Laterally Positioned Flap VS Coronally Advanced Flap

Laterally Positioned Flap VS Coronally Advanced Flap

1. Laterally Positioned Flap VS Coronally Advanced Flap by Amir Salahuddin Periodontist and Oral Hygienist

2. Coronally Advanced Flap-Based Procedures

3. Historical Note Historical reports proposing the advancement of the gingival marginal tissue over an exposed root surface were published initially in 1907 (by Harlan) and 1912 (by Rosenthal) in the USA. However, Norberg may be considered as the first author to describe a clinically viable technique involving the use of the coronally advanced flap (CAF).

4. CAF modifications Increase of the keratinized tissue band with a free gingival graft (FGG) before the surgery of coronal flap advancement. Tarnow described a new flap design, the semilunar coronally advanced flap, to be used in areas presenting a band of keratinized tissue. Zucchelli and de Sanctis proposed the use of a horizontal incision and a split-full-split approach to create an “envelope flap” with no releasing incisions in order to preserve the maximum soft tissue thickness above the root exposure.

5. Type of Defect to Be Indicated Treatment of localized or multiple Class I GR presenting a width of attached keratinized tissue (KT) of at least 2 mm and thick periodontal biotype . Class III GR may be benefited by this procedure also when adequate amount of keratinized tissue ( similar to Class I ) is present.

6. Basics of the Surgical Sequence

7. Implications for Practice and Clinical Decision-Making on Soft Tissue Coverage The use of CAF alone propitiates significant reductions in recession depth, as well as CAL gain for Miller Class I single or multiple defects at short term. CAF is less technically demanding, faster and less painful than connective graft-based procedures, and may be better indicated for less experienced clinicians. However, long-term maintenance of results seems to be directly linked to the type of periodontal biotype and tooth brushing habits.

8. CAF alone may be associated with a great amount of apical relapse of gingival margin position over time. In terms of mean root coverage and complete root coverage achieved, this technique is less effective than SCTG-based procedures or CAF plus biomaterials (i.e. enamel matrix derivative, acellular dermal matrix grafts or xenograft matrix grafts). Thus, the use of coronally advanced flap alone is better suitable for the treatment of localized or multiple recession-type defects when SCTG or the above- mentioned biomaterials could not be used.

9. Laterally Positioned Flap-Based Procedures

10. Historical Note Described in 1956 by Grupe and Warren. This technique was based on the preparation of a full-thickness pedicle flap using the soft tissue (gingiva and mucosa) of a tooth adjacent to the gingival recession and its positioning/rotation over the exposed root surface in order to cover it. later, modifications to the original technique (including papillary tissue-based procedures) were proposed to reduce the adverse effects related to the donor sites, as well as to improve the coverage of the recipient site.

11. Between 1964 and 1968, several groups of clinicians/ researchers proposed some changes The use of edentulous ridges adjacent to the recipient site as donor bed. the use of a partial-thickness flap created by sharp dissection to maintain the donor bed covered by periosteum.

12. Type of Defect to Be Indicated Treatment of localized Class I or II GR (Class III may be benefited by this procedure) adjacent to the donor teeth presenting a width of attached keratinized tissue (KT) of at least 2 mm and thick periodontal biotype .

13. Basics of the Surgical Sequence

14. Implications for Practice and Clinical Decision-Making on Soft Tissue Coverage The use of LPF may lead to significant reduction in recession depth and clinical attachment level gain for Miller Class I and II localized defects, as well as a great part of the root coverage achieved at short term may be maintained long term. Creeping attachment may occur in donor and recipient sites, but the amount of coronal displacement of the gingival tissue cannot be defined.

15. By requiring only one surgical site, its use is easier and less painful, and the chair time is smaller than SCTG, which, in practical terms, may be better indicated for less experienced clinicians. On the other hand, in terms of achieving complete root coverage, this technique is less effective than SCTG-based procedures, as well as its use is limited to localized areas, with an adjacent thick periodontal biotype. Consequently and despite their clinical advantages, the use of LPF is better suitable when SCTG could not be used

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