tensionless coronally positioned flap to completely cover the grafts.…”

“…The percentage of root coverage was 79% and 64% for test and control groups, respectively, after 6 months. After 12 months, the percentage of root coverage was 62.3% and 82.5% for the conventional and new techniques, respectively, showing an improvement on the test group …”

Coronally Positioned Flap for Root Coverage: Poorer Outcomes in Smokers

“…Precise mechanisms by which tobacco use interferes with root coverage procedures are not completely understood, whereas several physiological and cellular functions altered by smoking may account for the compromised periodontal wound healing in smokers. Regarding physiological functions, smoking negatively impacts the gingival blood supply, 33 a factor critical for proper periodontal flap healing 34 . Regarding cellular functions, nicotine inhibits the proliferation, adhesion, and chemotaxis of periodontal ligament cells, 35 alters the interaction between epithelial cells and gingival fibroblasts, 36 inhibits the production of collagen and non‐collagen matrix proteins by gingival fibroblasts, 36,37 increases gingival fibroblast collagenolytic activity, 37 and inhibits the adhesion of fibroblasts to root surfaces 38 .…”

Gingival Perfusion and Tissue Biomarkers During Early Healing of Postextraction Regenerative Procedures: A Prospective Case Series

“…Surgical trauma, including tooth extraction, flap elevation, vertical incisions and suturing, may impede blood circulation to the surgical site. 16 In addition, biomaterial properties (chemical and structural composition, morphology, absorption process and timing) affect healing outcomes. 13 Bone and membrane placement underneath the flap and physiological post-osseous tissue exposure changes can affect early postoperative soft tissue blood flow recovery and bone regeneration.…”