Periodontal Plastic Surgical Procedures Research Articles

Evaluation of Post-Operative Morbidity and Palatal Wound Healing after Implant Uncovering Surgical Procedure Performed with Apically Positioned Flap (APF) and Leukocyte and Platelet-Rich-Fibrin (L-PRF): An Original Technique.

Background and Objectives: Dental implants are recognized as an effective treatment in the management of edentulous patients; controversies surround the connection between the sufficiency of keratinized gingiva (KG) and peri-implant health. Maintaining an ample amount of peri-implant KG is crucial for minimizing gingival inflammation, highlighting the need for regular consideration of soft-tissue augmentation. Among the diverse periodontal plastic surgical procedures, the apically positioned flap (APF) is notable for its ability to enhance the width of keratinized tissue while minimizing patient morbidity. The aim of this study was to evaluate the effects of L-PRF on palatal wound healing and patient discomfort after surgery. Materials and Methods: Twenty patients with two adjacent submerged fixtures in the maxilla and buccal keratinized gingiva widths < 2 mm were treated with APF and L-PRF. Clinical evaluations were performed at 1, 2, 3, and 4 weeks post-surgery, focusing on parameters such as complete wound epithelialization (CWE), postoperative discomfort (D), changes in feeding habits (CFH), alteration of sensitivity (AS) around the wound area, and the consumption of analgesics. Results: Our data revealed CWE in 5 patients by the end of the second week, with the remaining 15 achieving CWE by the end of the third week. For D and CHF, a statistically significant improvement was recorded for all cases between the first and second weeks, as well as AS, although less substantial, by the third week. No significant changes were noted for AS over the initial two weeks. Conclusions: These findings suggest that L-PRF may enhance wound healing and decrease patient discomfort following APF for fixture uncovering.

Comparative evaluation of the efficacy of BlueM active oxygen gel and Coe-pak dressing on post-operative healing of gingival depigmentation: a study protocol

Introduction Dark colored gingiva is an esthetic concern that cannot be ignored, especially when accompanied by a high lip line or gummy smile. Gingival depigmentation is a periodontal plastic surgical procedure wherein the hyperpigmentation is removed or reduced by various techniques. Protecting the wound from mechanical trauma and stability of the surgical site during the healing process are among the most important advantages of periodontal dressing application after surgery. Aim This study is aimed to comparatively evaluate the effectiveness of reactive oxygen gel species (BlueM gel) and the traditional Coe-Pack dressing on gingival healing and pain after surgical depigmentation. Protocol This split-mouth randomized clinical trial will be conducted on 20 patients aged 18–45 years with maxillary physiologic gingival pigmentation classes (II) (III) and (IV) according to the Dummett–Gupta Oral Pigmentation Index (40 treated sites). The maxilla will be randomly divided into two symmetrical parts—from the right second premolar to the midline and from the midline to the left second premolar—to receive either BlueM gel or Coe- Pack as a dressing after surgical depigmentation with a scalpel. Various indices will be assessed, such as plaque index, papillary bleeding index, pain index, healing index and reepithelization index with toluidine blue, and the follow-up period will be one month. Expected results- A total of 20 patients will be included in this study. Statistically significant differences are expected to show in the pain index and healing index after one, two, three, four, and five days. The BlueM gel group is expected to show a higher significant difference after one, two, three and four weeks in the reepithelization index.

Awareness and Knowledge of Periodontal Plastic and Aesthetic Surgery amongst House Surgeons – An Online Survey

Abstract Aim: The survey aims to assess the degree of awareness and knowledge of periodontal plastic and aesthetic surgery amongst house surgeons. Materials and Methods: A questionnaire-based study was conducted to assess the degree of awareness and knowledge of periodontal plastic and aesthetic surgical procedures amongst 80 house surgeons in KMCT Dental College, Manassery, Kerala. A questionnaire containing 10 questions in English was prepared for data collection and distributed to 80 interns through Google form. Questions were formulated based on basic knowledge about mucogingival problems and their treatment modalities, understanding of various terminologies, indications for mucogingival procedures and awareness about prognosis and treatment outcome after mucogingival procedure. The possible options chosen by the participants were tabulated and the percentile for each question was represented using pie charts. Results: Amongst the 80 participants, around 80% of participants were having basic knowledge about mucogingival problems and their treatment modalities. About 48% of participants were aware of the indications of periodontal plastic and aesthetic surgical procedures and 85% of the participants knew about the prognosis and treatment outcome of these surgical procedures. Conclusion: Mucogingival procedures or periodontal plastic surgery involves the correction of soft-tissue defects involving the periodontium and frenum. The present study was able to assess the degree of knowledge of periodontal plastic surgical procedure amongst house surgeons. The awareness and knowledge of periodontal plastic and aesthetic surgery amongst house surgeons were good however it could be improved.

ESTHETIC MANAGEMENT OF GINGIVAL HYPERPIGMENTATION WITH ELECTROSURGERY TECHNIQUE: A CASE REPORT

The colour of gingiva is usually considered as “coral pink” which is determined by thickness and degree of keratinization, vascular supply, pigmentation like melanin, and various exogenous substances like tobacco, colouring agents in foods, etc. Gingival hyperpigmentation may be a pathological condition but it is usually a physiological condition that is a major esthetic problem for a patient with a high smile line. Gingival depigmentation is a periodontal plastic surgical procedure that reduces or eliminates the degree of pigmentation. Different treatment modalities for gingival depigmentation have been documented, such as scalpel, electrosurgery, diamond burs, chemical methods, cryosurgery, lasers, and micro-needling with ascorbic acid. This article reports the depigmentation procedure of hyperpigmented gingiva with electrocautery in 25 years old male patient.

A Comparative Clinical Evaluation of Surgical Blade Abrasion and Partial Thickness Flap as Treatment Modalities for Gingival Pigmentation.

Gingival hyperpigmentation is a major esthetic concern for many people, although it is not a medical problem, many people complain of dark gums as unesthetic. Gingival depigmentation is a periodontal plastic surgical procedure that removes or reduces hyperpigmented gingiva. Various methods like scalpel, free gingival autografts, electrosurgery, cryosurgery, and abrasion with diamond bur gingival hyperpigmentation is a major esthetic concern for many people, although it is not a medical problem, many people complain of dark gums as unesthetic. Gingival depigmentation is a periodontal plastic surgical procedure that removes or reduces hyperpigmented gingiva. Various methods like scalpels, free gingival autografts, electrosurgery, cryosurgery, abrasion with diamond bur, and various types of lasers have been used for cosmetic therapy of gingival melanin pigmentation. This article compare the efficacy of gingival melanin depigmentation done by excision with a surgical blade using scarping and partial thickness flap technique. and various types of lasers have been used for cosmetic therapy of gingival melanin pigmentation. This article compares the efficacy of gingival melanin depigmentation done by excision with a surgical blade using scarping and partial thickness flap technique.

A Novel Modification of Semilunar Coronally Advanced Flap for the Treatment of Gingival Recession: A Case Report

Recession of the gingival margin is still a common problem, with negative consequences for both aesthetics and periodontal health. Complete root coverage of gingival recession defects with periodontal plastic surgery is a necessity in this era where aesthetics are a top priority. Correction of mucogingival recession deformities has been described using a variety of periodontal plastic surgical procedures, each with varying degrees of success. The goal of this case report is to describe how a semilunar coronally advanced flap was modified to treat gingival recession in the maxillary anterior tooth.

SCALPEL VERSUS DIODE LASER FOR GINGIVAL DEPIGMENTATION: A CASE REPORT

Gingival hyperpigmentation is believed to be a genetic trait in populations and is more appropriately termed physiologic or racial gingival pigmentation a condition, which affects all races differently. Gingival depigmentation is most frequently performed as an esthetic periodontal plastic surgical procedure. There are various procedures like scalpel, laser. Cryosurgery, diamond burs and chemical methods have been used in this procedure. This case report compares the efficacy of two techniques. Maxillary anterior region was treated with scalpel technique and the mandibular anterior region was treated using Diode Laser. Both the treatment modalities were effective in terms of patient acceptance. Scalpel depigmentation resulted in uneventful healing of the treated site. Laser depigmentation showed some beneficial effects like bloodless field during surgical procedure which healed uneventfully. Patient discomfort was more in laser treated site during the initial healing period as compared to scalpel.

Histomorphometric Comparison between Two Types of Acellular Dermal Matrix Grafts: A Mini Pig Animal Model Study.

Acellular dermal matrix grafts (ADMG) have been used as soft tissue graft substitutes for autografts in periodontal plastic surgical procedures. They have benefits like avoiding a second surgical site and patient morbidity that have been associated with autografts, but there is limited evidence available on their tissue response and wound healing process. This histomorphometric animal model study was carried out in mini pigs and it aimed to compare the two types of ADMG materials of porcine derivative with a control group through observation of parameters like epithelial and Keratinized layer thickness, angiogenesis, cellularity, matrix resorption, and inflammatory infiltrate. The surgical technique involved punctures on the edentulous areas stripping the epithelial tissue and exposing the underlying connective tissue, placement of the ADMGs in the appropriate control and test sites. Following this, gingival biopsies were procured at three different time intervals of 15, 45, and 90 days. There were significant differences in epithelial and Keratinized layer thickness among the three groups. This study concluded that there was no clear consensus on which graft material was superior but it gave an insight into the tissue response and wound healing process associated with the graft materials.

Frenectomy with Lateral Pedicle Flap: A Novel Surgical Approach for Maintaining The width of Attached Gingiva: A Case Report

The aberrant frenum is usually managed by a common periodontal plastic surgical procedure called frenectomyto create a zone of attached gingiva. This surgical approach may often lead to loss of interdental papillacreating unacceptable esthetic results in the maxillary incisor region. Thus this case reported frenectomycombined with a laterally positioned flap which was a better approach to achieve primary closure. Andthe lateral pedicle sutured in midline provided better and faster healing with excellent esthetic results. Theesthetic results were far more superior then the classical frenectomy technique with a considerable gain inattached gingiva.

Recession coverage with coronally advanced flap along with PRF membrane- A case report

Gingival recession is a common pesky problem a?ecting almost all middle and older aged to some degree and in patients with good oral hygiene as well as in periodontally untreated populations with poor oral hygiene. Gingival recession has been associated with dentinal hypersensitivity, root caries and esthetic compromise. Various periodontal plastic surgical procedures are available including coronally advanced flap (CAF), each having advantages and disadvantages. To improve the clinical outcome of such surgical procedures, several regenerative materials have been combined with it. In this case report, we aimed the root coverage in Miller’s class II by means of coronally advanced flap technique along with PRF membrane. A platelet-rich ?brin (PRF) membrane is a readily available and inexpensive biomaterial that is bene?cial in periodontal plastic surgery procedures. Keywords:Gingival recession, Root coverage, Coronally advanced flap, Platelet-rich membrane

Gingival Depigmentation Techniques for Pink Aesthetics: Case Series

Introduction: Aesthetics has become a significant aspect of dentistry. Clinicians are facing challenges in achieving acceptable gingival aesthetics. The colour of the gingiva plays an important role in overall aesthetics. Melanin hyper-pigmented gingiva is a benign condition; however it is an aesthetic concern in individuals with high smile line and excessive gingival display. Gingival depigmentation is a periodontal plastic surgical procedure. The depigmentation procedure aims at removing or reducing this hyperpigmentation by various techniques. Aim: To discuss the different techniques for gingival depigmentation. Methodology: Individuals with melanin hyperpigmentation of gingiva were treated by different depigmentation techniques namely Scalpel technique (Conventional technique), Bur Abrasion, Diode Laser, Electrosurgery, Cryosurgery and injection of Vitamin C. All the individuals reported comparable post operative healing. Conclusion: Different gingival depigmentation techniques provide comparable postoperative healing resulting in an aesthetic smile.

The role of periodontal plastic surgery in the aesthetic management of localized gingival overgrowth

The localized gingival overgrowths are often a broad clinical expression of an inflammatory response that occurs against the long-standing irritation and/or chronic trauma in the affected gingival site. These reactive gingival overgrowths have a high inclination for the anterior maxillary region. Management of such a lesion is more challenging in the anterior region due to an unaesthetic outcome after surgical excision. Various surgical procedures have been applied for the management of post-excisional unaesthetic mucogingival complications. The free gingival graft (FGG) procedure is an excellent and predictable surgical approach in the root coverage aesthetic procedures. The aesthetic outcome can be enhanced if the periodontal plastic surgical procedure is combined with excisional procedures at the same visit. The purpose of the present case report is to discuss and management of peripheral ossifying fibroma (POF) by combining immediate excision and an FGG for coverage of gingival defect for the best functional and aesthetic outcome. Keywords: Aesthetic, Free gingival graft, Periodontal plastic surgery, Peripheral ossifying fibroma, Reactive gingival lesions.

An Integrated modified lip repositioning using bioresorbable collagen membrane: A long-lasting auxiliary treatment approach for gummy smile

Excessive gingival display is one of the major causes of patient embarrassment. An imbalance in the gingiva–tooth ratio results in the dominance of gingival appearance often referred to as “gummy smile.” A normal gingival display between the inferior border of the upper lip and the gingival margin of the central incisors during a normal smile is 1–2 mm. In contrast, an excessive gingivae-to-lip distance of 4 mm or more is classified as an unattractive. The objective of lip repositioning surgery is surgical correction of unesthetic gummy smile by limiting the retraction of the elevator smile muscles resulting in a narrow vestibule and restricted muscle pull, thereby reducing gingival display during smiling. This article presents a case of a gummy smile in which esthetic correction was achieved through periodontal plastic surgical procedure wherein 10–12 mm of partial-thickness flap was dissected apical to mucogingival junction sparing the midline maxillary labial frenum and placement of bioresorbable collagen membrane on excised area followed by approximation of flaps. This case with score 3 smile line was treated by lip repositioning technique with successful clinical outcome and enormous patient satisfaction. This technique holds importance as perioesthetics has become an integral part of periodontal treatment plan with the periodontist playing akey role to combat the patient's embarrassment.

Bone-enhanced periodontal plastic surgery: A case series

In recent years, esthetics has become apparently a crucial attribute in the periodontal treatment and is paving the way for newer modalities in the management of gingival recession. Gingival recession is one of the pivotal soft tissue problems that often constitute a challenge to a periodontist. The prognostic predictability in the management of gingival recession has been questionable when adequate bone support is not available. This case series propounds a technique that combines periodontal plastic surgery along with bone grafts, to give space for soft tissue coverage and adequate support. Case series brings a novel technique to the limelight, wherein bone substitutes are added to the conventional periodontal plastic surgical procedures, to enhance support for the soft tissue. Case series includes three patients with Millers Class II and Class III recession, involves a technique, which combines xenograft along with any one of the conventional plastic surgical procedures such as coronally advanced flap or pedicle flap. Pre- and post-operatively, clinical and radiographical parameters were evaluated. Satisfactory Clinical outcome was obtained when bone substitute were added to conventional periodontal plastic surgeries for root coverage and hence it prerequisites the need for long term evaluation.

The use of paquette blade handle in harvesting free gingival graft from the palate – a report of three cases with its method of use, advantages and disadvantages.

Free gingival grafting is a well-known periodontal plastic surgical procedure used for gingival augmentation, for root coverage procedures and in some cases of pre-prosthetic ridge augmentation. Several instruments have been used to harvest the graft from hard palate, ranging from scalpel to mucotome, each of which has its own advantages and disadvantages. One such instrument is Paquette blade handle, which incorporates a regular razor blade for graft harvesting. This article intends to describe in detail the handling of this instrument, its usefulness as well as limitations, as explained in the following three cases.

Inclusion of guided tissue regeneration membrane for the management of multiple gingival recession

Gingival recession (GR) is not only a major esthetic concern but also is often associated with dentinal hypersensitivity. Correction of mucogingival recession deformities with a variety of periodontal plastic surgical procedures has been described, each demonstrating a variable degree of success. However, among the various treatment modalities, coronally advanced flaps are the most commonly employed for multiple teeth recession coverage. This case report describes the management of Class I GR due to faulty brushing technique associated with dentinal hypersensitivity with coronally advanced flap combined with guided tissue regeneration membrane.

Evaluation of pain on use of electrosurgery and diode lasers in the management of gingival hyperpigmentation: A comparative study.

Background:Gingival depigmentation is a periodontal plastic surgical procedure whereby the gingival hyperpigmentation is removed by various techniques such as electrosurgery, cryosurgery, abrasion with diamond bur and lasers. The aim of this study was to determine the pain levels during the gingival depigmentation procedure using electrosurgery and lasers.Materials and Methods:Twenty patients, both male and female, between the ages of 20 and 40 years were randomly allocated into two groups of 10 patients each: Those undergoing depigmentation with electrosurgery (Group I) and those by diode lasers (Group II). Patients of both groups were asked to define the level of pain and discomfort by using the Visual Analog Scale (VAS) intraoperatively, 24 h post-operatively and 1 week post-operatively.Results:Both the groups showed a decrease in the pain levels, which was statistically highly significant 1 week post-operatively when compared 24 h post-operatively. There was a statistically highly significant difference in the pain levels between the electrosurgery and the lasers groups after 24 h (P < 0.001), with the lasers group demonstrating lesser pain and discomfort. Although there was no significant difference between the two groups intraoperatively and 1 week post-operatively on comparison, lesser mean scores were observed for the lasers group.Conclusion:The growing concern for esthetic requires the removal of hyperpigmentated gingival areas to create a confident and pleasant smile, which could be easily attained by using either electrosurgery or lasers. This study concluded that lasers produce lesser pain and discomfort compared with electrosurgery during gingival depigmentation.

Button anchored coronally advanced flap: Perio-ortho continuum

Periodontal plastic surgical procedures aimed at the coverage of exposed root surface have evolved into routine treatment modalities. Coronally advanced flap (CAF) was the most frequently used mucogingival procedure to achieve root coverage. Gingival recession resulting in root exposure is a common problem faced by clinicians. The continuous endeavor for innovation of newer interdisciplinary treatment modalities has resulted in the use of a passive object such as the orthodontic button being used to provide the initial stabilization in cases of root coverage using a CAF. The objective of this case report is to evaluate the effectiveness of a new treatment approach which consists of CAF procedure combined with orthodontic button application for the stabilization of flap for the treatment of Miller's Class I recession defects. After the application of orthodontic buttons in the middle third of the tooth surface, a split-full-split flap was raised for tooth number 43, and the flap was sutured 3-4 mm coronal to cementoenamel junction, and the central part of flap was suspended with sutures to the orthodontic button to maximize the stabilization of the immediate postoperative flap location. Clinical parameters such as probing depth and clinical attachment level were recorded at 1 month postoperatively. Complete root coverage was achieved when evaluated from baseline to 3 months along with gain in clinical attachment level and keratinized tissue. The final esthetics, both color match and tissue contours, were highly acceptable. One-month postoperative results showed that the CAF combined with the orthodontic button for stabilization is a very effective approach even in the treatment of Miller's Class I recession defects.

Fundamental principles in periodontal plastic surgery and mucosal augmentation – a narrative review

To provide a narrative review of the current literature elaborating on fundamental principles of periodontal plastic surgical procedures. Based on a presumptive outline of the narrative review, MESH terms have been used to search the relevant literature electronically in the PubMed and Cochrane Collaboration databases. If possible, systematic reviews were included. The review is divided into three phases associated with periodontal plastic surgery: a) pre-operative phase, b) surgical procedures and c) post-surgical care. The surgical procedures were discussed in the light of a) flap design and preparation, b) flap mobilization and c) flap adaptation and stabilization. Pre-operative paradigms include the optimal plaque control and smoking counselling. Fundamental principles in surgical procedures address basic knowledge in anatomy and vascularity, leading to novel appropriate flap designs with papilla preservation. Flap mobilization based on releasing incisions can be performed up to 5 mm. Flap adaptation and stabilization depend on appropriate wound bed characteristics, undisturbed blood clot formation, revascularization and wound stability through adequate suturing. Delicate tissue handling and tension free wound closure represent prerequisites for optimal healing outcomes.

Microsurgically assisted bilamminar free rotrated papilla autograft (FRPA) procedure for root coverage

When esthetic demands of the patient require accentuated precision in surgical technique, incorporation of advanced surgical aids in general clinical practice becomes a necessity. Periodontal plastic surgical procedures have been reviewed in the dental literature and assessed for their validity so as to provide the practitioner with the knowledge required in making patient-centered, evidence-based decisions with respect to the treatment of gingival recession. Connective tissue grafts is considered the gold standard for root coverage procedures due to statistically significantly superior results compared to other procedures. However, the coverage of multiple tooth recessions and patient morbidity due to the need of larger second surgical wound at the donor site in the gingival recession reduction are the major shortcomings. A case report of multiple roots recession treated using a modified connective tissue grafting procedure, the free rotated papilla autograft using periodontal microsurgery has been presented here. The advantages are the use of a single surgical site, avoiding any palatal patient discomfort, good color compatibility with adjacent tissue and healing by primary intension.