Grafting Techniques in Periodontal Surgery

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Questions and Answers

What is the primary technique used in creating a pedicle flap?

Surgical extraction technique

Lateral sliding technique

Roll technique and papilla preservation technique (correct)

Connective tissue grafting technique

In the semilunar coronally repositioned flap approach, where is the semilunar incision recommended to be placed?

In the interdental region (correct)

At the mucogingival junction

On the labial aspect of the teeth

In the buccal vestibule

What type of flap is used to create a reconstruction with intrasulcular and buccal incisions across the interdental papilla?

Semilunar coronally repositioned flap

Pedicle flap

Autogenous osseous graft flap

Envelop type flap (correct)

Which technique involves retaining as much gingiva as possible with an intrasulcular incision around the lateral and central incisors?

Autogenous osseous and connective tissue grafts technique Signup and view all the answers

What is the purpose of the horizontal incision made in the autogenous osseous graft technique?

To elevate a split-thickness flap Signup and view all the answers

What is packed around the grafted bone in the autogenous technique to shape the reconstructed interdental bone?

Crushed cancellous bone Signup and view all the answers

What is a critical component of the microsurgery described in the cases mentioned?

Augmentation of the interdental papilla Signup and view all the answers

In the envelop type flap technique, how is the palatal portion of the flap characterized?

Split thickness including interdental papilla Signup and view all the answers

What does 'white esthetics' refer to in modern restorative dentistry?

The natural dentition or the restoration of dental hard tissues Signup and view all the answers

What is the primary complication associated with the loss of interdental papillae?

Lateral food impaction Signup and view all the answers

Why is reconstruction of lost interdental papilla considered challenging?

The interdental papilla has a minor blood supply. Signup and view all the answers

What factor can contribute to the loss of interdental papillae?

Gingival inflammation and attachment loss Signup and view all the answers

Which of the following is not an aesthetic problem related to the interdental papilla?

Overlapping teeth alignment Signup and view all the answers

What is one potential consequence of missing interdental papillae?

Development of black triangle disease Signup and view all the answers

Which surgical technique is often used to attempt to rebuild lost papillae?

Pedicle grafting Signup and view all the answers

What characteristic of the interdental papilla complicates its preservation during dental procedures?

Minimal vascular supply Signup and view all the answers

What determines the shape of the interdental papilla?

The contact relationships between the teeth Signup and view all the answers

What happens to the interdental papilla when a contact point is absent?

It assumes a pyramidal shape with reduced esthetics Signup and view all the answers

Which study indicated that excised interdental papilla does not fully regenerate?

Holmes' clinical study Signup and view all the answers

Who was the first to describe the morphology of the interdental papilla?

Cohen Signup and view all the answers

What shape does interdental gingiva in the incisor area typically have?

Pyramidal shape Signup and view all the answers

Study Notes

Pedicle Flap Technique

Combines roll technique and papilla preservation technique
Palatal split-thickness flap is dissected and labially elevated
The flap is folded on itself and sutured to create a new papilla

Semilunar Coronally Repositioned Flap

Based on flap design reported by Tarnow
Semilunar incision placed in the interdental region
Intrasulcular incisions are made around the mesial and distal half of the two adjacent teeth
Connective tissue is displaced coronally
Measured amount of sub-epithelial connective tissue from the palate is placed into the semilunar incision

Envelope Type Flap

Intrasulcular and buccal incision made across the interdental papilla
Envelope type split-thickness flap is elevated buccally and palatally
Flap is dissected beyond the mucogingival line
Connective tissue graft placed under flaps in recipient site

Autogenous Osseous and Connective Tissue Grafts

Intrasulcular incision made around the neck of the lateral and central incisors
Horizontal incision from mucogingival junction to the labial vestibular fold
Gingivo-papillary unit displaced coronally
Osseous graft from maxillary tuberosity is reshaped
Crushed cancellous bone packed around the grafted bone
Connective tissue graft from the palate is placed on top of the bone graft

Microsurgery

Case report of three cases described microsurgical technique for Interdental Papilla augmentation
No releasing incisions are used
Minimizes tissue trauma, excessive bleeding, scarring, and pain
Donor tissue survival is optimized because vascular supply remains intact

Interdental Papilla

Importance: The interdental papilla is crucial for esthetics, phonetics, and function.
Loss : Occurs due to periodontal disease, inflammation, bone resorption, surgical therapy, and lack of blood supply.
Consequences: Cosmetic deformities (black triangle disease), phonetic problems (air/saliva passage), and food impaction.
Challenges: Reconstruction of lost papilla is difficult and unpredictable.
Goal: Preserve papillary integrity and minimize loss during dental procedures.
Treatment: Non-surgical and surgical modalities for papilla preservation and reconstruction are available.
Re-formation: Studies on monkeys showed papilla reformation after tissue stripping but complete regeneration is questionable.
Morphology:
- Determined by tooth contact, approximal tooth surface width, and cemento-enamel junction.
- Incisor area: Pyramidal shape.
- Posterior region: Broader, concave col or bridge shape.
Col: A defining feature of the interdental papilla (posterior region) that disappears when contact is absent or papilla migrates.
Significance: The shape influences aesthetics and functionality.

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Description

Explore various grafting techniques used in periodontal surgery, including the Pedicle Flap Technique, Semilunar Coronally Repositioned Flap, and Envelope Type Flap. This quiz covers the key procedures, incisions, and techniques involved in utilizing autogenous osseous and connective tissue grafts. Test your knowledge and understanding of these essential surgical methods.