Grafting procedures in periodontics

1. CORONALLY POSITIONED
PEDICLE GRAFTS

2. HISTORY
 In 1956, Grupe and Warren developed an original and
unique procedure called the sliding flap operation for
covering the isolated exposed root.
 It was modified in 1966 to prevent the donor side
recession.

3. PURPOSE
 To create a split thickness flap in the area apical to the
denuded root and position it coronally to cover the root.

4. INDICATIONS
 Cover denude root surface with adequate width of
keratinized gingiva.
 Coverage limited to one or two teeth.
 Suitable for recession shallow narrow mesiodistal width.

5. 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.

6. STEP BY STEP PROCEDURE
First technique:
 SCALING AND PLANNING: Scaling and planning is
done on the root surface with the help of curettes.
 INCISIONS: Internal bevel incision is given from the
gingival margin to the bottom of the pocket on the selected
site. At each end of internal bevel incision, vertical
incisions are given beyond the mucogingival junction, to
delineate the flap.
 FLAP REFLECTION: Partial thickness flap is raised with
surgical blade no. 11 and 15.
 SUTURING: The flap is then sutured to the level coronal
to pretreatment position to cover the recession. Cover the
area with periodontal pack

7. CORONALLY DISPLACED FLAP
3) Split thickness Flap
reflection
4) Suturing
2) Vertical releasing Incision
made
1) Gingival recession
measurement

8. SEMILUNAR CORONALLY REPOSITIONED FLAP
Second technique:
 This technique was given by Tarnow.
 Simple and predictably provides 2 to 3 mm of root
coverage which is stressful for the maxilla.
 Not recommended for mandibular teeth.

9. PROCEDURE
 INCISION: A semilunar incision is made
following the curvature of the receded
gingival margin and ending about 2 to 3 mm
short of the tip of the papillae, so that the
flap derives all of its blood supply from the
papillary areas. Semilunar incision is
made

10.  Perform a split thickness dissection of the
facially located tissue by
an intracrevicular incision extending apically
to the level of the semilunar incision.
Split thickness dissection
coronally from the
incision

11.  The tissue collapse coronally, covering the
denuded root. It is then held in its new
position and stabilized by light pressure for
5 minutes; there is no need to suture or to
pack. Tissue collapsing
coronally