Modified coronally advanced flap technique, coverage of multiple. Bed preparation has been done simulationally for apically positioned flap at. Post crown lengthening image after temporization 2. The modified apically repositioned flap marf technique has been previously published as a successful method to increase the zone of attached gingiva with numerous advantages, such as simplicity. Use of the modified apically repositioned flap technique to create attached gingiva in areas of no keratinized tissue. Conventional versus modified technique of the apically. Creating attached gingiva using a split thikness apically. Clinical image prior to crown lengthening for preparation for restoration fig. The single incision technique for multiple adjacent teeth. Flap apically positioned to cover 12mm of cementum class ii. Patients were divided into three groups based on preoperative anatomical considerations. The apically repositioned flap is a quick, simple and reliable method for exposing most teeth that are impacted labially or within the line of the arch. A surgical approach to enhance donor sites prior to employing a laterally positioned flap.
Increasing the width of attached gingiva by using modified apically. This article describes a surgical technique directed at increasing the dimensions of attached gingiva over multiple adjacent teeth. Flap apically positioned to the crest of the bone 70. 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. Surgical management of gingival recession using autogenous soft. Ramfjord and nissle 1974 described the modified widman technique, which is. The described technique is a variation of the modified apically repositioned flap marf technique previously proposed. The apically positioned flap is a commonly used surgical approach to achieve pocket elimination. Periosteum is left exposed in the area between the initial horizontal incision and the coronal margin of the flap. The shortterm followup of the marf technique demonstrated an increase in keratinized tissue and attached gingiva.
Gingival grafting, also called gum grafting or periodontal plastic surgery, is a generic term for the performance of any of a number of periodontal surgical procedures in which the gum tissue is grafted. Download pdf apically positioned flap, free gingival graft and apically positioned flap with collagen matrix around dental implants. Flap repositioning versus conventional suturing in third. It also shows the final healing creating attached gingiva using a split thikness apically repositioned flap dr hl gluckman on vimeo. Modified apically repositioned flap in the treatment of unerupted maxillary central incisors article pdf available in dental update 273. Flap surgical technique for pocket elimination apically displaced flap md. You can also choose from elastic closure folder, presentation folder, and clip file flap file, as well as from pp, paper, and leather flap file there are 898 suppliers who sells flap file on, mainly located in asia.
Situated nearer to the apex of a structure in relation to a specific reference point. This technique is important for maintaining an adequate zone of keratinized tissue, as opposed to the gingivectomy technique, where soft tissue is resected. This conventional apically repositioned flap method has been modified by. These cases show the modified apically repositioned flap marf technique and its potential to increase the likelihood of repigmentation of the surgical site with better matching esthetic results. The modified apically repositioned flap marf technique is an effective procedure to increase the dimensions of attached gingiva in areas that present with some existing keratinized tissue. 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. Various techniques to increase keratinized tissue for. The distance from the tooth, buccally or lingually, is dependent on the pocket depth, and the beveled incision should. Enhancing the zone of keratinized tissue around implants.
According to the results of this study, apical debris extrusion occurred independent of the type of instrument used. The undisplaced flap periodontal disease click to cure. Before and after photos on apically repositioned flap periodontal gum surgery performed in our gum disease treatment office. Apically definition of apically by medical dictionary. The modified apically repositioned flap technique and its.
Repositioned flap replacing the flap back to where it was before modified widman surgeries apically positioned flap used after 46week postop probing after srp assuming pocket depths dont improve crown lengthening restorative margin cannot be closer than 2mm to crestal bone, or will disrupt osseous structure. Pdf the modified apically repositioned flap to increase. Levy et al 1 examined the effect of apically repositioned flap surgery on the composition of the subgingival microbiota as well as clinical parameters. Associate professor of periodontology and oral pathology, school of dentistry, university of southern california, beverly hills, california. Flap techniques and flaps in the treatment of pocket therapy. Simple flap procedures include the simple apically repositioned flap and the modified widman reverse bevel flap. An external file that holds a picture, illustration, etc. Additional reading attached gingiva and dental implants. Relating to the apex or tip of a pyramidal or pointed structure. The undisplaced flap and the gingivectomy are the two techniques that surgically remove the pocket wall, lo perform this technique without creating a mucogingival problem it should be determined that enough attached gingiva will remain after removal ol the pocket wall. It also shows the final healing of the soft tissue. From history of various periodontal flap surgical techniques to incision and suturing. The reciprocating singlefile systems extruded significantly more debris compared with the fullsequence rotary niti instruments p apically repositioned flap marf technique uses a single horizontal incision within the keratinized tissue kt, elevating a splitthickness flap, and suturing of the flap to the periosteum in an apical position.
Adequate keratinized gingiva crestal incision used. The effect of apically repositioned flap surgery on. In the case described, the labial inclination was such that a crestal incision coronal incision in this patient would have resulted in the absence of any keratinized mucosa, and so the decision was taken to advance the incision to the palatal mucosa to incorporate this tissue into the apically repositioned flap. Modified apically repositioned flap in the treatment of. Periodontal gum surgery for a patient whose gums had 57mm periodontal pocketing and bleeding upon probing. The aim may be to cover exposed root surfaces or merely to. Dept of periodontics periodontal flaps presented by, shiji margaret d. Objective to gain access to the deeper periodontal structures using a flap reflected from the root and alveolar surfaces. The modified apically repositioned flap marf technique uses a single horizontal incision within the keratinized tissue kt, elevating a splitthickness flap, and suturing of the flap to the periosteum in an apical position. However, in the opinion of other investigators 9,11, healing by second intention, where wound drainage is. Case 5 was also treated as part of the second stage surgery utilizing pedicle flap with a. The modified apically repositioned flap marf technique has been previously published as a successful method to increase the zone of attached gingiva with. Pdf increasing the amount of attached gingiva using a. It is suitable for tooth exposure in both children and adults and will help to minimize potential problems.
In 1962, friedman proposed the term apically repositioned flap. However, to do so, the attached gingiva must be totally separated. The apically repositioned flap is a predictable method of increasing the zone of attached gingiva. 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 repositioned flap in combination with a free gingival graft for. 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. Pdf the modified apically repositioned flap to increase the. A wide variety of flap file options are available to you, such as folder, bag, and wallet. Apically extruded debris with reciprocating singlefile. Coronally advanced flap and connective tissue graft. The advantages of the marf technique includes its simplicity and ease of execution as it involves the use of a single horizontal incision in the recipient site, absence of palatal donor tissue, shorter operative time. 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. The modified apically repositioned flap to increase the dimensions of attached gingiva. Apically repositioned flap periodontal gum surgery nyc.
Split thickness apically repositioned flap last updated august 15, 2016 7 comments video from dr. Pdf apically positioned flap, free gingival graft and. Apically repositioned flap technique around implants. Pdf modified apically repositioned flap in the treatment. Periodontal flap is a section of gingiva andor mucosa which is separated from underlying tissues to provide visibility of and access to bone and root surface demontmorency college of dentistry, lahore. The term apically repositioned flap was initially used in 1957 by ariaudo and tyrell, who suggested modifications on the technique first introduced by nabers in 1954. Apically positioned flap with immediate implantation youtube. Apically repositioned flaps may be preferred due to its advantages. 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. Conventional versus modified technique of the apically repositioned. The apically positioned flap and crown lengthening. The apically positioned flap is a commonly used surgical approach, and is important for maintaining an adequate zone of keratinized tissue. Although many methods are used to increase the zone of attached gingiva, the modified apically repositioned flap marf technique has the advantages of simplicity and predictability. Clinical dental advantages of the apically positioned flap.
Apically repositioned flap as described by friedman has been successfully used to increase the width of attached gingival around natural teeth, this can be modified and used around implants in cases with thick gingival biotype, it has the advantage of low morbidity as it precludes the need of second surgical site, and results in an aesthetic. Define apically repositioned flap in mucogingival surgery. 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. According to these authors, primary closure of the flap avoids suture dehiscence and improves wound healing. Apically repositioned flap in mucogingival surgery.
In three patients, an apically repositioned flap was used as described in case 1, which resulted in a mean increase in the width of keratinized tissue of 3. Stagetwo surgery was performed using wither the apically repositioned flap, the roll flap, or an apically repositioned flap combined with a connective tissue graft. Split thickness apically repositioned flap osseonews. Layer to layer technique applied for contour augmentation on posterior buccal site. This video shows you how to create attached gingiva in the upper jaw by creating a split thickness flap and apically repositioning it. More than adequate keratinized gingiva width labial or buccal incision mm from crest of gingiva.
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