Author: Dr.Mehnaz

THE PERIODONTAL FLAP

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A periodontal flap is a section of gingiva and/or mucosa surgically separated from the underlying tissues to provide visibility of and access to the bone and root surface.

The flap also allows the gingiva to be displaced to a different location in patients with mucogingival involvement.
Classification of Flaps | Dentowesome

Source: Carranza’s Clinical Periodontolgy, 10th Ed

TECHNIQUES TO INCREASE ATTACHED GINGIVA (ROOT COVERAGE)

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The following is a list of techniques used for gingival augmentation coronal to the recession (root coverage):

  1. Free gingival autograft
  2. Free connective tissue autograft
  3. Pedicle autografts: • Laterally (horizontally) positioned flap • Coronally positioned flap; includes semilunar pedicle (Tarnow)
  4. Subepithelial connective tissue graft (Langer)
  5. Guided tissue regeneration
  6. Pouch and tunnel technique

Subepithelial connective tissue graft (Langer) 🔎

Indication:

  • Larger and multiple defects with good vestibular depth and gingival thickness to allow a split-thickness flap to be elevated.

Adjacent to the denuded root surface, the donor connective tissue is sandwiched between the split flap as shown in the figure.

Subepithelial connective tissue graft for root coverage.
cont’d F to J, Facial views. F, Gingival recession. G, Vertical incisions to prepare recipient site. H, Split-thickness flap reflected. I, Connective tissue sutured over denuded root surface. J, Split-thickness flap sutured over donor connective tissue.

Surgical Technique Steps:

Step 1. Raise a partial-thickness flap with a horizontal incision 2 mm away from the tip of the papilla and two vertical incisions 1 to 2 mm away from the gingival margin of the adjoining teeth.

Step 2. Thoroughly plane the root, reducing its convexity.

Step 3. Obtain a connective tissue graft from the palate by means of a horizontal incision 5 to 6 mm from the gingival margin of molar and premolars. The connective tissue is carefully removed along with all adipose and glandular tissue. The palatal wound is sutured in a primary closure.

Step 4. Place the connective tissue on the denuded root. Suture it with resorbable sutured to the periosteum.

Step 5. Cover the graft with the outer portion of the partial-thickness flap and suture it interdentally.

Step 6. Cover the area with dry foil and surgical pack.

After 7 days, the dressing and sutures are removed. The esthetics are favorable with this technique since the donor tissue is connective tissue.

Dentowesome|@drmehnaz

Source: Carranza’s Clinical Periodontolgy, 10th Ed

SURGICAL GINGIVECTOMY

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GINGIVECTOMY

Gingivectomy means excision of the gingiva. By removing the pocket wall, gingivectomy provides visibility and accessibility for complete calculus removal and thorough smoothing of the roots, creating a favorable enviornment for gingival healing and restoration of a physiologic gingival contour.

Indications:

  1. Elimination of suprabony pockets, regardless of their depth, if the pocket wall is fibrous & firm.
  2. Elimination of gingival enlargements
  3. Elimination of suprabony periodontal abscesses.

Contraindications:

  1. The need for bone surgery
  2. Situations in which the bottom of the pocket is apical to the mucogingival junction.
  3. Esthetic consiserations, particularly in the anterior maxilla.

SURGICAL GINGIVECTOMY

Armamentarium:

  1. Mouth mirror, probe
  2. Pocket markers, Kirkland and orban interdental gingivectomy knives
  3. Surgical blades, Bard Parker handle
  4. Surgical curettes, Gracey curettes, tissue forceps, scissors.
  5. Peiodontal dressings.

Surgical Technique Steps:

Step 1: The pockets on each surface are explored with a periodontal probe and marked with a pocket marker.

Step 2: The incision is started apical to the points marking the course of the pockets and is directed coronally to a point between the base of the pocket and the crest of the bone.

Step 3: Remove the excised pocket wall, clean the area, and closely examine the root surface.

Step 4: Carefully curette the granulation tissue, and remove any remaining calculus and necrotic cementum so as to leave a smooth & clean surface.

Step 5: Cover the area with a surgical pack.

Dentowesome|@drmehnaz🖊

Source: Carranza’s Clinical Periodontolgy, 10th Ed

Treatment Options for Drug-Associated Gingival Enlargement

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Periodic Dental Check-ups: You can say good riddance to tartar, plaque, cavities and gum disease…..

Here’s an overview of various treatment options for drugs known to cause Gum disease/Gingival Enlargement.💊

To discover more w.r.t this topic head on to ✍🏻 – https://dentowesome.in/2020/07/03/gingival-enlargement/

Presentation Tip💡: Try to present your answers with flowcharts & diagrams rather than long paragraphs!! It will definitely have more impact & help you score well in exams..👍👇🏻

Surgical Approach (Diagrammatic View); MGJ: Muco-gingival junction; BL: Bucco-lingual; CT: Connective Tissue
Decision Tree for treatment of Drug-Associated Gingival Enlargement

Source: Carranza’s Clinical Periodontolgy, 10th Ed

Dentowesome|@drmehnaz🖊

GIANT CELLS

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PDF link below..⬇️

https://drive.google.com/open?id=1dow8Kc-EV3SNamk1lFlkj6gttzViwvrN

Link highlights:

• Definition

• Pathogenesis of Giant cells

• Types of giant cells - grossly classified into 2 types. –
• The giant cells which exist in normal tissue (physiological) e.g 
osteoclasts in bones, trophoblasts in placenta, odontoclast, straited muscle.

• The giant cells which exist pathological -eg. 
Foreign body giant cells
Langhan's giant cells
Touton giant cells
Aschoff giant cells
Anaplastic cancer giant cells Reed-Sternberg giant cells

Curated by: Dr. Tabassum Sayyad (Dental Intern – MARDC)