Postoperative complications bleeding ibuprofen increased bleeding during oral surgery two fold braganza, bissada et al. The purpose of this study is to evaluate the increase in the width of attached gingiva ag in singlemultiple adjacent teeth using variation of modified apically repositioned flap marf. This surgical procedure produces minor surgical trauma and does not require palatal donor tissue or membrane placement. Modified technique for the sliding flap operation grupe. Although many methods are used to increase the zone of attached gingiva, the modified apically repositioned flap marf technique has the advantages of simplicity and predictability. Nov 16, 2017 the apically positioned flap is a commonly used surgical approach, and is important for maintaining an adequate zone of keratinized tissue. A recent report described use of the modified, apically repositioned flap to increase the apicocoronal dimension of keratinized tissue over multiple adjacent teeth. The apically positioned flap technique with bone recontouring resection. Conventional flaps include the modified widman flap, the undisplaced flap, the apically displaced flap, and the flap for reconstructive procedures. Gum recession exposes the roots of teeth, which can lead to sensitivity and put teeth at a higher risk of damage or disease due to the loosening of their attachment within the gums and bones of the jaw.
Creating attached gingiva using a split thikness apically. A beveled horizontal incision of approximately 6 mm was made distal to the implant, with a small vertical incision at. Vanarsdall jr the strategy for managing unerupted teeth has been debated for more than half a century. Isidor and korning 1986 compared the effect of root planing and modified widman flap to apically positioned flap during 5 year of follow up.
Attached gingiva plays a promising role in maintaining periodontal health. Clinical dental advantages of the apically positioned flap. Surgical management of gingival recession using autogenous. Which impacted mandibular third molar is easiest to remove. The blood clot is replaced by granulation tissue derived from the gingival connective tissue, the bone marrow, and the periodontal ligament.
When using forceps for extraction of a maxillary first molar, which of the following statements isare true. Clinical image prior to crown lengthening for preparation for restoration fig. Modified doublepapillae flap technique with subepithelial. What is apically repositioned flap in mucogingival surgery. Both fullthickness and partialthickness flaps can be displaced, but to do so, the attached gingiva must be to. Modified apically repositioned flap in the treatment of. Aug 15, 2016 in 1979, carranza classified flap as full thickness flap and partial thickness flap. Compared with the external version, the loss of tissue is very low. Displaced flap a flap that is sutured with the margin of the. While in the buccal area a split thickness flap is needed for the apical positioning, in the lingual area a full thickness flap is appropriate.
Robicsek coronally repositioned flap norberg 1926 semiflap all bone healthy repositioned flap kirkland 1931 not necrotic zemsky 1926 modified flap kronfeld 1935 kirkland. Periodontic surgery an overview sciencedirect topics. Periosteum is left exposed in the area between the initial horizontal incision and the coronal margin of the flap. The modified apically repositioned flap technique and its potential. To gain access to the deeper periodontal structures using a flap reflected from the root and alveolar surfaces. Pdf apically positioned flap, free gingival graft and. The apically repositioned flap is a predictable method of increasing the zone of attached gingiva.
The modified apically repositioned flap marf technique has been previously published as a successful method to increase the zone of attached gingiva with. Combine a containment sling periostal suture within a double papilla flap. This research study is looking at three different procedures for improving the oral mucosa membrane around dental implants. Stagetwo surgery was performed using wither the apically repositioned flap, the roll flap, or an apically repositioned flap combined with a connective tissue graft. The three procedures will be the standard procedure, the standard procedure with the use of tissue harvested from the mouth and the standard procedure with the use of mucograft membrane product. Split thickness apically repositioned flap osseonews dental. Borchard and erpenstein incisions and tissue management in periodontal surgery fig. Increasing the width of attached gingiva by using modified.
It also shows the final healing creating attached gingiva using a split thikness apically repositioned flap dr hl gluckman on vimeo. One to 3 days after flap surgery,the space between the flap and the tooth or bone is thinner, and epithelial cells migrate over the border of the flap one week after surgery. Root coverage with a modified laterally positioned flap. To overcome these disadvantages, carnio and miller in 1999 described the modified apically repositioned flap marf technique for increasing the width of. Change in probing pocket depth over a time period paper id. The conventional flap is used 1 when the interdental spaces are too narrow, thereby precluding the possibility of preserving the papilla, and 2 when the flap is to be displaced. The modified apically repositioned flap marf technique uses a single horizontal incision within the keratinized tissue. Modified apically repositioned flap in the treatment of unerupted maxillary central incisors article pdf available in dental update 273. Which of the following is the least likely primary site for the development of oral squamous cell carcinoma in the elderly.
The modified apically repositioned flap technique and its. Associate professor of periodontology and oral pathology, school of dentistry, university of southern california, beverly hills, california. With regards to implants, many studies suggest that the presence of healthy periimplant softtissue plays an important role in longterm success of dental implants see studies below. Methods of exposing impacted teeth in order to bring them into the line of the arch include gingivectomy, the apically repositioned flap and closed eruption techniques. A total of 20 systemically healthy controls with inadequate width of ag were recruited for the study based on inclusion and exclusion criteria. Patient preparation reevaluation after initial treatment srp may eliminate some pocket depths can firm the tissue o inflamed tissues have capillary loops, are less firm o sutures tear more easily through inflamed tissues gives time for patient educationcomfort o poor homecare is a contraindication for surgery. Introduction patients that have gingival melanin pigmentation present an esthetic challenge to clinicians because it is often hard to maintain or.
Download pdf apically positioned flap, free gingival graft and apically positioned flap with collagen matrix around dental implants. Habib ghanbari, ali forouzanfar, kazem fatemi, majid reza mokhtari. A new approach for increasing the width of attached. A new approach for increasing the width of attached gingiva by modified apically repositioned flap jafri z, saimbi c.
Increasing the apicocoronal dimension of attached gingiva using the modified apically repositioned flap technique. This technique is important for maintaining an adequate zone of keratinized tissue, as opposed to the gingivectomy technique, where soft tissue is resected. Apically repositioned flap periodontal gum surgery nyc dentist. This conventional apically repositioned flap method has been modified by carnio in 1996, where the existing keratinized tissue is retained as a marginal collar, referred to as modified apically repositioned flap. Friedman modification of apically repositioned flap for treatment of periodontal pockets on the palatal aspect of teeth. Case report a 12yearold girl was referred by her general dental practitioner to the department of orthodontics at the.
In this surgery, in the posterior region of the third quadrant a vestibular and lingual flap is repositioned apically a procedure that would be contraindicated if there was not enough keratinized gingiva. Apically repositioned flap in the lower jaw splitthickness. These procedures aim to facilitate the eruption of the. Periodontal gum surgery for a patient whose gums had 57mm periodontal pocketing and bleeding upon probing. Patients were divided into three groups based on preoperative anatomical considerations. Enhancing the zone of keratinized tissue around implants. Increasing the width of attached gingiva by using modified apically. Post crown lengthening image after temporization 2. When there is a need for osteoplasty in the buccal bone or removal of internal bone suture is a useful aid in this topic.
Sanchis bielsa 1, sergio hernandez bazan 2, miguel penarrocha diago 3 1 staff physician, service of stomatology, valencia university general hospital. Cohen and ross18 described the doublepapillae repositioned flap by joining both. The apically positioned flap is a commonly used surgical approach, and is important for maintaining an adequate zone of keratinized tissue. These cases show the modified apically repositioned flap marf technique and its potential to increase the likelihood of repigmentation of the surgical site with better matching esthetic results. Apically repositioned flap in mucogingival surgery. The effect of apically repositioned flap surgery on clinical. Clinical evaluation of increase in the width of attached.
Before and after photos on apically repositioned flap periodontal gum surgery performed in our gum disease treatment office. Split thickness apically repositioned flap osseonews. In the case described, the labial inclination was such that a crestal incision coronal incision in this patient would have resulted in the absence of any keratinized mucosa, and so the decision was taken to advance the incision to the palatal mucosa to incorporate this tissue into the apically repositioned flap. The distance from the tooth, buccally or lingually, is dependent on. The a6 custom invitation envelope features an eloquent square flap, and can be custom printed with your images, address, recipients address or any other text you desire. Free gingival graft versus modified apically repositioned flap. Although advances in root instrumentation techniques and antibiotic therapy have improved the available treatments for periodontal infections, periodontal surgery will continue to be a necessary procedure in the foreseeable future. An esthetic enhancement of the vertical movement of the tissue is the growing enamel technique figure 288. First, a conventional mucoperiosteal flap debridement and osseous recontouring performed. No alveolar mucosa is present on the palate to permit apical positioning. Miller, increasing the amount of attached gingiva using a modified apically repositioned flap, journal of periodontology, 70, 9, 11101117, 1999. Infact, other techniques were developed considering also autogenous from palate or retromolar trigone gingival graft andor the apically repositioned flap apf of friedman 1962. In 1962 friedman 7 proposed the term apically repositioned flap to more appropriately describe the surgical technique introduced by nabers. Laterally displaced positioned flap flaps are classified as 1 nondisplaced flaps, when the flap is returned and sutured to its original position, or 2 displaced flaps.
This particular size invitation envelope is often times used for items such as greeting cards, or announcements such as weddings, anniversaries, or baby showers. The shortterm followup of the marf technique demonstrated an increase in keratinized tissue and attached gingiva. This video shows you how to create attached gingiva in the upper jaw by creating a split thickness flap and apically repositioning it. An fgg is adapted to the periosteal bed apically to widen the residual keratinized gingiva around the recession defects after an incision is placed at the mgj. The mean probing pocket depth at base line 0 week was 1. The apically repositioned flap in tooth exposure helen lawton and p.
Pdf modified apically repositioned flap in the treatment of. The modified apically repositioned flap marf technique is an effective procedure to increase the dimensions of attached gingiva in areas that present with some. Increasing the amount of attached gingiva using a modified. Apically repositioned flap technique around implants. In that study of 11 subjects, there was a significant decrease in mean pocket depth and the percentage of sites exhibiting gingival redness 3 months after scaling and root planing srp and apically repositioned flap surgery at sites 4 mm. The apically repositioned flap is a technique that results in an existing pocket removal and ends with keratinized attached gingiva surrounding the area. Definition a periodontal flap is a section of gingiva andor mucosa surgically separated from the underlying tissues to provide visibility and access to the bone and root surface. Adam bear discusses the advantages this procedure has for surgical crownlengthening procedures.
Patel 3 1 department of periodontics, sri rajiv gandhi college of dental sciences and hospital, bengaluru, karnataka, india 2 department of prosthodontics, ibn sina national college for medical studies, gulail, jeddah 21418, ksa 3 department of prosthodontics, sri. The palatal flap prepared with a secondary scalloped and beveled incision secured with interproximal sutures. Associate professor of periodontology and oral pathology, school of dentistry, university. A surgical flap not repositioned over a bony base will result. C l widening keratinized tissue using modified free. C24 esthetic crown lengthening by apically positioned flap. Carapace elongate, in dorsal view almost as long as head and mesosoma combined figure 9, apicodorsally rounded, 2. Sctg was placed to augment tissue thickness and obtain predictable biological attachment, thereby increasing the root coverage. Since the early twentieth century, periodontal surgery has been used to help dentists control the progression of periodontal disease. The apically positioned flap is a commonly used surgical approach to achieve pocket elimination.
Define apically repositioned flap in mucogingival surgery. Procedures for improving the mucosa around implants full. The advantages of the marf technique includes its simplicity and ease of execution as it involves the use of a single horizontal incision in the recipient site, absence of palatal donor tissue, shorter operative time. Various techniques to increase keratinized tissue for implant. Pdf the modified apically repositioned flap to increase the. Levy et al 1 examined the effect of apically repositioned flap surgery on the composition of the subgingival microbiota as well as clinical parameters. A surgical flap not repositioned over a bony base will result in 1. Displaced flap a flap that is sutured with the margin of the flap placed at a from econ 202 at seattle central college.
Increasing the apicocoronal dimension of attached gingiva. Incisions and tissue management in periodontal surgery. The pedicle flap technique is an approach similar to an apically repositioned flap and should be used when there is adequate keratinized tissue adjacent to the implant. Pocket elimination by palatal flap that just covers the contours of the bone to eliminate osseous defects. The main distinguishable feature of this approach from the classical apically repositioned flap fgg technique is the preservation of preexisting keratinized gingiva.
Pdf the modified apically repositioned flap to increase. Patient preparation reevaluation after initial treatment srp. For flap placement after surgery, flaps are classified as either 1 nondisplaced flaps, when the flap is returned and sutured in its original position, or 2 displaced flaps, which are placed apically, coronally, or laterally to their original position. Apically definition of apically by medical dictionary. In 1979, carranza classified flap as full thickness flap and partial thickness flap. Use of the modified apically repositioned flap technique. Gum grafting, also known as a gingival graft or periodontal plastic surgery, is a surgical procedure to reverse gum recession. Jan 29, 20 flap raised by sharp dissection, periosteum retained over bone3. Flap repositioning versus conventional suturing in third molar surgery jose m. Various techniques to increase keratinized tissue for. Meaning of apically repositioned flap in mucogingival surgery medical term. First, a paramarginal incision is performed on the buccal side following the tooth shape and creating new papillae. Atlas of cosmetic and reconstructive periodontal surgery.
Flap is apically positioned at or below alveolar crest 36. In this surgery, in the vestibular and lingual area of tooth 36 and 37 the gingiva is apically repositioned to facilitate the prosthetic procedures planned. Among various techniques for augmenting width of attached gingiva, modified apically repositioned flap marf is a simple and easy procedure that does not require a second surgical site. Duration of treatment, adverse responses, and type of surgical procedure and mechanotherapy to align ectopically positioned teeth. Flap repositioning versus conventional suturing in third. The results of this study demonstrate that this modification of the apically repositioned flap is effective and efficient for increasing the height of attached gingiva. Simple flap procedures include the simple apically repositioned flap and the modified widman reverse bevel flap.
Dept of periodontics periodontal flaps presented by, shiji margaret d. Conventional versus modified technique of the apically. A periodontal flap is a section of gingiva andor mucosa surgically separated from the underlying tissues to provide visibility and access to the bone and root surface. Increasing the width of attached gingiva by using modified apically repositioned flap a case series chakrapani swarna, surekha govada, karyamsetti susmitha, chintapalli sowjanya department of periodontology, sibar institute of dental sciences, takkellapadu, andhra pradesh, india. Looking for online definition of apically repositioned flap in mucogingival surgery in the medical dictionary. A beveled horizontal incision of approximately 6 mm was made distal to the implant, with a small vertical incision at the distal end part of the first incision. Widening keratinized tissue using modified free gingival. Apical repositioned flap for increasing attached gingiva around the dental implant is a known technique. Partial or split thickness flap is an elevated flap which includes only epithelium and the layer of underlying connective tissue.
Full thickness flap is surgical procedure of which all soft tissue and the periosteum are reflected. Comparison of three crown lengthening procedures a. The modified apically repositioned flap marf technique uses a single horizontal incision within the keratinized tissue kt, elevating a splitthickness flap, and suturing of the flap to the periosteum in an apical position. The modified widman flap the undisplaced flap the palatal flap. An adequate width of attached gingiva prevents plaque formation and softtissue recession.
318 162 752 818 752 819 1125 203 459 334 633 840 541 391 1131 532 630 826 738 1053 233 961 819 44 1013 193 941 636 821 753 405 1453