Vestibular deepening via periosteal fenestration for root coverage.

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Journal name: Journal of Indian Society of Periodontology
Original article title: Vestibular deepening by periosteal fenestration and its use as a periosteal pedicle flap for root coverage
The Journal of Indian Society of Periodontology (JISP) publishes original scientific articles on periodontology (the study of supporting structures of teeth) and oral implantology. It is a bimonthly open-access journal with special issues for specific occasions.
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Author:

Jaisika Rajpal, Krishna K. Gupta, Ruchi Srivastava, Aakash Arora


Journal of Indian Society of Periodontology:

(A bimonthly open-access journal)

Full text available for: Vestibular deepening by periosteal fenestration and its use as a periosteal pedicle flap for root coverage

Year: 2013 | Doi: 10.4103/0972-124X.113095

Copyright (license): CC BY-NC-SA


Summary of article contents:

Introduction

Gingival recession, characterized by the apical displacement of the gingival margin, often results in reduced vestibular depth and inadequate width of attached gingiva, leading to aesthetic concerns and potential periodontal issues. Various techniques have been developed to enhance root coverage and increase the width of attached gingiva, typically requiring multiple surgical procedures. The need for innovative methods that provide predictable results, minimize surgical sites and discomfort, and improve patient comfort has led to the exploration of a single-stage surgical approach. This paper introduces a technique utilizing a periosteal pedicle flap to simultaneously achieve vestibular deepening and root coverage in a patient with localized gingival recession.

Single-Stage Technique for Root Coverage

The case report details a 17-year-old girl with Class II gingival recession affecting the lower left central incisor, accompanied by inadequate vestibular depth and width of attached gingiva. A single-stage surgical treatment was planned, combining vestibular deepening through the fenestration technique and root coverage using the periosteal pedicle flap. The procedure involved creating a split-thickness flap, fenestration of the periosteum, and harvesting a pedicled periosteal graft without requiring an additional surgical site. The autogenous periosteal tissue, rich in vascularization, was precisely positioned at the recession site, resulting in an effective closure of the exposed root surface and a notable increase in the width of attached gingiva. The patient experienced minimal postoperative discomfort and achieved excellent aesthetic results six months later, confirming the efficacy of the method.

Conclusion

The introduction of the periosteal pedicled flap technique for the treatment of localized gingival recessions enhances clinical outcomes by offering a successful alternative to traditional procedures. This method provides significant advantages, including the avoidance of a second surgical site, reduced surgical trauma, the dual blood supply to the graft, and improved patient satisfaction. The results demonstrated in this case support the viability of the technique for managing gingival recession with insufficient attached gingiva, suggesting that it may serve as a promising option in periodontal plastic surgery.

FAQ section (important questions/answers):

What is the purpose of a periosteal pedicle flap procedure?

The periosteal pedicle flap procedure helps in treating gingival recession by increasing the width of attached gingiva and facilitating root coverage in a single surgical procedure, enhancing patient comfort and reducing the need for multiple surgeries.

What is a key advantage of using a periosteal pedicled flap?

One key advantage is that the periosteal pedicled flap does not require an additional surgical site to obtain donor tissue, which reduces trauma, surgery time, and post-operative complications, leading to better patient satisfaction.

How does vestibular deepening benefit gingival recession treatment?

Vestibular deepening improves the depth of the vestibule, which can alleviate discomfort during oral hygiene practices and mastication, while also providing necessary support for the root coverage procedure, ultimately enhancing treatment outcomes.

What are the indications for surgical treatment of gingival recession?

Indications for treating gingival recession include reducing root sensitivity, preventing root caries, increasing the zone of attached gingiva, and improving aesthetic appearance, addressing both functional and cosmetic concerns.

What promotes healing in the periosteal pedicle flap technique?

The high vascularity of the periosteum and dual blood supply promote healing and integration of the graft, facilitating effective regeneration of periodontal tissues and enhanced attachment to the root surface.

Glossary definitions and references:

Scientific and Ayurvedic Glossary list for “Vestibular deepening via periosteal fenestration for root coverage.”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.

1) Incision:
In surgical procedures, an 'incision' refers to the cut made into the tissues to access underlying structures. In the context of periodontal surgery, incisions are strategically placed to allow for proper flap elevation and tissue manipulation, facilitating effective treatment of gingival recession by ensuring adequate exposure of the operative area.

2) Post:
The term 'post' in this context refers to the period that follows the surgical procedure. It encompasses recovery and monitoring the healing process. During the post-operative phase, patients are often advised on care regimens to optimize healing and prevent complications, highlighting the importance of aftercare in surgical success.

3) Surface:
'Surface' refers to the outermost layer of the tissues involved in the surgical procedure. In periodontal treatment, achieving coverage of the root surface is crucial, as it plays a key role in aesthetics and function. Proper management of the root surface ensures effective healing and integration of graft materials used in surgery.

4) Blood:
In surgical contexts, 'blood' is vital as it facilitates healing through its components – red blood cells for oxygen transport, white blood cells for immune response, and platelets for clotting. Ensuring good blood supply is essential for the viability of grafts during procedures like periodontal surgery, contributing to better outcomes.

5) Hygiene (Hygienic):
'Hygiene' refers to practices intended to maintain health and prevent disease, particularly following surgery. In periodontal care, maintaining oral hygiene post-operatively is crucial to prevent infections and ensure successful healing. Patients are counseled on proper brushing techniques and the use of antimicrobial rinses to support recovery after surgical procedures.

6) Accumulation (Accumulating, Accumulate):
The term 'accumulation' refers to the buildup of substances, such as plaque or food particles, in the oral cavity. In the context of periodontal health, accumulation can lead to periodontal disease. Surgical techniques aim to correct conditions that favor accumulation, thus promoting a healthier environment for gum tissue through careful management.

7) Inflammation:
'Inflammation' is the body’s response to injury or infection, characterized by redness, swelling, pain, and heat. In periodontal surgery, managing inflammation is essential for healing. Excessive inflammation can affect recovery and graft success; hence, controlling this response through medication and careful surgical technique is vital for optimal outcomes.

8) Surrounding:
In surgical discussions, 'surrounding' typically refers to the tissues or anatomical structures adjacent to the surgical site. Understanding the surrounding tissues is critical in periodontal surgery, as they influence the surgical approach taken, healing processes, and ultimate success of techniques like grafting, which rely on healthy surrounding tissues for integration.

9) Measurement:
'Measurement' pertains to the precise assessment of various parameters, such as recession depth, width of attached gingiva, and vestibular depth prior to surgery. Accurate measurements are crucial for devising a tailored treatment plan, predicting outcomes, and ensuring the effectiveness of surgical interventions aimed at correcting gingival defects.

10) Developing:
'Developing' refers to the process of creating or refining techniques within the field of periodontal surgery. As new surgical methods are explored, successful innovations aim to enhance predictability, reduce trauma, and improve patient outcomes. This continual development is essential to meet patient needs and improve the efficiency of surgical treatments.

11) Antibiotic (Antibacterial):
'Antibiotic' refers to a class of medications used to treat or prevent bacterial infections. In periodontal surgery, antibiotics may be prescribed post-operatively to help minimize the risk of infection, thereby enhancing recovery. Their use is an important aspect of post-surgical care, particularly for patients with compromised immune responses.

12) Dressing:
'Dressing' refers to the protective covering applied to surgical wounds to promote healing and prevent contamination. In periodontal surgeries, dressings like Coe-Pak provide a barrier that supports the surgical site, reduces discomfort, and enhances healing by protecting the area from external irritants and maintaining a moist environment.

13) Bleeding:
'Bleeding' denotes the loss of blood due to injury or surgery. In periodontal procedures, it is crucial to manage bleeding effectively to ensure a clear view of the surgical field and promote healing. Proper hemostasis techniques are thus an essential facet of surgical protocols to prevent complications during and after procedures.

14) Grafting:
'Grafting' refers to the surgical technique involving transferring tissue to another site to aid in repair or regeneration. In periodontal surgery, grafting is employed to enhance tissue volume, promote root coverage, and improve aesthetics. The choice of graft material influences healing and the overall success of the procedure.

15) Raising:
'Raising' relates to the action of mobilizing or elevating tissue during surgery, particularly when creating flaps. This technique allows for access to underlying structures and is vital in procedures aimed at correcting gingival defects. Proper elevation techniques are crucial for achieving optimal surgical exposure while minimizing tissue trauma.

16) Repair:
'Repair' is the process of restoring damaged or lost tissues to their normal state. In periodontal treatments, repair focuses on reestablishing healthy tissue around teeth through surgical intervention and grafting, which helps restore function and aesthetics, ultimately improving the patient's oral health and preventing further complications.

17) Powder:
'Powder' refers to the formulation used in therapies such as the tetracycline powder mentioned in the text, which is used to treat the root surface. This powder acts to disinfect and prepare the root area for grafting, helping to eliminate bacterial contamination and promoting better integration of the graft material during healing.

18) Study (Studying):
'Study' pertains to research or clinical investigation aiming to evaluate the efficacy of treatments or techniques. In the context of periodontal procedures, studies are essential for validating new methods like the periosteal pedicle flap approach, providing evidence that can help refine practices and improve outcomes in dental surgeries.

19) Food:
'Food' in this context refers to the substances consumed by patients that can contribute to oral hygiene challenges. Proper diet can influence gingival health, and surgical interventions may address issues arising from food accumulation, thereby underscoring the importance of educating patients about dietary habits in the context of preventing periodontal issues.

20) Hand:
'Hand' refers to the use of manual instruments in surgical procedures. In periodontal surgeries, hand instruments are essential for precise tissue manipulation and careful management of delicate structures. Mastery of hand techniques is vital for optimizing surgical outcomes and minimizing trauma to surrounding tissues during interventions.

21) Gold (Golden):
'Gold' is often used as a reference to established, high-quality standards or techniques in surgical practice, such as the 'gold standard' of connective tissue grafts. In the field of periodontal surgery, comparisons are made against such gold standard techniques to evaluate the effectiveness and advantages of new methods or approaches developed.

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Discover the significance of concepts within the article: ‘Vestibular deepening via periosteal fenestration for root coverage.’. Further sources in the context of Science might help you critically compare this page with similair documents:

Antibiotic therapy, Informed consent, Gingival Recession, Surgical trauma, Attached gingiva, Class-II gingival recession, Periodontal plastic surgery, Oral hygiene instruction, Keratinized gingiva, Root coverage, Patient comfort, Mucogingival surgery, Periodontal surgery, Post operative complication.

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