Flap approaches in plastic periodontal and implant surgery: critical elements in design and execution

Abstract

Flap approaches in plastic periodontal and implant surgery: critical elements in design and execution de Sanctis M, Clementini M. Flap approaches in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol 2014; 41 (Suppl. 15): S108-S122. doi: 10.1111/jcpe.12189. AbstractAim: To identify critical elements in design and execution of coronally advanced flap, lateral positioned flap and their variations for the treatment of facial gingival recessions or peri-implant soft tissue dehiscences. Materials and Methods: Clinical studies were identified with both electronic and hand searches, and examined for the following aspects: flap design and incision techniques, flap elevation, root conditioning, flap mobility, flap stability and suturing. Moreover, prognostic factors for complete recession coverage were identified. Results: Some critical elements are evident in flap design and execution: the dimension and the thickness of tissue positioned over the denuded roots; the use on root surface of enamel matrix derivate; the stability and suturing of the flap in a position coronal to the cemento-enamel junction. The pre-determination of the clinical cemento-enamel junction, smoking status, operator surgical skills and the compliance to a supportive care programme have a role in obtaining and maintaining a complete root coverage. Conclusions: Different flap approaches are available when performing periodontal plastic surgery, resulting in a great variability in clinical outcomes. The possibility of using pedicle flaps alone to achieve complete soft tissue coverage of facial implant dehiscence has not yet been investigated.

Root Coverage in Miller Classes I and II associated with Subepithelial Connective Tissue Graft: A comparative Clinical Trial of Two Techniques

“…Among these conditions, the presence alveolar bone interproximal, gingival thickness, amount of keratinized tissue, the presence of cervical lesions, the size of adjacent papillae, and the location of the tooth, 19 including the skills and experience of the surgeon, have already been emphasized by Cortellini et al 20 and Tonetti and Jepsen. 21 Other factors that can limit root coverage are related to the correct identifi cation of anatomical CEJ, the presence of cervical abrasions associated with recession, rotations and extrusions, 22 as well as loss of height, even with no interproximal bone loss.…”

Endodontic drug delivery for root surface disinfection: a laboratory feasibility evaluation

“…A complete and efficacious removal of the smear layer with the treatment used is not given [38]. For root conditioning and smear layer removal EDTA [39], citric acid [40] and tetracycline hydrochloride [41] is recommended but these root conditioning procedures are normally used in regenerative periodontal therapy or recession treatment [42]. In clinical periodontal treatment root conditioning after scaling and root planing is not common.…”

Rationale for the Surgical Treatment of Single and Multiple Recession-Type Defects

“…traumatic toothbrushing, periodontal disease, etc.) and compliance with regular periodontal maintenance seem directly associated to long-term stability of results achieved with surgical therapy [ 56 ]. [ 57 ].…”

“…Overall, a small percentage of patients may experience early post-operative bleeding, swelling and pain, but these do not modify the fi nal aesthetic/functional outcomes. Moreover, it should be noted that the amount of vascularisation adjacent to a root surface is crucial when a fl ap is moved over avascular sites (root surface); consequently, it is adequate to extend the base of the pedicle (fl ap) to improve the local blood supply during early healing [ 56 ].…”

“…Likewise, fl ap stabilisation and suture coronal to the CEJ are important and desirable too [ 56 ], but other local conditions should be considered during the decisionmaking process (choice of best procedures), such as periodontal conditions (lack of biofi lm infl ammation), recession anatomy (classifi cation, depth and width), anatomy of adjacent soft tissue (thickness and presence of keratinised tissue) and tooth/root conditions (tooth position and root prominence) [ 56 ].…”