Aesthetic Periodontal Therapy – Root Coverage
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defect as well as apical to the defect, where the epithelium together with the outer portion of
the connective tissue is removed by sharp dissection (Weneström et al., 2008).
The flap design
is outlined by two vertical incisions that extended from the horizontal
incision to several millimeters apically to the mucogingival junction. A horizontal incision is
performed either at the gingival or 3 mm apically, following the marginal gingival contour,
thus joining the vertical incisions. A beveled linear horizontal incision is performed to
optimize the content of keratized tissue in the flap when the donor site is an edentulous site.
The flap is elevated as full thickness in the portion adjacent to the recession and as partial
thickness in the portion distal to the recession. Partial-thickness dissection is continued
apically and laterally to obtain passivity of flap movement and absence of muscle pull or
periosteal adhesion. The flap is rotated laterally to cover the recession defect completely and
extend for approximately 1 mm coronal to the cemento-enamel junction.
Careful flap suturing
is performed to position and secure the soft tissues over the root surface by means of sling
and simple sutures (Santana et al., 2010).
Figure 1. Schematic drawing of rotational flap procedure.
Figure 2. Schematic drawing of double papilla flap technique.
A. L. Dumitrescu, Liviu Zetu and Silvia Teslaru
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Following removal of the dressing and the sutures, usually after 10-14 days, the patient is
instructed to avoid mechanical tooth cleaning for further 2 weeks, but to use twice daily
rinsing with chlorhexidine solution as a means of infection control (Weneström et al., 2008).
Several modifications have been described to overcome the problem of dehiscence at the
donor site. Staffileno (1964) used a split-thickness pedicle flap so as not to denude the
adjacent site. This approach compromises vascularity and does not preclude bone resorption
at the donor site (Bahat et al., 1990). Other modifications of the procedure are the oblique
rotated flap (Pennel et al., 1965), the rotation flap (Patur, 1977), the double papilla flap
(Cohen and Ross, 1968) (Figure 2.) and the transpositioned flap (Bahat et al., 1990).
Zucchelli et al. (2010) revealead that present data do not seem to indicate the laterally
moved flap is an highly predictable and effective root coverage surgical procedure. From the
studies reviewed, the reported mean percentage of root coverage ranges between 34% and
82% (Smuckler,1976; Guinard and Caffesse, 1978; Espinel and Caffesse 1981; Waite, 1984;
Zade and Hirani, 1985; Oles et al., 1985) and only Oles et al. (1988) reported data relating the
―percentage of complete (up to the cemento-enamel junction) root coverage‖ and the range
was between 40% and 50% (Zucchelli et al., 2010).
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