Gingival recession: part 3. Surgical management using free grafts and guided tissue regeneration

Transcription

1 Gingivl reession: prt 3. Surgil mngement using free grfts nd guided tissue regenertion M. Ptel, 1 P. J. Nixon 2 nd M. F. W.-Y. Chn 3 VERIFIABLE CPD PAPER IN BRIEF Free grfts re n lterntive to pedile grfts nd re the tretment of hoie in res where the gingivl iotype is thin or there is lk of kertinised tissue. Guided tissue regenertion or the use of llogrfts nd xenogrfts void the need of seond (donor) surgil site. The suepithelil onnetive tissue grft with ornonlly dvned flp is onsidered to e the gold stndrd grfting proedure. PRACTICE This pper is the third in three prt series looking t the etiology nd mngement of gingivl reession. Prt 1 in this series disussed the etiology of gingivl reession nd the non-surgil mngement. Prt 2 disussed in detil the ftors ffeting the outome of periodontl surgery nd the use of pedile flps. This pper ims to disuss the surgil options ville to orret lolised reession defets using free grfts nd guided tissue regenertion. INTRODUCTION FACTORS AFFECTING OUTCOME OF PERIODONTAL PLASTIC SURGERY - 1* Speilist Registrr in Restortive Dentistry, 2,3 Consultnts in Restortive Dentistry, Deprtment of Restortive Dentistry, Leeds Dentl Institute, Clrendon Wy, Leeds, LS2 9LU *Correspondene to: Dr Mitl Ptel Emil: mitlptel@nhs.net Refereed Pper Aepted 21 July 2011 DOI: /sj.dj British Dentl Journl 2011; 211: FREE GRAFTS IN THE MANAGE- MENT OF GINGIVAL RECESSION Fig. 1 Gingivl reession used y high frenl tthment nd mnged using free gingivl grft: () pre-op; () immeditely post-op; () five months post-surgery Epithelilised free gingivl grft linil tehnique 4 BRITISH DENTAL JOURNAL VOLUME 211 NO. 8 OCT

2 Fig. 2 Shows reession defet treted with onnetive tissue grft: () pre-opertive view of reession defet t UL2 plnned for onnetive tissue grft with oronlly positioned flp; () linil pperne immeditely post-op; () linil pperne following heling of soft tissues d e f Fig. 3 Shows onnetive tissue grft eing rised from the plte nd pled over reession defet: () onnetive tissue grft hrvested from the plte using three sided flp; () hrvested grft tissue; () donor site flp sutured k; (d-e) ross setionl digrmmti view showing pltl onnetive tissue grft eing hrvested; (f) grft sutured in ple over reession defet 354 BRITISH DENTAL JOURNAL VOLUME 211 NO. 8 OCT

3 et l Suepithelil onnetive tissue grft linil tehnique e g Fig. 4 Reession defet treted with onnetive tissue grft nd doule ppill pedile flp: () pre-opertive view showing 10 mm reession defet on UR3; () doule ppill flp is rised; () sutured together in the midline over the reession defet; (d) onnetive tissue grft rised from the plte is pled over the reession defet; (e) grft sutured into ple over reession defet; (f) grft is then overed with the doule ppill pedile flp; (g) finl post-op view shows signifint root overge ut not omplete root overge; (h) the finl ridge utment is pled t the level of the new gingivl mrgin to restore esthetis - d f h BRITISH DENTAL JOURNAL VOLUME 211 NO. 8 OCT

4 et l. 13 GUIDED TISSUE REGENERATION e g Fig. 5 Connetive tissue grft rried out using the tunnelling tehnique: () reession defet over upper entrl inisors; (-) tunnel flp prepred to reeive onnetive tissue grft; (d) onnetive tissue grft hrvested from the plte; (e) the grft is pssed through the tunnel preprtion; (f) nd pked under the lil soft tissue up towrds the reession defet; (g) finl pperne immeditely post plement of the grft; (h) piture shows reession defet t the two month review d f h BRITISH DENTAL JOURNAL VOLUME 211 NO. 8 OCT

5 THE USE OF ALLOGRAFTS AND XENOGRAFTS IN MANAGEMENT OF GINGIVAL RECESSION 20 - et l SUTURING POST-OPERATIVE INSTRUCTIONS in situ 24 PROGNOSIS et l CONCLUSIONS Kss M M, Cohen R E. Tretment of gingivl reession. J Am Dent Asso 2002; 133: BRITISH DENTAL JOURNAL VOLUME 211 NO. 8 OCT

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