mucoperiosteal flaps with and without removal of pocket

7/31/2019 Mucoperiosteal Flaps With and Without Removal of Pocket

1/17

Billy A. Smith Journal of Periodontology, 1987


2/17

Introduction

Traditional suggested that in order to getreattachment pocket epithelium shouldbe eliminated.

Many studies have shown that pocketepithelium not always completelyremoved out.

Incomplete removal of pocket epitheliumhave shown good long-term clinicalresults can be achieved.


3/17

Introduction

Recent studies has shown bothcompletely removal and non-removalhave similar result in gaining attachment

and pocket reduction. This article evaluated the need to

eliminate pocket epithelium during

mucoperiosteal flap surgery in order toestablish and maintain health of theperiodontal status.


4/17

Materials and Methods

30 patients were included in this study 5 males and 8 females rank age 30-72 year

The rest is median age of 40 year

Total of 104 teeth constituted the finalsample.

The University of Michigan School ofDentistry who were diagnosed Moderate and advance periodontitis

Pocket at 2 bicuspids and molars on eitherMax or Man arch


5/17


After completion of hygienic phase, theneed for additional therapy was requiredfor continuation in the study.

Mucoperiosteal flaps aimed at

reattachment and readaptation wereindicated bilaterally as part of proposedtreatment plan.

Upon completion of hygienic phase and at

1 month and 3 months after surgery,following measurements and indices weretaken for GI; PD; Level of attachment; GR; FI and Mobility


6/17


Clinical attachment level; probing depthand GR were measure on 2 bicuspids and2 molars. MB; B; DB; ML and Lingual

All biometric measurements were taken atbaseline (immediately before surgery)

GR was taken

at pre-baseline Immediately after flaps were replaced and

sutured

1-3 months after surgery


7/17


Split mouth design was used in thisstudy

A reverse bevel incision as part of a

modified Widman flap Intracrevicular incision as part of a crevicular

mucoperiosteal flap

Toss of the coin method was used torandomized.


8/17

Reverse bevel

incision

Intracrevicularincision


9/17


All patients were seen at 1 and 3months post-surgery, and all clinicalmeasurements were done by the same

examiner. All data was calculated by using t-test

Baseline and 1 month post surgical

Baseline and 3 months post surgical


10/17

Results

MW flap reduced PD significantly at 1 and3 months regardless of initial depth.

Crevicular flap reduced significantly in

>4mm group only. There was no significant different of

interproximal attachment loss betweenboth techniques in 1 and 3 months.

There were significant loss of attachmentat 3months in both surgical technique. CFwas seen loss of attachment since 1month.


11/17

Results

There was no significant differentbetween this two surgical techniques.

There was no GR happened after

performing at the interproximal or buccaland lingual area. However, it occurred increvicular flap at 1 and 3 months.

There were no significant change inmobility or furcation involvementbetween the two surgical techniques.


12/17

Discussion

The surgery without removing pocketepithelium shown gain clinical attachmentand reduction in PD.

PI and GCF flow level did not shown anydifferent after MW and CF following withfrequently OHI and rubber cup prophylaxis.

During the study a low grade of gingival

score were observed, because of aprofessional oral dental cleaning and 2surgical procedures.


13/17

Discussion

MW surgical technique was shown pocketreduction over CF surgical technique.

An interproximal gain in clinical attachmentwas seen in both techniques, but not Buccal

and lingual site. Greater GR was performed in MW, because of

a reverse incision approach was used.

Possible explanation were Gingival shrinkage during healing

When epithelium was retained, the fibrin clot maynot have held the flap in the desired position, andapical displacement would have occurred.


14/17

Discussion

Kerry et. al cited there were no changein mobility after 3months MW or crevicalcurretage.

Many authors supported the lack ofremoval of the pocket epitheliumshowed in gaining clinical attachmentand PD reduction. Meanwhile, other

authors claimed that long junctionalepithelium would replace at that area inMW flap.


15/17

Discussion

Listgarten et. al cited that the bonding oflong juctional epithelium was weakerthan the true connective attachment.

Magnusson et.al suggested that longjunctional epithelium had ability toagainst plaque infection.

Beaumont et.al supported that longjuctional epithelium resistant toperiodontal disease in Beagle dog.


16/17

Clinical significance

CF advantages over MW Easy

Adequate maintenance

Less time consuming If connective tissue attachment is sought

using adjunctive therapeutic resourcesthen a reverse bevel incision is

indicated. This type of flap left theconnective tissue opened, so it enhancepotential of reattachment.


17/17

Conclusion

CF that retain pocket epithelium showed

Gain clinical attachment

Reduction of PD over MW flap.

It not imperative to remove pocketepithelium during flap operations foraccessibility and when aiming at

readaptation.

mucoperiosteal flaps with and without removal of pocket

Documents