Journal of Dental Implants
   About JDI | Search | Ahead of print | Current Issue | Archives | Instructions | SubscribeLogin 
Users Online: 807  Wide layoutNarrow layoutFull screen layout Home Print this page  Email this page Small font size Default font size Increase font size


 
 
Table of Contents
TECHNICAL NOTE
Year : 2015  |  Volume : 5  |  Issue : 1  |  Page : 62-63

Bone suture: Useful aid in apical repositioning full thickness mucoperiosteal flap during dental implant surgery, Technical Note


1 Associate Professor of Oral and Maxillofacial Surgery, Oral and Maxillofacial Diseases Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
2 Assistant Professor of Oral and Maxillofacial Pathology, Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran

Date of Web Publication2-Apr-2015

Correspondence Address:
Saeedeh Khajehahmadi
Dental Research Center, Mashhad University of Medical Sciences, Vakilabad Blvd, Mashhad
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-6781.154445

Rights and Permissions
   Abstract 

Increasing attached gingiva around dental implants has beneficial effects in maintaining health and esthetic around the implants. Palatal incision, partial thickness flap and finally apical repositioning the elevated flap is the solution. In the case that the reflected flap is full thickness, such as the need for osteoplasty in the buccal bone or removal of internal fixative devices (screws or miniplate) then preventing the coronal movement of the flap is difficult. Bone suture that is creating a hole in the bone for fixing soft tissue to it is beneficial.

Keywords: Apical repositioning flap, bone suture, dental implant


How to cite this article:
Rahpeyma A, Khajehahmadi S. Bone suture: Useful aid in apical repositioning full thickness mucoperiosteal flap during dental implant surgery, Technical Note. J Dent Implant 2015;5:62-3

How to cite this URL:
Rahpeyma A, Khajehahmadi S. Bone suture: Useful aid in apical repositioning full thickness mucoperiosteal flap during dental implant surgery, Technical Note. J Dent Implant [serial online] 2015 [cited 2019 Jun 26];5:62-3. Available from: http://www.jdionline.org/text.asp?2015/5/1/62/154445


   Introduction Top


Increasing attached gingiva around dental implants has beneficial effects in maintaining health and esthetic around the implants. [1] Palatal incision, partial thickness flap and finally apical repositioning the elevated flap is the solution. [2] In the case that the reflected flap is a full thickness, then preventing the coronal movement of the flap is difficult. Bone suture that is creating a hole in the bone for fixing soft tissue to it, is beneficial.

Patient and surgical technique

The patient was 22-year-old male patient with lost four teeth in the right maxillary quadrant, including the right anterior teeth and first premolar.

Remaining bone was insufficient in the width and length for implant insertion. The problem of the width had been managed with lateral onlay bone graft from the anterior iliac crest by the other surgeon, and he was attended for implant insertion. The attached gingiva in buccal aspect of the edentulous ridge was minimal and hence palatal full thickness incision 3 mm palatal to the ridge crest and two vertical releases in buccal soft tissue exposed the augmented bone. Two mini screws that were used for graft fixation were removed and then dental implants were inserted in predetermined sites according to the surgical stent fabricated by prosthodontist.

At the end of operation, from the hole remained after removal of miniscrew and with the aid of round bur in straight handpiece, a through and through bone hole was created, and then the flap was apical repositioned and sutured to the bone. Vascularized interpositional periosteal connective tissue flap from palatal submucosa was used to cover denuded bone at ridge crest in between the inserted implants [Figure 1].
Figure 1: Through and through bone hole for repositioning the flap apically. Vascularized interpositional periosteal connective tissue flap (*) is used to cover the exposed bone between the implants

Click here to view



   Discussion Top


Apical repositioned flap for increasing attached gingiva around the dental implant is a known technique. [3] Supraperiosteal dissection and periosteal sutures are necessary for maintaining the apical position of the flap. [4] When there is a need for osteoplasty in the buccal bone or removal of internal fixative devices (screws or miniplate) then full thickness mucoperiosteal reflection of soft tissue is necessary. Bone suture is a useful aid in this topic. In dentate patients with root proximity, this technique is not applicable because of probable root damage except in cases with large diastema.


   Conclusion Top


Bone suture is a useful aid to overcome the problem of coronal movement after apical repositioning full thickness mucoperiosteal gingival flaps in edentulous ridges.

 
   References Top

1.
Goldberg PV, Higginbottom FL, Wilson TG. Periodontal considerations in restorative and implant therapy. Periodontol 2000 2001;25:100-9.  Back to cited text no. 1
    
2.
Carnio J, Camargo PM. The modified apically repositioned flap to increase the dimensions of attached gingiva: The single incision technique for multiple adjacent teeth. Int J Periodontics Restorative Dent 2006;26:265-9.  Back to cited text no. 2
    
3.
Basegmez C, Ersanli S, Demirel K, Bölükbasi N, Yalcin S. The comparison of two techniques to increase the amount of peri-implant attached mucosa: Free gingival grafts versus vestibuloplasty. One-year results from a randomised controlled trial. Eur J Oral Implantol 2012;5:139-45.  Back to cited text no. 3
    
4.
Carnio J, Camargo PM, Passanezi E. Increasing the apico-coronal dimension of attached gingiva using the modified apically repositioned flap technique: A case series with a 6-month follow-up. J Periodontol 2007;78:1825-30.  Back to cited text no. 4
    


    Figures

  [Figure 1]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Discussion
   Conclusion
    References
    Article Figures

 Article Access Statistics
    Viewed3905    
    Printed49    
    Emailed0    
    PDF Downloaded243    
    Comments [Add]    

Recommend this journal