Lateral pedical graft


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Lateral pedical graft

  2. 2. INDEX <ul><li>INTRODUCTION </li></ul><ul><li>TECHNIQUES FOR INCREASING THE ATTACHED GINGIVA </li></ul><ul><li>INDICATIONS </li></ul><ul><li>CONTRAINDICATION </li></ul><ul><li>ADVANTAGES </li></ul><ul><li>DISADVANTAGES </li></ul><ul><li>STEP BY STEP TECHNIQUE </li></ul><ul><li>COMMON REASON FOR FAILURE </li></ul><ul><li>PARTIAL FULL THICKNESS PEDICAL </li></ul><ul><li>VARIANT TECHNIQUE </li></ul><ul><li>CONCLUSION </li></ul>
  3. 3. INTRODUCTION <ul><li>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 </li></ul><ul><li>Associated with attached gingiva </li></ul><ul><li>Associated with shallow vestibule </li></ul><ul><li>Associated with frenum interfering with marginal gingiva </li></ul><ul><li>In 1996 world workshop renamed mucogingival surgery as periodontal plastic surgery </li></ul>
  4. 4. <ul><li>Peridontal plastic surgery </li></ul><ul><li>It is defined as a surgical procedure performed to correct or eliminate anatomic developmental traumatic deformities of the gingiva or alveolar mucosa </li></ul><ul><li>Objectives </li></ul><ul><li>Problems associated with attached gingiva </li></ul><ul><li>Problems associated with shallow vestibule </li></ul><ul><li>Problems associated with aberrant frenum </li></ul>
  5. 5. Techniques for increasing attached gingiva <ul><li>Gingival augmentation apical to the area of recession eg. by </li></ul><ul><li>free gingival autograft </li></ul><ul><li>apically positioned flap </li></ul><ul><li>Gingival augmentation coronal to the recession </li></ul><ul><li>Free gingival autografts </li></ul><ul><li>Free connective tissue autografts </li></ul><ul><li>Pedical autograft </li></ul><ul><ul><ul><li>Laterally positioned </li></ul></ul></ul><ul><ul><ul><li>Coronally positioned </li></ul></ul></ul><ul><ul><ul><li>Semilunar pedical </li></ul></ul></ul>
  6. 6. <ul><li>Subepithelial connective tissue graft </li></ul><ul><li>Guided tissue regeneration </li></ul><ul><li>Pouch and tunnel technique </li></ul>
  7. 7. Lateral pedical graft <ul><li>Historical review </li></ul><ul><li>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 </li></ul>
  8. 9. <ul><li>INDICATIONS </li></ul><ul><li>Sufficient tissue exist adjacent to the area of recession </li></ul><ul><li>Coverage limited to one or two teeth </li></ul><ul><li>Suitable for recession with narrow mesiodistal width </li></ul>
  9. 10. <ul><li>Contraindications </li></ul><ul><li>Insufficient keratinized tissue at the donor site </li></ul><ul><li>Presence of deep interproximal pockets </li></ul><ul><li>Excessive root prominences </li></ul><ul><li>Deep or extensive root abrasion or erosion </li></ul><ul><li>Significant loss of interproximal bone height </li></ul><ul><li>Narrow vestibule </li></ul><ul><li>Multiple tooth involvement </li></ul>
  10. 11. <ul><li>Advantages </li></ul><ul><li>One surgical site </li></ul><ul><li>Good vascularity of the pedicle flap </li></ul><ul><li>Ability to cover the denuded root surface </li></ul>
  11. 12. <ul><li>Disadvantages </li></ul><ul><li>Limited by the amount of adjacent keratinized attached gingiva </li></ul><ul><li>Possibility of recession at the donor site </li></ul><ul><li>Dehiscence or fenestrations at the donor site </li></ul><ul><li>Limited to one or two teeth with recession </li></ul>
  12. 13. <ul><li>Step by step procedure for following the technique </li></ul><ul><li>I Preparation of recipient site </li></ul><ul><li>Root planing to remove the soft cementum and reduce or eliminate the prominent convexity of the root </li></ul><ul><li>Citric acid is burnished over the exposed root surface to enhance the linkage </li></ul>
  13. 14. <ul><li>View of the exposed root as </li></ul><ul><li>a result of recession </li></ul>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
  14. 15. 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
  15. 16. 5.coronal portion of pedicle Flap begun Preparation of donor site 6. Final dissection of the Pedicle is in apicoocclusal direction
  16. 17. 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
  17. 18. 9. Tension is placed on the pedicle when the positioning is attempted 10. a releasing incision is made
  18. 19. 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
  19. 22. preop Postop
  20. 23. <ul><li>Incisions given R. recipient tooth, D Donor tooth </li></ul><ul><li>F. flap, S. Split thickness dissection , E. exposed bone </li></ul>
  21. 24. B. suturing after rotation of the flap lip is retracted to immobilize the graft
  22. 25. For multiple teeth Tooth are easier to stabilize because of the increase size of the flap.(better blood supply )
  23. 26. 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
  24. 27. 3. Bone exposed resulting in the dehiscence, 4. Excessive movement because of poor stabilization
  25. 28. Partial-full-thickness pedicle <ul><li>Goldman et al.(1982) </li></ul><ul><li>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 </li></ul>Initial view
  26. 29. 2. V shaped incision over exposed root begun 3. V shaped beveled incision completed & partial thickness flap begun
  27. 30. Partial full thickness portion completed
  28. 31. Flap is sutured with overlap of the beveled incision
  29. 32. VARIANT TECHNIQUES Obliquely placed flap
  30. 34. 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.
  31. 35. <ul><li>REFERENCES </li></ul><ul><li>Michael G. Newman, Henry H. Takei, Fermin A. Caranza; clinical periodontology ; 9 th edition; 2003 </li></ul><ul><li>Edwards S. Cohen ; Atlas of Cosmetic & Recontructive periodontal surgery; second edition 1994 </li></ul><ul><li>Louis F. Rose, Brian L. Mealey Robert; Periodontics Medicine , Surgery Implants 2004A </li></ul>