Shettyn department of periodontology, manipal college of dental sciences, manipal university, lhh road, mangalore 575001, india article info keywords. Modified papilla preservation technique can be used in singlerooted teeth and lower molars without neighboring tooth 24. The oblique rotational flap, the rotation flap and the transpositioned flap are modifications in incision design. Several os seous defects are seen c, the flap returned to its original position covering the entire interdental spaces. Due to the aggressiveness of the procedure bleeding is common. A case report pallavi samatha yalamanchili1, 2davanapelly pavithra, sushma. This is a double throw, followed by a locking stitch. The procedure was then modified and named as the laterally positioned flap.
Conventional and modified papilla flap preservation technique is used for wide interdental spaces in the anterior and premolar region and simplified papilla preservation flap surgery. Double pedicle flap predictability and aesthetics using. The doublepapilla flap can also be performed either as a full thickness flap or a split thickness flap depending on the thickness of the gingival tissues. Make a buttjoint incision at the base of the papilla at the site of the. Two basic flap designs, those with and those without vertical releasing incisions. The papilla base incision consisted of a shallow first incision at the base of the papilla and a sec. Guided tissue regeneration and papilla preservation with the wales tail flap. Double papilla flap is an alternative technique to cover isolated recessions and correct gingival defects in areas of insufficient attached gingiva, not suitable for a lateral sliding flap. Modified doublepapillae flap technique with subepithelial connective tissue graft for root coverage in the esthetic zone.
The double papilla flap procedure was first described by tackas 1995 24. Preservation of good blood supply to the flap is another important consideration. It was designed to achieve an adequate zone of attached keratinized gingiva andor coverage of a denuded root surface by joining two interdental papillae. A palacci papilla regenerating flap is used the flap is closed with atraumatic compression sutures.
The labial ridge had previously been regenerated using biooss. Atlas of cosmetic and reconstructive periodontal surgery. Double papilla flap technique for dual purpose kumar p m. Many variations of the grafting technique have been proposed for predictable root. May 11, 2014 nelson proposed a technique that combines a free connective tissue graft with a full thickness double papilla graft. Case report double papilla flap for root coverage a case report gayathri p e1, arunkumar. Esthetic root coverage with double papillary subepithelial. This case report demonstrates the use of a double papilla repositioned flap technique along with cgf, that achieved optimal results in treating an isolated millers class i gingival recession.
The double papillae repositioned flap in periodontal therapy. 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. I drank celery juice for 7 days and this is what happened no juicer required. Alternative techniques include those described by nelson 12 which involved the combination of a ct graft with a double papilla repositioned. B incise and elevate the modified laterally positioned flap.
Singapore dental journal vol 34, issue 1, pages 128. It is designed to achieve an adequate attached gingiva than can be gotten from the. Professor and chairman, department of periodontics, university of pennsylvania, school of dental medicine, philadelphia, pa. Present state of the interdental denudation procedure.
Jan 29, 20 modified papilla preservation technique can be used in singlerooted teeth and lower molars without neighboring tooth 24. Associate professor, clinical director department of periodontology and oral biology, boston university school of dental medicine, 100 east newton street, boston, ma 02118. Types of flaps used in placement of dental implants. Root coverage with a modified laterally positioned flap. The clinical predictability of this procedure is fairly. Armamentarium includes the basic surgical kit for the lateral sliding and obliquely rotated flaps. The preserved papilla can be incorporated into the facial or the lingual palatal lap b, the reflected flap exposes the underlying bone. They reported elevating a fullthickness flap one tooth away from the defect and rotating it to cover the recession. Pdf double papilla repositioned flap for the treatment. View enhanced pdf access article on wiley online library html view download pdf for offline viewing.
Double papilla flap was indicated in millers class ii recession with inadequate attached gingiva because of sufficient width and length of. Principles of flap design and closure 76 april 2016. Periodontics historical the double papillae repositioned flap in periodontal therapy. Oct 21, 2011 alternative techniques include those described by nelson 12 which involved the combination of a ct graft with a double papilla repositioned flap or a laterally repositioned pedicle flap and. Different flap procedures further modified this technique resulting in a high success. Double papilla repositioned flap for the treatment of isolated recession. B, connective tissue graft and doublepapilla flap sutured. Modified approach of double papillae laterally positioned flap technique using alloderm for root coverage. To apply esthetic value to teeth having narrow interproximal zone, cortellini et al in 1999 proposed the simplified papilla preservation flap. The papilla preservation flap incorporates the entire papilla in one of the flaps. Papilla preservation flap periodontal disease click to. Modified papilla preservation technique slideshare.
Efficacy of a new papilla generation technique in implant. Root coverage with laterally sliding flap case series. Read double pedicle flap predictability and aesthetics using connective tissue, periodontology 2000 on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Surgical periodontal flap with conventional incision will result in gingival recession and loss of interdental papillae after treatment. Double papilla repositioned flap for the treatment of isolated recession a. This was a modification of nelsons technique, which was originally described as the combination of the double papilla technique, lateral sliding flap, and connective tissue graft. The double papilla technique combines the esthetic results of pedicle graft with the predictability and usefulness of free gingival graft and is an effective and. Discipline of periodontics, bauru dental school, brazil. Double papilla flap is an alternative technique to cover.
Double laterally rotated bilayer flap, another modification of double papillae flap had also resulted in complete coverage of root. A2,saravanakumar r3 abstract gingival recession is defined as the displacement of the gingival margin apical to the cementoenamel junction cej. It is associated with sensitivity, tissue irritation, cervical abrasions, and esthetic concerns. Palacci flap closure to preserve the papilla osseonews. Proposed flap design for double papillary in relation to tooth number 32. In this technique, there is less chance of flap necrosis and suturing is easy because interdental papillae are thicker and wider than labial gingiva on single root.
Apr 01, 20 the procedure was then modified and named as the laterally positioned flap. Single versus double flap approach in periodontal regenerative treatment. 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. The papilla base flap, consisting of the papilla base incision and two releasing incisions, was used to expose the bone. Double papilla repositioned flap for the treatment of. Root coverage using double papilla preservation flap. Modified approach of double papillae laterally positioned. 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. The advantages of laterally repositioned over other procedures are the presence of its own blood supply after the transfer of the graft and a high survival rate. Root coverage using double papilla repositioned flap with. Case report double papilla flap for root coverage a. When the lateral movement is both mesial and distal to the defect, the flap is called a double papilla flap.
Double papilla flap technique for root coverage can be achieved with less tension to the pedicle flap and this technique can be used when sufficient width and length of the interdental papilla on both sides of the area of gingival recession are present. Papilla preservation flap as aesthetic consideration in periodontal flap surgery flap surgery is treatment for periodontal disease with alveolar bone destruction. Pdf double papilla repositioned flap for the treatment of. This type of flap design is used to preserve both mesial and distal papilla, both these are preserved even in the punch type flap as well but this is given in 2stage placement approach where uncovering of good amount of tissue is mobilized towards the buccal aspect. Double papilla flap technique for dual purpose kumar p m, reddy. Sctg on lower anterior teeth for treatment of recession. In one of the study, lateral positioned flap showed results similar to that of connective tissue graft for recession coverage with regard to mean recession change lpf 2. Alloderm, cosmetic, double papilla flap, gingival recession. The double papillae repositioned flap in periodontal therapy d. Jul 19, 2016 this video, from cambridge academy of dental implantology, demonstrates implant placement utilizing a palacci flap closure to preserve the papilla. Double papillae laterally positioned flap technique has been considered to be a reliable and predictable method for treating localised gingival recession. Here the papillae are taken from both sides of the recession defect and repositioned over the exposed root surface. This video, from cambridge academy of dental implantology, demonstrates implant placement utilizing a palacci flap closure to preserve the papilla.
Doublepapilla flap, gingival recession, root coverage. Depending on how the interdental papilla is managed, flaps can either split the papilla conventional flap or preserve it papilla preservation. The double papillae repositioned flap in periodontal. Double papillae pedicle graft has shown excellent root coverage if the indications. A, before after unsuccessful priorfree gingival graft treatment. Pdf double papilla flap technique for dual purpose researchgate. Oct 28, 2009 i drank celery juice for 7 days and this is what happened no juicer required. The double papilla flap procedure was first described by tackas 1995. Modified doublepapillae flap technique with subepithelial. To apply esthetic value to teeth having narrow interproximal zone, cortellini et al in 1999 proposed the simplified papilla preservation flap technique8. The incision starts 2 mm below the zenith of the interproximal papilla and should cross the mucogingival junction in vertical and oblique directions to increase the flexibility. Papilla article about papilla by the free dictionary.
Double papilla repositioned flap for the treatment of isolated recession a case report article pdf available in singapore dental journal 341. C pedicle sutured andstabilized with cyanoacrylate. Multiple marginal tissue recession treated with a simplified. More demanding in narrow interproximal spaces necrosis7. Professor and chairman, department of periodontics, university of pennsylvania, school of. Preserving the ridge if ridge preservation is planned for the extraction socket, many. Among the pedicle grafts, the choice of using a double papilla repositioned flap is considered ideal when the tissue at the adjacent donor site is adequate. Root coverage is being achieved by a variety of techniques. Double papillary flap a treatment for gingival recession. Guided tissue regeneration and papilla preservation with. This case report presents the advantages of double papilla flap in enhancing esthetic and functional outcome of the patient. The use of wide papillae on either side of the defect, helps in precise flap approximation and dual blood supply. Papilla preservation flap surgery technique maintains esthetic value and a better approach edures. Papilla preservation flap as aesthetic consideration in.
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