Download pdf apically positioned flap, free gingival graft and apically positioned flap with collagen matrix around dental implants. The modified apically repositioned flap technique and its. Increasing the width of attached gingiva by using modified apically. Patients were divided into three groups based on preoperative anatomical considerations. Periodontal gum surgery for a patient whose gums had 57mm periodontal pocketing and bleeding upon probing. 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.
Bed preparation has been done simulationally for apically positioned flap at. Various techniques to increase keratinized tissue for. Modified coronally advanced flap technique, coverage of multiple. Split thickness apically repositioned flap osseonews. Additional reading attached gingiva and dental implants. Case 5 was also treated as part of the second stage surgery utilizing pedicle flap with a. 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. Pdf the modified apically repositioned flap to increase. More than adequate keratinized gingiva width labial or buccal incision mm from crest of gingiva. The single incision technique for multiple adjacent teeth. Levy et al 1 examined the effect of apically repositioned flap surgery on the composition of the subgingival microbiota as well as clinical parameters. However, in the opinion of other investigators 9,11, healing by second intention, where wound drainage is. Pdf the modified apically repositioned flap to increase the.
According to these authors, primary closure of the flap avoids suture dehiscence and improves wound healing. 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. 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. The modified apically repositioned flap to increase the dimensions of attached gingiva. Flap techniques and flaps in the treatment of pocket therapy.
Stagetwo surgery was performed using wither the apically repositioned flap, the roll flap, or an apically repositioned flap combined with a connective tissue graft. 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. According to the results of this study, apical debris extrusion occurred independent of the type of instrument used. 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. An external file that holds a picture, illustration, etc. It also shows the final healing of the soft tissue.
Apically repositioned flap in mucogingival surgery. Clinical image prior to crown lengthening for preparation for restoration fig. 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. 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. The distance from the tooth, buccally or lingually, is dependent on the pocket depth, and the beveled incision should. Pdf increasing the amount of attached gingiva using a. 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. This article describes a surgical technique directed at increasing the dimensions of attached gingiva over multiple adjacent teeth. Split thickness apically repositioned flap last updated august 15, 2016 7 comments video from dr.
Conventional versus modified technique of the apically repositioned. 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. Patient preparation reevaluation after initial treatment. A surgical approach to enhance donor sites prior to employing a laterally positioned flap. Apically definition of apically by medical dictionary. 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. Apically extruded debris with reciprocating singlefile. Apically repositioned flap periodontal gum surgery nyc. In 1962, friedman proposed the term apically repositioned flap. Periosteum is left exposed in the area between the initial horizontal incision and the coronal margin of the flap. This conventional apically repositioned flap method has been modified by. Before and after photos on apically repositioned flap periodontal gum surgery performed in our gum disease treatment office. Post crown lengthening image after temporization 2.
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. Surgical management of gingival recession using autogenous soft. Ramfjord and nissle 1974 described the modified widman technique, which is. Pdf apically positioned flap, free gingival graft and. The apically positioned flap is a commonly used surgical approach to achieve pocket elimination. The apically positioned flap and crown lengthening.
This video shows you how to create attached gingiva in the upper jaw by creating a split thickness flap and apically repositioning it. Creating attached gingiva using a split thikness apically. Conventional versus modified technique of the apically. However, to do so, the attached gingiva must be totally separated. Modified apically repositioned flap in the treatment of unerupted maxillary central incisors article pdf available in dental update 273. 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. 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. It is suitable for tooth exposure in both children and adults and will help to minimize potential problems.
The apically repositioned flap is a predictable method of increasing the zone of attached gingiva. 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. Flap surgical technique for pocket elimination apically displaced flap md. The undisplaced flap periodontal disease click to cure. The described technique is a variation of the modified apically repositioned flap marf technique previously proposed. The effect of apically repositioned flap surgery on. Pdf modified apically repositioned flap in the treatment. Coronally advanced flap and connective tissue graft. Adequate keratinized gingiva crestal incision used. 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. 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. Flap repositioning versus conventional suturing in third. The modified apically repositioned flap marf technique has been previously published as a successful method to increase the zone of attached gingiva with. This technique is important for maintaining an adequate zone of keratinized tissue, as opposed to the gingivectomy technique, where soft tissue is resected.
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. 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. 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. Clinical dental advantages of the apically positioned flap. Use of the modified apically repositioned flap technique to create attached gingiva in areas of no keratinized tissue. Layer to layer technique applied for contour augmentation on posterior buccal site. Both fullthickness and partialthickness flaps can also be displaced. Apically repositioned flaps may be preferred due to its advantages. Situated nearer to the apex of a structure in relation to a specific reference point. Enhancing the zone of keratinized tissue around implants. Objective to gain access to the deeper periodontal structures using a flap reflected from the root and alveolar surfaces.
Apically positioned flap with immediate implantation youtube. It also shows the final healing creating attached gingiva using a split thikness apically repositioned flap dr hl gluckman on vimeo. Simple flap procedures include the simple apically repositioned flap and the modified widman reverse bevel flap. Apically repositioned flap technique around implants. From history of various periodontal flap surgical techniques to incision and suturing. Define apically repositioned flap in mucogingival surgery. Previous studies have indicated that gingivectomy can lead to a severe loss of gingiva, as can apically repositioned. 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.
A wide variety of flap file options are available to you, such as folder, bag, and wallet. Associate professor of periodontology and oral pathology, school of dentistry, university of southern california, beverly hills, california. The aim may be to cover exposed root surfaces or merely to. The apically positioned flap is a commonly used surgical approach, and is important for maintaining an adequate zone of keratinized tissue. 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 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. Relating to the apex or tip of a pyramidal or pointed structure. Flap apically positioned to the crest of the bone 70. 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. Dept of periodontics periodontal flaps presented by, shiji margaret d. Apically repositioned flap in combination with a free gingival graft for. The shortterm followup of the marf technique demonstrated an increase in keratinized tissue and attached gingiva. Flap apically positioned to cover 12mm of cementum class ii.
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