Comparison of three crown lengthening procedures a. Modified apically repositioned flap in the treatment of unerupted maxillary central incisors article pdf available in dental update 273. Vertical incisions are made extending beyond the mucogingival junction. The amount of keratinized tissue should be taken into consideration when planning for implantsupported overdentures. For flap placement after surgery, flaps are classified as either 1 nondisplaced flaps, when the flap is returned and sutured in its original position, or 2 displaced flaps, which are placed apically, coronally, or laterally to their original position. The third criterion involves the evaluation of the amount of keratinized gingiva kg. To overcome these disadvantages, carnio and miller in 1999 described the modified apically repositioned flap marf technique for increasing the width of. Full thickness flap is surgical procedure of which all soft tissue and the periosteum are reflected. It is also important to remember that, for esthetic reasons, symmetry of tooth length must be maintained. What is apically repositioned flap in mucogingival surgery. Bone is recontoured so that 2 mm distance between level of proposed crown margin and crest of bone. Stagetwo surgery was performed using wither the apically repositioned flap, the roll flap, or an apically repositioned flap combined with a connective tissue graft. After removal ol all granulation tissue, scaling and root planing, and osseous surgery il needed, the flap is displaced apicallv.
The idea is to move the gingival margin apically and not to excise the gingiva. Split thickness apically repositioned flap osseonews dental. Before and after photos on apically repositioned flap periodontal gum surgery performed in our gum disease treatment office. Periodontal gum surgery for a patient whose gums had 57mm periodontal pocketing and bleeding upon probing.
Apically repositioned flap in the lower jaw splitthickness. Patient preparation reevaluation after initial treatment srp. Nov 16, 2017 the apically positioned flap is a commonly used surgical approach, and is important for maintaining an adequate zone of keratinized tissue. Increasing the width of attached gingiva by using modified apically. Case report a 12yearold girl was referred by her general dental practitioner to the department of orthodontics at the. This is the 2010 version of hcpcs d4245 please refer to the 2016 hcpcs code set for the latest version added on. During healing the supracrestal soft tissues will proliferate coronally to cover 23 mm of the root19, 20, thereby leaving only 1. Adam bear discusses the advantages this procedure has for surgical crownlengthening procedures. After removal of all granulation tissue, scaling and root planing, and osseous surgery if needed, the flap is displaced apically. When the crown is apical to the mgj, a closed technique is generally utilized. Relating to the apex or tip of a pyramidal or pointed structure.
Flap techniques and flaps in the treatment of pocket therapy. Suture around the tooth prevents the flap from sliding to a position more apical. Bed preparation has been done simulationally for apically positioned flap at the 1st. The effect of apically repositioned flap surgery on. When the flap is returned and sutured in its original position. Free gingival graft versus modified apically repositioned flap.
When the operator does not desire to expose the bone 8. Patients were divided into three groups based on preoperative anatomical considerations. The apically positioned flap and crown lengthening youtube. Indicated when the flap has to be positioned apically. Both fullthickness and partialthickness flaps can also be displaced. This type of flap is also called the splitthickness flap. Split thickness apically repositioned flap osseonews. Within the limitations of the study the biologic width, at treated sites, was reestablished to its original vertical dimension by 3 months. A simple technique for stabilization of apically repositioned.
Associate professor of periodontology and oral pathology, school of dentistry, university of southern california, beverly hills, california. This research study is looking at three different procedures for improving the oral mucosa membrane around dental implants. However, due to the anatomy in this region the lingual flap does not move coronally but rather stays in the desired apical position. Situated nearer to the apex of a structure in relation to a specific reference point. Aug 15, 2016 in 1979, carranza classified flap as full thickness flap and partial thickness flap. Contraindications apically positioned flap without osseous surgery.
The described technique is a variation of the modified apically repositioned flap marf technique previously proposed. Flap surgical technique for pocket elimination apically displaced flap md. The effect of apically repositioned flap surgery on clinical. Coronally and apically positioned flaps, although technically not grafting procedures, are other forms of a pedicle grafts in that gingival tissue is freed up and moved either coronally or apically. Consequently, substantial amounts of attachment may have to be sacrificed when crown lengthening is accomplished with an apically positioned flap technique. Apically repositioned flap periodontal gum surgery nyc dentist. Apically definition of apically by medical dictionary. Start studying peri 538 lecture 9 resective periodontal surgery. Prior to flap surgery full thickness labial and lingual flaps. Pdf modified apically repositioned flap in the treatment of. Preprosthetic periodontal surgery the apically positioned flap.
Based on flap placement after surgery non displaced flaps. Borchard and erpenstein incisions and tissue management in periodontal surgery fig. It also shows the final healing creating attached gingiva using a split thikness apically repositioned flap dr hl gluckman on vimeo. A comparative evaluation for biologic width following. Bed preparation has been done simulationally for apically positioned flap at. To correct these mucogingival issues, a free gingival graft fgg, an apically positioned flap, or a connective tissue graft is required if there is a minimal width of keratinized tissue, in order. Skin grafts and flaps dr ehsanur reza shovan assistant professor department of surgery. Pdf the modified apically repositioned flap to increase. If the crown is located at the mgj level, an apically repositioned flap is done. Jul 23, 2017 flap surgical technique for pocket elimination apically displaced flap md. Pdf modified apically repositioned flap in the treatment. Apically repositioned flap periodontal gum surgery nyc. Mucogingival procedures page 3 of 8 unitedhealthcare dental clinical policy effective 03012020 proprietary information of unitedhealthcare. Using resective techniques apically positioned flap with osseous resection, the degree of furcation involvement is not reduced it is often increased in the interest of enhanced access for cleaning.
The apically positioned flap is a commonly used surgical approach, and is important for maintaining an adequate zone of keratinized tissue. Define apically repositioned flap in mucogingival surgery. To ensure a satisfactory esthetic result, the gingival displacement should not exceed a few millimeters. As a general rule, at least 4 mm of sound tooth structure must be exposed at time of surgery. The apically positioned flap and crown lengthening. B two months later with better access and visualization tooth is efficiently positioned to the occlusal plane with preservation of adequate labial gingiva.
Flaps are positioned apically to increase length of. Skin graft a skin graft is a procedure performed where healthy skin is removed from one area of the. Ppt clinical crown lengthening and preprosthetic surgery. Modified apically repositioned ap guar d et al 26 by bohannan in 1962, the apically repositioned flap apf by freidman in 1962, and free autogenous gingival grafts by king and pennel 1964. The current study aims at evaluating the esthetic improvement in kg around dental implants applying apically positioned flap apf technique. Clinical dental advantages of the apically positioned flap perio. Dec 28, 2016 periodontal flap with clinical photos. This video shows you how to create attached gingiva in the upper jaw by creating a split thickness flap and apically repositioning it. Evaluating the clinical and esthetic outcome of apically positioned. While in the buccal area a split thickness flap is needed for the apical positioning, in the lingual area a full thickness flap is appropriate.
Clinical crown lengthening and preprosthetic surgery online module a dentistry 664 preprosthetic surgery crown lengthening ridge augmentation ridge reduction. Levy et al 1 examined the effect of apically repositioned flap surgery on the composition of the subgingival microbiota as well as clinical parameters. Various techniques to increase keratinized tissue for implant. Apically positioned flap and resective surgery part i week 5. Looking for online definition of apically repositioned flap in mucogingival surgery in the medical dictionary. Ostectomy with apically positioned flap can be considered as a more effective procedure than gingivectomy for surgical crown lengthening. The modified apically repositioned flap marf technique is an effective procedure to increase the dimensions of attached gingiva in areas that present with some. This technique is important for maintaining an adequate zone of keratinized tissue, as opposed to the gingivectomy technique, where soft tissue is resected. The goal of this study was to evaluate the ability of the modified apically repositioned flap marf technique to increase keratinized tissue at the donor site and to analyze if this procedure would. The bone remains covered by a layer of connective tissue that includes the periosteum. Crown lengthening procedures with minimal attached gingiva.
Figure 4 a apically positioned labial flap was used to uncover second premolar in similar location and position as tooth in fig 3. One of the following surgical techniques was utilized to increase the amount of keratinized tissue. Apically repositioned flap technique around implants. If you continue browsing the site, you agree to the use of cookies on this website. Partial or split thickness flap is an elevated flap which includes only epithelium and the layer of underlying connective tissue. Apically positioned flap and resective surgery part i. If a split thickness flap is required, it is elevated using sharp dissection with 1 hardparker knife to split it, leaving a layer ol connective tissue, including the periosteum, 011 the bone. Layer to layer technique applied for contour augmentation on posterior buccal site. Resective techniques have often been used in treatment of class 3 furcation involvements. The required area of skin and tissue is moved without interrupting the blood supply. Mucogingival procedures page 4 of 8 unitedhealthcare dental clinical policy effective 03012020.
Thirty patients with class i localized gingival recession were included. If it doesnt stay down, a blood clot can form there and cause tissue rebound. Apically positioned flap with immediate implantation youtube. Compared with the external version, the loss of tissue is very low. Meaning of apically repositioned flap in mucogingival surgery medical term.
Patient preparation reevaluation after initial treatment. Utilization of sling sutures to stabilize the repositioned flap is also not always favorable, we found that the flaps might unexpectedly migrate. In that study of 11 subjects, there was a significant decrease in mean pocket depth and the percentage of sites exhibiting gingival redness 3 months after scaling and root planing srp and apically repositioned flap surgery at sites 4 mm. With regards to implants, many studies suggest that the presence of healthy periimplant softtissue plays an important role in longterm success of dental implants see studies below. Definition a periodontal flap is a section of gingiva andor mucosa surgically separated from the underlying tissues to provide visibility and access to the bone and root surface. Apically positioned flap without osseous surgery the idea is to move the gingival margin apically and not to excise the gingiva. Dept of periodontics periodontal flaps presented by, shiji margaret. Clinical dental advantages of the apically positioned flap. Flap techniques and flaps in the treatment of pocket therapy authorstream presentation. Modified apically repositioned flap in the treatment of.
Incisions and tissue management in periodontal surgery. Various techniques to increase keratinized tissue for. Start studying apically positioned flap and resective surgery part i week 5. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. The apically positioned flap is a commonly used surgical approach to achieve pocket elimination. Pdf the modified apically repositioned flap to increase the. This requires adequate thickness and width of gingival tissue at the base of the recession defect. Tissue must lay down and be positioned apically to prevent rebound o combined technique. Procedures for improving the mucosa around implants full. To be able to use an apically displaced flap for canine exposure the tip of the crown of the impacted canine must be near the mucogingival line of the lateral incisor. Apically repositioned flap in mucogingival surgery.
A free powerpoint ppt presentation displayed as a flash slide show on id. The partialthickness flap is indicated when the flap is to be positioned apically or when the operator does not want to expose bone. The apically positioned flap technique with bone recontouring resection may be used to expose sound tooth structure. Dept of periodontics periodontal flaps presented by, shiji margaret d. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The goal of this study was to evaluate the ability of the modified apically repositioned flap marf technique to increase keratinized tissue at the donor site and to analyze if this procedure would enhance the indication for and predictability of the laterally positioned flap lpf without any consequences to the donor area. In this surgery, in the vestibular and lingual area of tooth 36 and 37 the gingiva is apically repositioned to facilitate the prosthetic procedures planned. In 1979, carranza classified flap as full thickness flap and partial thickness flap. Use of the modified apically repositioned flap technique to create. The three procedures will be the standard procedure, the standard procedure with the use of tissue harvested from the mouth and the standard procedure with the use of mucograft membrane product. Creating attached gingiva using a split thikness apically. Pdf this article describes a surgical technique directed at increasing the dimensions of attached gingiva over multiple adjacent teeth.