Mucogingival Esthetic Surgery Zucchelli Free 41 Fix
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In this first part of the trilogy, Prof. Zucchelli shares his expertise on the topic of mucogingival esthetic surgery, highlighting his successful approach with autologous connective tissue. In addition, he illustrates the extremely effective use and application of mucoderm and the long-term outcome in multiple recession coverage.
Currently, the leading theme in mucogingival surgery is the correction of gingival recession defects. Free gingival graft (FGG) has been successfully in use in this category of reconstructive therapeutic modality.
Objective: This study aims to reveal the effects of cyanoacrylate application at the recipient bed and the donor site in free gingival graft surgery on graft dimensions, clinical healing parameters and patient-based outcomes. Methods: Free gingival graft operations were conducted on individuals who were randomly assigned to control or test groups. In the test group, the graft was stabilized and the donor site was coated with cyanoacrylate. In the control group, 6/0 polyvinylidene fluoride sutures were used for stabilization, while the donor site was left untreated. Variables including re-epithelization, post-operative complications, pain, bleeding and quality of life at recipient site, and color match, graft dimensions at donor site were assessed for up to 6 months. Results: Twenty-three individuals completed the study. No differences were observed in any variable between groups except horizontal dimension loss of the graft, which was more abundant in the cyanoacrylate group at six months (p>0.05, p
In order to treat these challenging Miller class III [4] or RT2 [5] recessions, several mucogingival approaches have been proposed such as tunnel techniques, coronally advanced flaps, free gingival grafts, rotated techniques and two-stage procedures. These techniques have been developed along the twentieth century (pre-twenty-first century techniques) and the twenty-first century as well. Although modern modifications of classical techniques have been proposed in this century, aiming to increase the blood supply in the recipient area, there is no evidence about their predictability.
On the other hand, there would also be patient-related factors, such as bad oral hygiene, poor general health or smoking, which have been associated with negative results when performing any periodontal surgery [54, 77]. Therefore, the same might be expected for mucogingival surgery, but to our knowledge, there is no clinical study that has assessed the influence of delayed healing associated with certain determined systemic diseases on root coverage. In fact, the majority of patients in these studies usually showed good oral hygiene and general health, and were non-smokers, so these results should initially be extrapolated only to this kind of patients. Furthermore, while the analysis at the patient level may be more clinically relevant as it might allow assessing the results on each surgery [6], it would also be interesting to analyze results at recession level in order to know the amount of coverage can be achieved with each technique and to enable comparison between studies.
Blanco-Carrion, J., LiƱares-Gonzalez, A., Betalla-Vazquez, P., & Diz-Dios, P. (2004). Morbidity and economic complications following mucogingival surgery in a hemophiliac HIV-infected patient: A case report. Journal of Periodontology, 75(10), 1413-1416.
Caffesse, R. G., De La Rosa, R. M., De La Rosa, G. M., & Weltman, R. (2002). Effect of interleukin-1 gene polymorphism in a periodontally healthy Hispanic population treated with mucogingival surgery. Journal of Clinical Periodontology, 29(2), 177-181.
De Campos, G. V., Bittencourt, S., Sallum, A. W., Nociti Junior, F. H., Sallum, E. A., & Casati, M. Z. (2006). Achieving primary closure and enhancing aesthetics with periodontal microsurgery. Practical Procedures & Aesthetic Dentistry: Ppad, 18(7), 449-454.
Francetti, L., Del Fabbro, M., Testori, T., & Weinstein, R. L. (2004). Periodontal microsurgery: Report of 16 cases consecutively treated by the free rotated papilla autograft technique combined with the coronally advanced flap. International Journal of Periodontics & Restorative Dentistry, 24(3), 272-279.
Duval, B. T., Maynard, J. G., Gunsolley, J. C., & Waldrop, T. C. (2000). Treatment of human mucogingival defects utilizing a bioabsorbable membrane with and without a demineralized freeze-dried bone allograft. Journal of Periodontology, 71(11), 1687-1692.
Pini Prato, G., Clauser, C., Cortellini, P., Tinti, C., Vincenzi, G., & Pagliaro, U. (1996). Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal recessions. A 4-year follow-up study. Journal of Periodontology, 67(11), 1216-1223.
Prato, G. P., Clauser, C., Cortellini, P., Tinti, C., Vincenzi, G., & Pagliaro, U. (1996). Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal recessions. A 4-year follow-up study. Journal of Periodontology, 67(11), 1216-1223.
Within the scope of modern periodontal therapy, pocket elimination can still make sense in areas outside the esthetic zone if periodontal regeneration is not possible. Classical interventions like tunneling procedures, root amputation or hemisection have not died out but are still used to treat furcation-involved molars. In fact, not that it is becoming more and more evident that patients with a history of periodontitis have an increased risk of developing peri-implant diseases, these techniques are undergoing a renaissance and are more current than ever. Last but not least: up to date restorative dentistry would not be imaginable without resective periodontal surgery in situations where subgingival restoration margins cannot be managed by other methods. Fortunately, the radical approaches used in the 1960s and 1970s do not have much in common with the state-of-the art techniques performed today.
In this book, the authors provide the first comprehensive overview of the basic principles, indications and clinical techniques of plastic-esthetic periodontal and implant microsurgery.
Negri, B., Zuhr, O., Fickl, S., Ciurana, X. R., Navarro Martinez, J. M., & Blanco, V. M. (2016). Socket seal surgery: Clinical uses in implant dentistry and guided bone regeneration procedures for single tooth replacement in the esthetic zone. Quintessence Int, 47(2), 123-139. Retrieved from doi:10.3290/j.qi.a34455
Layout table for study information Study Type : Interventional (Clinical Trial) ActualEnrollment : 30 participants Allocation: Randomized Intervention Model: Parallel Assignment Masking: Double (Participant, Outcomes Assessor) Primary Purpose: Treatment Official Title: Treatment of Localized Gingival Recession Defects at Lower Mandibular Incisors Using a Modified-free Gingival Graft: a Randomized Clinical Trial Actual Study Start Date : March 10, 2021 Actual Primary Completion Date : May 5, 2022 Actual Study Completion Date : May 5, 2022 Arms and Interventions Go to Top of Page Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information Arm Intervention/treatment Active Comparator: Free Gingival GraftA mucogingival surgery where a gingival graft harvested from the palate is placed on a conventionally prepared recipient site and sutured to cover the mucosal recession Procedure: Mucogingival surgeryThe gingival recession at mandibular incisor site will be covered by a gingival graft harvested from the palate. Experimental: Modified Free Gingival GraftA mucogingival surgery where a gingival graft harvested from the palate is placed on a modified recipient site and sutured to cover the mucosal recession Procedure: Mucogingival surgeryThe gingival recession at mandibular incisor site will be covered by a gingival graft harvested from the palate. Outcome Measures Go to Top of Page Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information Primary Outcome Measures : mean mid-facial recession coverage (mRC) [ Time Frame: up to 1 year ]mRC measured as a percentage Secondary Outcome Measures : Keratinized tissue (KT) gain [ Time Frame: 6 months and 1 year ]KT gain measured in mm Eligibility CriteriaGo to Top of Page Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies. Layout table for eligibility information Ages Eligible for Study: 18 Years to 50 Years (Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: 153554b96e
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