The present clinical case shows that this technique may have good results on gingival recession after 3years of followup. To overcome this, a modification in apically repositioned flap was. Marf is an effective technique in increasing the width of the. Conventional flaps include the modified widman flap, the undisplaced flap, the apically displaced flap, and the flap for. Split thickness apically repositioned flap osseonews. Studies have shown that free gingival graft, apically positioned flap and collagen matrix graft can be. In addition, the modified apically repositioned flap can be considered in some instances.
Apically positioned flap and resective surgery part i. Patients were divided into three groups based on preoperative anatomical considerations. The distance from the tooth, buccally or lingually, is dependent on the pocket depth, and the beveled incision should. The apically repositioned flap in tooth exposure dental. Pdf the modified apically repositioned flap to increase. Modified apically repositioned flap in the treatment of. Flap techniques and flaps in the treatment of pocket therapy. A recent report described use of the modified, apically repositioned flap to increase the apicocoronal dimension of keratinized tissue over multiple adjacent teeth.
The apically repositioned flap is a predictable method of increasing the zone of attached gingiva. The described technique is a variation of the modified apically repositioned flap marf technique previously proposed. The flap technique for pocket therapy pocket dentistry. Attached gingiva is desirable for the maintenance of gingival health. 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. Apically positioned flap d4245 procedure is used to preserve keratinized gingiva in conjunction with osseous resection and second stage implant procedure. Dept of periodontics periodontal flaps presented by, shiji margaret d. Case 5 was also treated as part of the second stage surgery utilizing pedicle flap with a. It does not attempt to reduce the pocket depth, but it does eliminate the pocket. 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. The modified widman flap facilitates instrumentation for root therapy.
The purpose of this paper is to compare the results obtained with the free gingival graft and modified apically repositioned flap techniques in terms of patient morbidity and the volume of anesthetic solution administered during surgery. The modified apically repositioned flap marf technique is an effective procedure to increase the dimensions of attached gingiva in areas that present with some. Although many methods are used to increase the zone of attached gingiva, the modified apically repositioned flap marf technique. To calculate the area per recipient tooth, the mesiodistal dimension of the graft was divided by the. Gingivectomy surgery for correction of osseous deformities and osseous enhancement procedures closed procedures. Vascularized buccal inversion flap journal of oral. The modified apically repositioned flap to increase the dimensions of attached gingiva. Modified technique for the sliding flap operation grupe.
Clinical techniques straight forward straight wire. The modified apically repositioned flap marf technique uses a single horizontal incision within the keratinized tissue. Clinical evaluation of increase in the width of attached gingiva using. Clinical image prior to crown lengthening for preparation for restoration fig.
An fgg is adapted to the periosteal bed apically to widen the residual keratinized gingiva around the recession defects after an incision is placed at the mgj. The conventional flap is used 1 when the interdental spaces are too narrow, thereby precluding the possibility of preserving the papilla, and 2 when the flap is to be displaced. Modified apically repositioned flap in the treatment of unerupted maxillary central incisors article pdf available in dental update 273. It also shows the final healing creating attached gingiva using a split thikness apically repositioned flap dr hl gluckman on vimeo. Increasing the width of attached gingiva by using modified apically. The young patient had only 1 mm of keratinized gingiva in correspondence of the recession so that a modified apically repositioned flap was performed with free gingival graft sutured apically to inferior incisal teeth.
Clinical dental advantages of the apically positioned flap. The single incision technique for multiple adjacent teeth. The apically positioned flap is a commonly used surgical approach, and is important for maintaining an adequate zone of keratinized tissue. 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 technique around implants. Start studying apically positioned flap and resective surgery part i week 5.
The aim of this paper is to discuss the various surgical methods of. It has been shown experimentally in animals11 and humans that with a close adaptation of gingival tissues to the tooth surface. The marf technique uses one single horizontal incision within keratinized tissue, elevation of a splitthickness flap, and suturing of. Pdf the apically repositioned flap in tooth exposure. 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.
Looking for online definition of apically repositioned flap in mucogingival surgery in the medical dictionary. 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. Various techniques to increase keratinized tissue for. 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. Flap techniques and flaps in the treatment of pocket therapy authorstream presentation. The described technique is a variation of the apically repositioned flap technique previously proposed by freidman in 1962. Adam bear discusses the advantages this procedure has for surgical crownlengthening procedures. This conventional apically repositioned flap method has been modified by carnio in 1996, where the existing keratinized tissue is retained as a marginal collar, referred to as modified apically repositioned flap. Stagetwo surgery was performed using wither the apically repositioned flap, the roll flap, or an apically repositioned flap combined with a connective tissue graft. To overcome these disadvantages, carnio and miller in 1999 described the modified apically repositioned flap marf technique for increasing the width of.
This technique is important for maintaining an adequate zone of keratinized tissue, as opposed to the gingivectomy technique, where soft tissue is resected. Conventional versus modified technique of the apically. The modified apically repositioned flap marf technique is an effective procedure to increase the dimensions of attached gingiva in areas that present with. Socket bone graft implant placement with bone graft mandibular premolar. Most of the crestal tissue, however, would be discarded or apically repositioned by traditional methods.
Procedure may also be used to preserve keratinizedattached gingiva during surgical exposure of labially impacted teeth, and may be used during treatment of periimplantitis. A new approach for increasing the width of attached gingiva by. The modified apically repositioned flap technique and its potential. Download pdf apically positioned flap, free gingival graft and apically positioned flap with collagen matrix around dental implants. Pdf use of the modified apically repositioned flap. 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. Free gingival graft versus modified apically repositioned flap. Surgical management of gingival recession using autogenous. A new approach for increasing the width of attached. Miller, increasing the amount of attached gingiva using a modified apically repositioned flap, journal of periodontology, 70, 9, 11101117, 1999. The three different categories of flap techniques used in periodontal flap surgery are as follows. Pdf modified apically repositioned flap in the treatment. Modified apically repositioned ap guar d et al 25 3 v 3 1 w 3, 1 x v w z 1 j d o r case report modified apically repositioned flap.
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. Use of the modified apically repositioned flap technique to create attached gingiva in areas of no keratinized tissue. How to take a wax bite for a twin block pdf 777 kib. In 1979, carranza classified flap as full thickness flap and partial thickness flap.
Widening keratinized tissue using modified free gingival. The main goals of the procedure include optimum mechanical sub gingival root. Journal of pierre fauchard academy india section vol. What is apically repositioned flap in mucogingival surgery. Use of the modified apically repositioned flap technique to create. The modified apically repositioned flap to increase the. These procedures aim to facilitate the eruption of the impacted tooth with a minimum of disruption or damage to the tooth itself or adjacent structures. The apically repositioned flap in tooth exposure helen lawton and p. Pdf the modified apically repositioned flap to increase the. 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 main distinguishable feature of this approach from the classical apically repositioned flapfgg technique is the preservation of preexisting keratinized gingiva. This case series describes a modified technique for increasing the width of the attached gingiva ag. To apply esthetic value to teeth having narrow interproximal zone, cortellini et al in 1999 proposed the. To gain access to the deeper periodontal structures using a flap reflected from the root and alveolar surfaces. A new approach for increasing the width of attached gingiva by modified apically repositioned flap jafri z, saimbi c. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
Post crown lengthening image after temporization 2. The exposed periosteal area between the initial horizontal incision and coronal border of the apical repositioned flap was measured in height apicocoronal and length mesiodistal figures 2a through 2d. This video shows you how to create attached gingiva in the upper jaw by creating a split thickness flap and apically repositioning it. Case report a 12yearold girl was referred by her general dental practitioner to the department of orthodontics at the. The modified apically repositioned flap technique and its. A novel technique for increasing the width of attached gingiva. Full thickness flap is surgical procedure of which all soft tissue and the periosteum are reflected.
Partial or split thickness flap is an elevated flap which includes only epithelium and the layer of underlying connective tissue. These procedures aim to facilitate the eruption of the. The apically positioned flap is a commonly used surgical approach to achieve pocket elimination. Apically repositioned flap in mucogingival surgery. Creating attached gingiva using a split thikness apically. The modified apically repositioned flap technique and its potential to regain gingival melanin pigmentation. 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. An apically repositioned graft would not allow for primary closure of the flap around the healing abutment, which presents a compromise in. Simple flap procedures include the simple apically repositioned flap and the modified widman reverse bevel flap. Methods of exposing impacted teeth in order to bring them into the line of the arch include gingivectomy, the apically repositioned flap and closed eruption techniques.
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