Gingival graft over flipped periosteum for root coverage: case report

| Posted in: Science

Journal name: Journal of Indian Society of Periodontology
Original article title: Free gingival graft embossed over laterally flipped periosteum for root coverage: A novel case report
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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Original source:

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Author:

R. Ambili, Devika Gopakumar, Basim Burhan Kurudamparambil Badarudhin


Journal of Indian Society of Periodontology:

(A bimonthly open-access journal)

Full text available for: Free gingival graft embossed over laterally flipped periosteum for root coverage: A novel case report

Year: 2024 | Doi: 10.4103/jisp.jisp_447

Copyright (license): CC BY-NC-SA


Summary of article contents:

Introduction

Gingival recession is a common issue worldwide, which can compromise aesthetic appearance and lead to increased root sensitivity and a higher risk of dental caries. Various surgical techniques exist for root coverage, including free gingival grafts (FGG), coronally advanced flaps, and subepithelial connective tissue grafts, with the latter being considered the gold standard. However, challenges in treating cases characterized by inadequate vestibular depth and frenal attachments often limit the applicability of these techniques. This case report presents an innovative approach combining FGG with a laterally rotated periosteal flap to enhance the predictability and outcomes of root coverage procedures.

Enhanced Vascularity with a Laterally Rotated Periosteal Flap

The novel surgical technique introduced in this report aims to address the limitations associated with the FGG by integrating it with a laterally placed periosteal flap. This method not only enhances the blood supply to the graft but also improves its chances for survival and successful adaptation. In this case, a 25-year-old female patient underwent the procedure due to sensitivity caused by gingival recession. The surgical approach involved meticulous preparation of both the recipient and donor sites, emphasizing careful elevation of the periosteum and secure placement of the graft with the aid of cyanoacrylate adhesive and sutures. The results demonstrated satisfactory root coverage, with significant improvements observed at the recipient site, including an increase in the width of keratinized tissue.

Conclusion

The case study highlights the efficacy of using an FGG positioned over a laterally rotated periosteal pedicle flap for achieving predictable root coverage in cases where traditional techniques may not suffice. Though promising, the findings call for further clinical trials to validate the efficacy and long-term predictability of this innovative surgical approach. The successful outcomes observed, including enhanced patient satisfaction and maintenance of results over a 1-year period, reinforce the potential of this technique in periodontal plastic surgery.

FAQ section (important questions/answers):

What is a free gingival graft (FGG)?

A free gingival graft (FGG) is a surgical technique that involves harvesting gingival tissue from one area of the mouth and transplanting it to another to augment the attached gingiva and improve esthetics and function.

How does the novel surgical technique enhance root coverage?

The novel technique integrates the FGG with a laterally rotated periosteal flap, enhancing vascularity and improving graft survival, which helps achieve more predictable root coverage for cases with anatomical limitations.

What outcomes were achieved with this surgical approach?

The technique resulted in satisfactory root coverage, increased keratinized tissue width, and enhanced vestibular depth, with excellent functional outcomes and high patient satisfaction maintained over a one-year follow-up period.

Why is periosteum used in this surgical technique?

The periosteum is utilized due to its abundant vascularity and cellularity, which can significantly improve the healing process, facilitate graft acceptance, and enhance the overall success of root coverage procedures.

What are the potential benefits of using cyanoacrylate adhesive?

Cyanoacrylate adhesive simplifies the stabilization of free gingival grafts without suturing through the graft tissue, minimizing disruption of blood supply and potentially enhancing overall graft survival and healing.

Glossary definitions and references:

Scientific and Ayurvedic Glossary list for “Gingival graft over flipped periosteum for root coverage: case report”. 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) Table:
In medical contexts, a 'table' often refers to a systematic arrangement of data or information. In surgical literature, it might summarize outcomes, techniques, or comparisons among various strategies. The clarity provided by tables is essential for understanding treatment results and making informed decisions in clinical practice.

2) Hygiene (Hygienic):
Hygiene refers to practices that maintain health and prevent the spread of diseases. In dentistry, good oral hygiene is crucial for successful surgical outcomes, as it minimizes infection risk and promotes healing. Emphasizing hygiene before and after procedures ensures that patients maintain optimal oral health.

3) Incision:
An incision is a surgical cut made in the skin or tissue to facilitate access to underlying structures. Precise incisions are critical during dental procedures for achieving optimal outcomes. The placement and technique of the incision can affect healing, post-operative pain, and the overall success of the surgery.

4) Surface:
In a surgical context, 'surface' often pertains to the area of the body exposed during an operation. The root surface, for example, is critical during dental grafting procedures, as its condition directly influences graft attachment and healing. Understanding surface characteristics aids in planning effective interventions.

5) Blood:
Blood supply is vital for tissue health and healing. In surgical procedures, adequate blood flow to the grafted areas ensures survival and integration of grafts, impacting overall success. Insufficient blood supply can lead to complications, necessitating careful planning and techniques designed to enhance vascular support.

6) Sign:
In medical terminology, a 'sign' refers to an observable manifestation of a condition or disease. In surgical contexts, signs can indicate infection, healing progress, or complications. Understanding and identifying signs during patient evaluation is crucial for guiding treatment decisions and managing post-operative care effectively.

7) Detachment:
Detachment in surgical terms often relates to the separation of tissue layers, which can be intentional (as in flap mobilization) or due to complications (such as graft failure). Managing detachment effectively can impact healing and graft success, necessitating strategies to maintain tissue integrity.

8) Relative:
The term 'relative' may refer to comparisons between different surgical techniques or outcomes in clinical studies. Establishing relative effectiveness helps in evaluating the merits of various approaches, guiding practitioners in selecting the most appropriate technique for particular patient situations based on comparative data.

9) Line:
In surgical contexts, 'line' can describe the edge or boundary of a surgical incision, or it may pertain to anatomical structures. Clear demarcation lines during procedures are vital for ensuring precision and safety, impacting the aesthetic and functional results of surgical interventions.

10) Gold (Golden):
The term 'gold standard' refers to a treatment or procedure that is considered the best or most effective based on prevailing evidence. In dentistry, identifying a 'gold standard' assists practitioners in choosing techniques with proven efficacy, leading to better patient outcomes in surgical interventions.

11) Discussion:
Discussion in a clinical paper serves to analyze results, compare findings with existing literature, and propose implications for practice. It's an essential component that synthesizes information, provides insights, and helps practitioners understand the broader context of the research, thereby enhancing clinical decision-making.

12) Harvesting (Harvest):
Harvesting refers to the process of obtaining tissue, such as grafts or flaps, from a donor site. In dental surgeries, effective harvesting techniques are crucial for ensuring donor site healing while yielding adequate tissue for grafting, directly influencing surgical outcomes and patient satisfaction.

13) Gathering:
Gathering often relates to the collection of surgical instruments, tissues, or data. In the context of surgery, it implies the preparation and organization of necessary components before the procedure, ensuring that the surgical team is equipped to perform efficiently and effectively, minimizing errors.

14) Dressing:
Dressing refers to materials applied to a surgical site to protect it from infection and promote healing. The choice of dressing can impact patient comfort and recovery in dental surgeries. Properly applied dressings are crucial for minimizing complications and supporting optimal healing post-operatively.

15) Bleeding:
Bleeding during surgery is a critical concern, as excessive blood loss can complicate procedures and affect patient outcomes. Effective hemostatic measures are essential to manage bleeding, ensuring patient safety and minimizing the risk of postoperative complications related to insufficient blood supply.

16) Grafting:
Grafting involves transferring tissue from one location to another to repair or reconstruct an area. In periodontology, grafting is vital for procedures aimed at restoring lost gum tissue. Success in grafting directly impacts patient aesthetics, function, and overall satisfaction with dental surgical outcomes.

17) Cutting:
Cutting is a fundamental part of surgical techniques, involving precise incisions to access or manipulate anatomical structures. Skillful cutting during dental surgeries affects the speed of operation, precision of tissue handling, and ultimately the quality of patient outcomes and recovery.

18) Beating:
Beating might not have direct relevance to surgical contexts, but in broader medical terminology, it can reference robust responses to treatment or management strategies. For surgical outcomes, achieving a 'beating' heart during procedures implies successful stabilization of the patient, crucial for maintaining health.

19) Raising:
Raising refers to elevating tissue, such as during the creation of flaps in surgical procedures. The method used for raising flaps affects blood supply and healing potential. Proper techniques ensure that sufficient tissue is made available for grafting while preserving vascular integrity.

20) Charter:
Charter in this context may suggest the establishment of protocols or guidelines for surgical procedures. It often serves to standardize practices, ensuring consistency and safety in treatments while contributing to better patient outcomes through adherence to established best practices.

21) Kumar:
Kumar likely refers to a researcher or author cited within the text, contributing insights to the methodology or findings discussed. Referencing specific individuals in the literature provides credibility and context to research claims, alongside acknowledging the foundation of previous scholarly work.

22) Silk:
Silk is a type of suture material often used in surgical procedures. Its properties, such as strength and compatibility with tissues, make it beneficial for closing incisions. The choice of silk sutures can influence healing times, post-operative comfort, and the appearance of surgical sites.

23) Pose:
Pose in a surgical context might refer to positioning, either of the surgical site or the patient during a procedure. Proper posing is essential for optimizing visibility and access during surgery, ensuring that practitioners can perform procedures safely and effectively with minimized risk of complications.

Other Science Concepts:

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Discover the significance of concepts within the article: ‘Gingival graft over flipped periosteum for root coverage: case report’. Further sources in the context of Science might help you critically compare this page with similair documents:

Clinical trial, Gingival Recession, Suturing technique, Attached gingiva, Gingivoplasty procedure, Free gingival graft, Root coverage, Keratinized tissue, Cyanoacrylate adhesive.

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