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Lateral pedical graft

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Lateral pedical graft Lateral pedical graft Presentation Transcript

  • LATERAL PEDICAL GRAFT
  • INDEX
    • INTRODUCTION
    • TECHNIQUES FOR INCREASING THE ATTACHED GINGIVA
    • INDICATIONS
    • CONTRAINDICATION
    • ADVANTAGES
    • DISADVANTAGES
    • STEP BY STEP TECHNIQUE
    • COMMON REASON FOR FAILURE
    • PARTIAL FULL THICKNESS PEDICAL
    • VARIANT TECHNIQUE
    • CONCLUSION
  • INTRODUCTION
    • Mucogingival surgery introduced by Friedman to describe the surgical procedures for the correction of the relationship between the gingiva and the oral mucous membrane with reference to three specific problems
    • Associated with attached gingiva
    • Associated with shallow vestibule
    • Associated with frenum interfering with marginal gingiva
    • In 1996 world workshop renamed mucogingival surgery as periodontal plastic surgery
    • Peridontal plastic surgery
    • It is defined as a surgical procedure performed to correct or eliminate anatomic developmental traumatic deformities of the gingiva or alveolar mucosa
    • Objectives
    • Problems associated with attached gingiva
    • Problems associated with shallow vestibule
    • Problems associated with aberrant frenum
  • Techniques for increasing attached gingiva
    • Gingival augmentation apical to the area of recession eg. by
    • free gingival autograft
    • apically positioned flap
    • Gingival augmentation coronal to the recession
    • Free gingival autografts
    • Free connective tissue autografts
    • Pedical autograft
        • Laterally positioned
        • Coronally positioned
        • Semilunar pedical
    • Subepithelial connective tissue graft
    • Guided tissue regeneration
    • Pouch and tunnel technique
  • Lateral pedical graft
    • Historical review
    • In 1956 Grupe and Warren developed an original and unique procedure called the sliding flap operation for covering the isolated exposed root . And modified it in 1966 to prevent the donor side recession
  •  
    • INDICATIONS
    • Sufficient tissue exist adjacent to the area of recession
    • Coverage limited to one or two teeth
    • Suitable for recession with narrow mesiodistal width
    • Contraindications
    • Insufficient keratinized tissue at the donor site
    • Presence of deep interproximal pockets
    • Excessive root prominences
    • Deep or extensive root abrasion or erosion
    • Significant loss of interproximal bone height
    • Narrow vestibule
    • Multiple tooth involvement
    • Advantages
    • One surgical site
    • Good vascularity of the pedicle flap
    • Ability to cover the denuded root surface
    • Disadvantages
    • Limited by the amount of adjacent keratinized attached gingiva
    • Possibility of recession at the donor site
    • Dehiscence or fenestrations at the donor site
    • Limited to one or two teeth with recession
    • Step by step procedure for following the technique
    • I Preparation of recipient site
    • Root planing to remove the soft cementum and reduce or eliminate the prominent convexity of the root
    • Citric acid is burnished over the exposed root surface to enhance the linkage
    • View of the exposed root as
    • a result of recession
    2. Basic incisions are outlined The donor flap should be 1 1/2 Times the size of the recipient Area to be covered & 3 to 4 times Longer than it is wide
  • 3. V – shape incision is made About the exposed root With No. 15 scalpel blade 4. V – shaped incision removed. give a beveled incision on the opposite side Of the donor area to permit Overlap of flap
  • 5.coronal portion of pedicle Flap begun Preparation of donor site 6. Final dissection of the Pedicle is in apicoocclusal direction
  • Preparation of pedicle flap 7.flap is released & reflected, Exposing the underlying periosteum 8. If a full thickness flap were Raised the underlying bone Would have been exposed
  • 9. Tension is placed on the pedicle when the positioning is attempted 10. a releasing incision is made
  • 11. In partial thickness pedicle is sutured with periosteum Covering bone 12.cover aluminum foil And place a soft perio pack. Remove the pack and the suture after one week
  •  
  •  
  • preop Postop
    • Incisions given R. recipient tooth, D Donor tooth
    • F. flap, S. Split thickness dissection , E. exposed bone
  • B. suturing after rotation of the flap lip is retracted to immobilize the graft
  • For multiple teeth Tooth are easier to stabilize because of the increase size of the flap.(better blood supply )
  • Common reasons for failure 1.Tension at the base of the distal incision , corrected by use of releasing incision 2. Too narrow pedicle flap, care to be taken to have the Donor flap should be 1 1/2 Times wider
  • 3. Bone exposed resulting in the dehiscence, 4. Excessive movement because of poor stabilization
  • Partial-full-thickness pedicle
    • Goldman et al.(1982)
    • Advantage of a full thickness flap over the denuded root surface and at the same time permitting coverage of the exposed donor site with periosteum
    Initial view
  • 2. V shaped incision over exposed root begun 3. V shaped beveled incision completed & partial thickness flap begun
  • Partial full thickness portion completed
  • Flap is sutured with overlap of the beveled incision
  • VARIANT TECHNIQUES Obliquely placed flap
  •  
  • CONCLUSION New techniques are constantly being developed and are slowly incorporated into periodontal practice. Critical analysis of newly presented techniques should guide our constant evolution towards better clinical methods.
    • REFERENCES
    • Michael G. Newman, Henry H. Takei, Fermin A. Caranza; clinical periodontology ; 9 th edition; 2003
    • Edwards S. Cohen ; Atlas of Cosmetic & Recontructive periodontal surgery; second edition 1994
    • Louis F. Rose, Brian L. Mealey Robert; Periodontics Medicine , Surgery Implants 2004A