Several reasons contribute to the loss of interdental papillae and the establishment of black. A modified mattress suture allows coronal positioning of the buccal flap and primary closure of the interdental space. Early postoperative healing following buccal single flap. A modified papilla preservation technique, 22 years later. The dental papilla appears after 810 weeks intra uteral life. Pierpaolo cortellini giovanpaolo pini prato maurizio s. Papilla preservation and regeneration in reconstructive therapy description. Guided tissue regeneration and papilla preservation with the. The patient was advised to refrain from brushing at the grafted site for 3 weeks. Widman flap and the simplified papilla preservation flap. Periodontal regenerative emdogain surgery with papilla.
Two vertical incisions reaching the alveolar mucosa were made on the line angle area of the adjacent teeth. These clinical innovations in flap design and handling have radically changed surgery and have allowed a drastic limitation of interdental wound failure to less than 30% of the treated cases. Surgical periodontal flap with conventional incision will result in gingival recession and loss of interdental papillae after treatment. No adjunct guided tissue regeneration was attempted. Edward pat allen describes in great detail root preparation, instrumentation, and flap management techniques utilized in settingup the root coverage of multiple adjacent recession defects.
This procedure simplified papilla preservation flap, sppf was designed to provide surgical access to interproximal bony defects while preserving interdental soft tissues, even in narrow interdental spaces and posterior teeth. Jan 29, 20 the modified papilla preservation technique. In the 1990s, the modified papilla preservation technique mppt15 and the simplified papilla preservation flap sppf24 have been tested and proposed. Ebscohost serves thousands of libraries with premium essays, articles and other content including the simplified papilla preservation flap. Pdf a modified papilla preservation technique, 22 years. Modified papilla preservation technique can be used in singlerooted teeth and lower molars without neighboring tooth 24. It is designed to achieve an adequate attached gingiva than can be gotten from the zone of attached keratinized gingiva andor coverage of a radicular surface of a tooth. Papilla preservation and tunneling technique in root coverage. Noncontained intrabony defect treated with the simplified papilla preservation flap in conjunction with straumann emdogain and a particulate bone grafting material prof. The techniques include papilla preservation flap 23, modified papilla preservation 24, and simple papilla preservation flap 25 to prevent inadvertent papillary loss as a result of flap.
A palacci papilla regenerating flap is used the flap is closed with atraumatic compression sutures. A periosteal incision in the most apical portion of the buccal flap 4. In embryology and prenatal development, the dental papilla is a condensation of ectomesenchymal cells called odontoblasts, seen in histologic sections of a developing tooth. A novel surgical approach for the management of soft tissues in regenerative procedures. Flap technique for periodontal bone implants thomas j. In 1995 and 1999, cortellini described a modification to the conventional papilla preservation flap.
The simplified papilla preservation flap a novel surgical approach for the management of soft tissues in regenerative procedures presenter. Papilla preservation flap periodontal disease click to. The distal extensions of the incision were continued as intrasulcular incisions on the buccal, interdental and palatal aspect of the central incisors. The papilla base incision consisted of a shallow first incision at the base of the papilla and a second incision directed to the crestal bone, creating a split thickness flap in the area of the papilla base.
Narrow interproximal space and thin interdental tissues 1 interrupted suture 2. Papilla augmentation using platelet rich fibrin a case report dr. Black triangle dilemma and its management in esthetic dentistry. Thomas han outlines the clinical decision making rational for choosing a specific surgical technique for diverse papilla regenerative challenges in the anterior region. B modified papilla preservation flap cortellini et al. Several techniques such as free gingival graft, laterally positioned flap 46, coronally positioned flap 7, 8, and double papilla graft have been proposed for the same. Abrams roll flap, performed at the implant second surgical stage, allows for the correction of small horizontal defects by enhancing the buccal soft tissue thickness and improves the buccal soft tissue profile. This study aims to evaluate the early postoperative healing of papillary incision wounds and its association with 1 patientsiterelated factors and technical surgical aspects as well as with 2 6month clinical outcomes following buccal single flap approach sfa in the treatment of intraosseous periodontal defects.
Incision papilla preservation should be the primary consideration in periodontal flap surgery if possible. The present article describes a case with a surgical approach to papilla reconstruction based on the. Duodenal papilla definition of duodenal papilla by. Insufficient blood supply is the major limiting factor in all the surgical papilla reconstructive and regeneration techniques. Surgical reconstruction of lost interdental papilla. To avoid maxillary anterior softtissue loss, papilla preservation flap surgery was done. Papilla preservation and regeneration in reconstructive.
In the papilla preservation flap the facial surface is prepared with a. Flap design and suturing for periodontal regeneration of a furcation grade 2 and an intrabony defect. The flap design may also be dictated by the aesthetic concerns of the area of surgery. Fortythree intraosseous defects in 35 patients were accessed with a. A modified version of takeis papilla preservation technique. Simplified method of interimplant papilla preservation around. The labial ridge had previously been regenerated using biooss.
Clinical responses to bone blend or hip marrow grafts. Preservation of good blood supply to the flap is another important consideration. Progress in gingival papilla reconstruction thomas han dds. Root coverage using double papilla preservation flap. Papilla preservation flap as aesthetic consideration in periodontal flap surgery flap surgery is treatment for periodontal disease with alveolar bone destruction. Mar 25, 2017 flap design and suturing for periodontal regeneration of a furcation grade 2 and an intrabony defect. Simplified method of interimplant papilla preservation around immediate implant in the maxillary aesthetic zone a case report sheethalan 1, archana mootha 1 and thiyaneshwaran nesappan 2 1department of periodontology, saveetha dental college, chennai, india. A partialthickness pedicle flap that included sufficient interdental papilla bilaterally was prepared. It was brought in practice by cortellini as minimally invasive surgical technique. Mar 12, 2017 the preserved papilla can be incorporated into the facial or the lingual palatal lap b, the reflected flap exposes the underlying bone.
Comparison of longterm papilla healing following sulcular. Evaluation for both cases were obtained by incision papilla preservation of primary closure was perfect, good aesthetic results, minimal gingival recession and the interdental papillae can be maintained properly. Comparison of two surgical techniques for the reconstruction. On the basis of these findings, it seems best to combine the sfa with specific. Duodenal papilla definition of duodenal papilla by medical. This was the modified and simplified papilla preservation technique. Vs introduction gtr predictable significant amount of attachment and bone gains at 1 year lack of primary closure, flap dehiscence, membrane exposure occurs in 70% 80% of cases. Papilla of vater definition of papilla of vater by. Dr ehab rashed remove periapical root infection,preserve the papilla, bone graft the site then place dental implant along with ctg and. A higher gingival blood flow to different parts of the periodontium might have an essentially positive effect on the speed and on the quality of the healing process. Noncontained intrabony defect treated with the simplified. Papilla preservation and tunneling technique in root coverage part 1 description. After adequate anesthesia, two semilunar incisions were made on both sides of the frenum. Surgical techniques are diverse, but none have given predictable results.
Papilla preservation flap as aesthetic consideration in. Comparison of two surgical techniques for the reconstruction of interdental papilla s shruthi 1, sheela kumar gujjari 2, kiran prakash mallya 3 1 department of periodontology, sri siddhartha dental college and hospital, a constituent of sri siddhartha university, agalkote, tumkur, india 2 department of periodontology, jss dental college and hospital, a constituent of jss. Depending on how the interdental papilla is managed, flaps can either split the papilla conventional flap or preserve it papilla preservation. Vertical releasing incisions used only as a last resort 16. Sutures were placed and periodontal pack is accomplished using 40 absorbable suture with a p3 was given. Modified papilla preservation technique linkedin slideshare. Simplified method of interimplant papilla preservation. Case 2 was a surgical incision flap with preservation of papillae on the posterior region of tooth 46 with inlay restoration. Interdental papilla reconstruction combining periodontal. Cortellini et al14 used a modified approach and reported a significant reduction in membrane exposures in the interproximal space 27% of 15 treated cases. Introduction gtr predictable significant amount of attachment and bone gains at 1 year lack of primary closure, flap dehiscence, membrane exposure occurs in. Papilla preservation flap technique not only re sults in an. A horizontal incision was made on the mesial and distal interdental papilla coronally. Papilla preservation, periodontal plastic surgery, ridge augmentation, roll flap, softtissue augmentation.
Introduction goals 1 primary closure of the flaps in interdental spaces 2 avoid the collapse of nonself supporting barrier membranes into interproximal defects 3 usable. Apr 24, 2018 regarding the surgical technique, it has been proposed the simplified papilla preservation technique. Restoration of lost interdental papilla remains one of the most challenging goals for clinicians. Kasaj 0108 preoperative probing pocket depth ppd at the distal aspect of tooth 11 was 7 mm. Double papilla repositioned flap for the treatment of. Papilla preservation and tunneling technique in root. When the interdental areas are too narrow to permit the preservation of flap. Surgical site was protected with tin foil figure 6, and periodontal dressing was given with coepack. The advantages for this modification lies in the fact to preserve the papilla morphology and enhancement of the softtissue esthetic results.
More demanding in narrow interproximal spaces necrosis7. Interdental papilla reconstruction combining periodontal and. Loss of interdental papilla marks phonetics, functional and esthetic problem. Several articles have been devoted to flap designs and surgical techniques to maintain full papillary form and preserve the soft tissues during. Double papillary flap a treatment for gingival recession. In conclusion, periodontal flap surgery on the anterior region or regions that require high aesthetic value could be addressed with papilla preservation incision.
Interrupted suturing 50 vicryl was done across the medial area of the two papilla flaps figure 5. Modified papilla preservation flap mppf primary intrasulcular incision fig. Wide intrabony defect treated with the modified papilla preservation flap in conjunction with straumann emdogain and autogenous bone dr. When a single tooth is replaced with an implant, the papilla between the tooth and the implant can often be maintained or predictably restructured as long as the periodontal attachment and bone of the adjacent tooth is preserved. Modified whales tail technique for the management of bone. Comparison of two surgical techniques for the reconstruction of interdental papilla s shruthi 1, sheela kumar gujjari 2, kiran prakash mallya 3 1 department of periodontology, sri siddhartha dental college and hospital, a constituent of sri siddhartha university, agalkote, tumkur, india 2 department of periodontology, jss dental college and hospital, a constituent of jss university, mysore. In this technique,24 the facial surface is prepared with sulcular incision around each tooth with no incision being made through the. Papilla preserving modified roll technique for stage 2 soft.
Esthetic considerations for the interdental papilla. Surgical reconstruction of interdental papilla with buccal and palatal thickness flap and a connective tissue graft has also been presented7. Coadaptation of the doublepapillae flap in relation to 31. The paper presented various surgical and nonsurgical approaches to restore the same. Comparison of longterm papilla healing following sulcular full thickness flap and papilla base flap in endodontic surgery. Esthetic or cosmetic dentistry strives to merge function. The medial extensions of both the semilunar incisions excised only the base of the frenal attachment, preserving the continuity of the flap.
Pdf a modified papilla preservation technique, 22 years later. The recipient site of the interdental space where the papilla is to be created provides a small surface area for either free grafting or pedicle grafting in terms of blood supply for the donor tissue. Does the papilla preservation flap technique induce soft tissue modifications. The patient was followed 6 weeks for postoperative care. The later technique may be associated with faster recovery of the gingival blood flow postoperatively. Guided tissue regeneration and papilla preservation with.
The aim of this article was to describe an abrams techniques modification. Palacci flap closure to preserve the papilla osseonews. Simplified papilla preservation technique dentistry. Conventional and modified papilla preservation flap ppf. The preserved papilla can be incorporated into the facial or the lingual palatal lap b, the reflected flap exposes the underlying bone. A modified papilla preservation technique, 22 years later article pdf available in quintessence international berlin, germany. Papilla preservation flap surgery was the ideal choice in relation to the two central incisor teeth, as these teeth presented wide interdental spacing with a broad interproximal d semilunar. In part 1 of this surgical instructional video series, dr. Modifications in the conventional papilla preservation flap technique can be appropriately used with coronally displaced flap along with bone graft and barrier membrane. The clinical predictability of this procedure is fairly. Jan 29, 20 modified papilla preservation technique can be used in singlerooted teeth and lower molars without neighboring tooth 24.
Esthetic root coverage with double papillary subepithelial. The objective of free gingival graft procedure is to prevent future recession by increasing the width of keratinized gingiva rather than covering the root surface. Several os seous defects are seen c, the flap returned to its original position covering the entire interdental spaces. The purpose of this case report is to describe the efficacy of a modified whales tail technique to achieve primary closure and thereby aid in regeneration of an interdental osseous defect between maxillary central incisors complicated by an aberrant frenal attachment. Wide intrabony defect treated with the modified papilla. Regarding the surgical technique, it has been proposed the simplified papilla preservation technique. A modification ofthe papilla preservation technique has been applied to achieve primary closure of. Conventional and modified papilla preservation flap ppf using. Pdf the effects of interimplant distances on papilla. Esthetic considerations for the interdental papilla this pdf is available for free download from a site hosted by medknow publications. The flap is designed with simplified papilla preservation 4746, modified papilla.