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Accueil

Congrs IAHD 2000

$istoire de la Soci't' Evolution of Organisation

Periodontal Surgery Techniques in this Century

Adh'sion SILVIO ANTONIO DOS SANTOS PE EI A, D.D.S., MSc.D. Nouvelles Assistant Professor, Periodontology Department, Fac lty of Dentistry, !ni"ersity Camilo Castelo #ranco, S$o Pa lo annuel ED!A Congr(s DO SA"A#C$!%&I , D.D.S., MSc.D., PH.D. Professor and C%airman, Periodontology Department, Fac lty of Dentistry, !ni"ersity Camilo Castelo #ranco, S$o Actes de la S&$AD

In t%e 'eginning of t%e cent ry, t%e s rgical treatment (as not attracti"e to clinicians, not (ell)accepte npredicta'ility of gooden res lts. Enseigne)ents histoire de In t%e l*odontologie 'eginning of t%e cent ry, (e also didn*t +no( m c% a'o t t%e etiologic agent of ,al"eolar pyorr%ea,.

Petite de and clinician 0o'icse+, (as t%e first to descri'e t%e radical tec%ni1 e of gingi"ectomy In -../, t%e histoire researc%er dentaire meas l*art red t%e poc+et dept% to determinate t%e line (%ere t%e gingi"al tiss e (o ld 'e e2cised. After t%is pro +,--#+,.incision on eac% toot%, %e incised t%e tiss e to 'e remo"ed on t%e la'ial and ling al s rfaces of t%e s rgical are interdental gingi"a (as e2cised and t%e remaining tiss e (as remo"ed (it% c rettes. 3%e remo"al of t%e $istoire du ca/inet of t%e dentaire s rgery. 3%e follo(ing s rgical p%ase consisted on remo"ing t%e 'one tiss e (it% s rgical drills. 3%e s r iodine dye and t%e patient instr cted to mo t%(as% (it% an antiseptic sol tion 4Stern I#5 6"erett F75 0o'icse+ Actes IA$D 0--s rgical treatment of periodontal disease. 9 Periodontol -:;<5 =;>2;<)2;.?.

According to Stern et al. 4-:;<?, S. 0o'icse+ %ad some remar+a'le insig%ts a'o t t%e periodontal disease tre infl enced t%e de"elopment of s rgical periodontal tec%ni1 es in t%e (orld. 3%e nat re of %is contri' tion is neit% as (e +no(, ' t rat%er t%e radical gingi"ectomy (%ic% is an e2cision of t%e gingi"a, e2posing t%e marginal and to remo"e gran lation tiss e and c%ange t%e s%ape of t%is 'one 'y a proper instr mentation 4Stern I#5 6"erett pioneer in t%e s rgical treatment of periodontal disease. 9 Periodontol -:;<5 =;>2;<)2;.?.

7@ADMAB 4-:<0? introd ced t%e concept on t%e de"elopment and importance of p%ysiologic conto rs of t%e tiss poc+ets, t%e control of gingi"al inflammation and t%e re)esta'lis%ment of p%ysiologic f nction of periodontal tiss t%e s ccess of periodontal treatment. So, t%e con1 est of an e2cellent 'acterial pla1 e mec%anic control perform rele"ant aspect for t%e maintenance of t%e o'tained res lts 47oldman HM 3%e de"elopment of p%ysiologic gingi"a S rg @ral Med @ral Pat%ol -:<05 =>.C:)...?.

3%e gingi"ectomy proced re as it is sed today (as descri'ed in -:<- 'y Henry M 7oldman. In gingi"ectomy te faces t%e toot% is e2cised do(n to t%e 'ase of t%e poc+et in order to incl de t%e D nctional epit%eli m, lea"ing pa t%e al"eolar crest.

In -:-;, Aeonard Eidman in t%e entitled monograp% ,3%e @perati"e 3reatment of Pyorr%ea Al"eolaris, (as one o in detail t%e se of flaps to eliminate periodontal poc+ets.

A m coperiosteal flap is lifted e2posing t%e in"ol"ed 'one and soft tiss e5 a complete remo"al of gran lation reac res%aping s%o ld 'e performed for t(o reasons> -? to eliminate of s%arp tips of 'one tiss e, and 2? to elimi displaced flap is first mentioned 46"erett F5 Eaer%a g 95 Eidman A Aeonard Eidman> s rgical treatment of p -:C-5 /2><C-)<C:?.

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Historically, osseo s s rgery (as performed for t%e primary p rpose of eliminating necrotic or infected 'one reconstr cti"e periodontal s rgery. 2ed Mal"ern> Aea Fe'iger, -::/, p.2<:?.

In -:=<, 8ronfeld, in t%e researc% ,Condition of t%e #one 3iss e of t%e Al"eolar Process 'elo( t%e Per scientifically, t%ro g% %istological st dies t%at t%e 'one tiss e of al"eolar process adDacent to t%e perio c%aracteristics of necrotic 'one 48ronfeld 0 9 Periodontol -:=<5 ;>22?.

HI0SCHF6AD 4-:<2? proposed t%e tec%ni1 e of s 'gingi"al c rettage in order to eliminate or to red ce poc+et d inflammatory process in t%e tiss es and s 'se1 ent %ealing. 3%e proced re (as e2ec ted nder local anest%esi order to remo"e t%e lcerated epit%eli m of t%e poc+et 4Hirsc%feld A S 'gingi"al c rettage in periodontal tre //>=0-)=-/?.

According to 0@#IBS@B 4-:;;?, t%e periodontal poc+ets adDacent to distal root s rfaces of t%e second and periodontal t%erapy of diffic lt sol tion and t%ey %a"e 'een denied fre1 ently for many periodontists. 3%e period of molars can 'e e2tremely deep d e to t%e anatomy of t%is area. E%en t%e poc+et 'ecomes deeper, t%at dept% t%e inaccessi'ility of t%e area leads to t%e ina'ility in t%e mec%anical control of 'acterial pla1 e e2ec ted 'y aspects, %e de"eloped t%e Distal Eedge proced re in order to treat periodontal poc+ets adDacent to t%e dis tec%ni1 e ses internal 'e"el incisions and it %as as o'Decti"es> to o'tain access to t%e 'one tiss e, to preser periodontal poc+ets, to red ce t%e %ealing period and to minimi&e t%e postoperati"e pain 40o'inson 06 3%e />2<;)2;/?.

0AMF9@0D5 BISSA6 4-:C/?, concerned a'o t 'one tiss e preser"ing, o'taining a perfect clos re of t%e flaps facilitating t%e oral %ygiene e2ec ted 'y t%e patient, t%ey modified t%e tec%ni1 e initially descri'ed 'y Eid conser"ati"e proced re. 3%e c%anges (ere> primer incision is an in"erse 'e"eled, partial)t%ic+ness, t%inning inci of t%e toot% and directed to(ard t%e crest of 'one, and intra)s lc lar 4secondary? incision (as performed aro nd t%e flaps t%e loosened collar of tiss e (as remo"ed at t%e al"eolar crest. 3%ese modifications try to maintain t%e aest%etics, g arantee t%e repairing t%ro g% long D ncional epit%eli m, 'esides facilitate t%e mec%anical control of patient 40amfDord SP5 Bissle 00 3%e modified Eidman operation. 9 Periodontol -:C/> /<>;0-);0C?.

According to 3A86I et al. 4-:.<?, t%e most common postoperati"e pro'lem associated (it% grafting proced

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In -:/:, SCHA!760 (as one of t%e first researc%ers t%at descri'ed t%e principles of resecti"e osseo s s rgery 'one (%ere it co ld 'e esta'lis%ed t%e p%ysiologic conto rs (it%o t attac%ment loss, elimination of interdental c t%e o'Decti"e of eliminating periodontal poc+ets and reac%ing a p%ysiologic gingi"al and osseo s arc%itect re afte A 'asic principle in periodontal s rgery. @ral S rg @ral Med @ral Pat%ol -:/:5 2>=-;)=2<?.

F0I6DMAB 4-:<<? introd ced t%e terms ,osteoplasty, and ,ostectomy,, designed to define t%e red ction and s pporting 'one, respecti"ely 4Friedman B @steoplasty and ostectomy. 9 Periodontol -:<<5 2;>2<C)2;:?.

For 7@ADMAB5 C@H6B 4-:<.?, a classification of 'one defects is necessary not only for academic p rposes ' t al of treatment met%ods. #ased on t%ese aspects, t%ey s ggested a classification of 'one defects 'ased on t% remaining 'one (alls. 3%ese can 'e classified in defects of t%ree, t(o or one 'one (alls and com'inations. 3%is esta'lis%ment of t%e periodontal t%erapy 47oldman HM, Co%en DE 3%e infra'ony poc+et> classification and 2:>2C2)2:-?.

In -:<., 7AIC8MAB (it% t%e o'Decti"e to facilitate and to select t%e proper treatment to 'e performed, propo pro'lems. In t%e %ori&ontal aspect, 1 alified it in> 7rade I ) incipient lesion5 7rade II ) partial destr ction of f rcation area5 7rade III ) total destr ction of t%e s pporting str ct res of t%e f rcation area, allo(ing t%e inserti t%e clinical e2pos re of t%e f rca5 7rade IF ) t%e same as 7rade III pl s t%e clinical e2pos re of t%e f rcation are la sal d y la enfermedad. 0econocimiento de la enfermedad periodontal en la prGctica de la odontologHa general. # enos Aires> M ndi -:;- p.<=2)</0?.

3%e e2istence of intra'ony defect cases (it% potential to 'e reconstit ted, stim lated t%e appearance and de" sed 'one grafts (it% ind ctor potential capa'le to stim late t%e osteogenesis, cementogenesis and format ligament. In -:;<, BA#60S5 @*A6A0I, de"eloped t%e tec%ni1 e of a togeno s 'one graft to treat t%ree (alls 'on are easy)o'tained, compati'le (it% t%e recei"ing tiss es and (it% ind cti"e perspecti"es 4Ba'ers CA5 @*leary 39 t%e treatment of osseo s defects. 9 Periodontol -:;<5 =;><)-/?.

6E6B 4-:;<? presented t%e 'one s(aging tec%ni1 e. It is necessary t%e e2istence of a prost%etic space adDacen 'one tiss e adDacent to t%e defect is mo"ed and pressed to(ards t%e root s rface (it%o t 'een fract red entire tec%ni1 e is indicated for t%e treatment of 'one saliencies, 'if rcations and 'one defects of t%ree (alls 46(en -:;<5 =;><C)=;?.

D e to t%e diffic lties (%en sing a togeno s 'one grafts in relation to t%e occ rrence of 'one se1 estrations ( sed and t%e diffic lty of o'taining 'one marro( and ade1 ate 1 antities of cancello s 'one intraorally, 0@# osseo s coag l m tec%ni1 e for 'one ind ction, sing small particles of cortical 'one (it% some cancello s 'one, t%e donor site. 3%e 'one tiss e o'tained is mi2ed (it% 'lood and its 'ecomes an 'one coag l m. It is no( collec into t%e interior of a 'one defect 40o'inson, 06 @sseo s coag l m for 'one ind ction. 9 Periodontol -:;:5 /0><0=

According to SCHAAAH@0B et al. 4-:C0?, efforts %a"e 'een made to regenerate t%e portions of lost 'one tiss e d diseases. E%ile fa"ora'le res lts %a"e 'een reac%ed (it% se"eral types of 'one grafts, t%ere are gro(ing e"idence marro( 'one 4from t%e iliac crest? is 'est material a"aila'le for 'one graft p rposes 4Sc%all%orn 075 Hiatt, E periodontal t%erapy. 9 Periodontol -:C05 /-><;;)<.0?.

According to DI6M et al. 4-:C2?, t%e 'iggest o'Decti"e of t%e periodontal t%erapy %as 'een t%e de"elopment o regeneration of periodontal lost tiss es. A 'ig n m'er of researc%ers %as 'een relating an apparent osteogenic minerali&ed dental fragments and particles of 'one tiss e. 3%ey de"eloped a tec%ni1 e to red ce 'one fragment smaller particles, prod ced 'y trit ration for ;0 seconds in mec%anical amalgamator 4Diem C05 #o(ers 7M5 tec%ni1 e for osseo s implants. 9 Periodontol -:C25 /=>2:<)2:C?.

HIA335 SCHAAAH@0B 4-:C=?, p 'lis%ed an article demonstrating, clinically, t%at t%e t 'erosity, edent lo s are

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I@!B760 4-:02? (as one of t%e first clinical researc%ers to descri'e a s rgical tec%ni1 e to restore t%e los proced re consisted in scaling t%e root s rfaces to remo"e dental calc l s, treat it (it% lactic acid, dry t%e s rf alco%olic sol tion, place on t%e root and 'one defect a piece of 9apanese paper soa+ed in cell loid li1 id, s pre"enting all possi'ilities of t%e paper getting o t of position and, finally, s t re t%e flaps of t%e s rgical (o nd cl ' t%e Paris. Dental Cosmos -:0/5 /;>=:?.

In -:.2, BIMAB et al., tested t%e %ypot%esis t%at ne( connecti"e tiss e attac%ment co ld 'e o'tained on a pre" s rface t%ro g% cells originating from t%e periodontal ligament. 3%ey demonstrated 'y %istological st dies a inserting principal fi'ers formed on t%e pre"io sly diseased root s rface (%en a periodontal s rgery tec%ni1 e (a 4(%ic% d ring t%e (o nd %ealing did not allo( t%e dentogingi"al epit%eli m and t%e gingi"al connecti"e tiss e prepared root s rface?4Byman S5 Aind%e 95 8arring 35 0ylander H Be( attac%ment follo(ing s rgical treatment Clin Periodontol -:.25 :>2:0)2:<?.

7@ADMAB, in -:<=, affirmed t%at t%ere are t%ree specific pro'lems t%at in"ol"e t%e interrelation 'et(een t%e ging first consists of periodontal poc+ets t%at e2tend 'eyond t%e attac%ed gingi"a reac%ing t%e al"eolar m cosa. 3%e fren l m t%at can transmit tension for t%e gingi"al margins and ca se recessions. 3%e t%ird, t%e f nctional con promotes a decrease of attac%ed gingi"a le"els 47oldman HM Periodontia. =ed St Ao is> CF Mos'y -:<=?.

In -:;/, @@0B de"eloped a tec%ni1 e for repositioning t%e fren m in periodontal pro'lems 4Corn H Cir rgia 7oldman HM5 Co%en E Periodontia ;ed 3rad. 9osJ A i& Freire de Andrade, 0io de 9aneiro> 7 ana'ara 8oogan, -:.

According to BA#60S 4-:</?, (%en t%e apical point of periodontal poc+et migrates apically 'eyond t%e m coging to create diffic lties d ring t%e periodontal treatment d e to t%e str ct ral differences 'et(een t%e attac%ed g #ased on t%ese aspects, t%e a t%or (as one of t%e first a t%ors to relate t%e necessity of preser"ing t%e strip s rgical tec%ni1 e for repositioning t%e attac%ed gingi"a in relation to t%e 'one crest of t%e al"eolar process. A f t%e reaction of e2istent gran lation in t%e area is eliminated, t%e flap is no( apically repositioned along t%e marg 'elo( t%e original position and, finally, s t red 4Ba'ers CA 0epositioning t%e attac%ed gingi"a. 9 Periodontol -:</

A0IA!D@5 3I006AA 4-:<C?, modified t%e BA#60*s tec%ni1 e 4-:</?, introd cing t%e concept of t%e t(o "ertical in allo(s to preser"e or to increase t%e strip of attac%ed gingi"a alt%o g% t%e periodontal poc+et is apically positio 'eca se a ne( 'and of attac%ed gingi"a is formed coronally to t%e replaced attac%ed gingi"a 4Aria do AA5 3yrrel t%e &one of attac%ed gingi"a. 9 Periodontol -:<C5 2.>-0;)--0?.

F0I6DMAB 4-:;2? Proposed t%e term ,apically repositioned flap,, instead of t%e term ,attac%ed gingi"a rep BA#60S, in -:</ 4Friedman B M cogingi"al s rgery> t%e apically repositioned flap. 9 Periodontol -:;25 ==>=2.)=

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C@0B 4-:;/'? and 70!P6 4-:;;?, proposed different modifications in t%e tec%ni1 e of lateral sliding of t%e flap. ) c t'ac+ incision 4Corn H Periodontics -:;/'5 2>22:?.

) s 'marginal incision 47r pe H6, Modified tec%ni1 e for t%e sliding flap operation. 9 Periodontol -:;;5 =C>/:-)/

For C@H6B5 0@SS 4-:;.?, t%e lateral sliding of t%e flap and t%e flap mo"ed laterally from edent lo s areas are donor area. 3%ese displacement tec%ni1 es re1 ire a 'and of attac%ed gingi"a e1 al or lig%tly larger t%an t%e nec Fre1 ently, an ins fficient or a'sent 'and of attac%ed gingi"a in t%e adDacent toot% red ces t%e predicta'ility o aspects, t%ey de"eloped t%e tec%ni1 e of do 'le papilla laterally positioned flaps. 3%e flap is formed 'y s t ring t to 'e co"ered 4Co%en DE5 0oss S6 3%e do 'le papillae repositioned)flap in periodontal t%erapy. 9 Periodontol -:;

B@0#607 in -:2; (as t%e first to report t%e coronally repositioned flap in order to co"er root s rfaces. In -:C< tec%ni1 e (it% t%e same goal ' t com'ining t%e se of a free gingi"al graft 2 mont%s prior to t%e coronally repo performed t%ro g% t(o "ertical parallel incisions lea"ing reac%ing t%e al"eolar m cosa, o'taining a enlarged 'and 9P5 AKsc%er #5 MK%lemann H0 Coronally repositioned periodontal flap> clinical e"al ation after one year. 9 Clin Per

In -:;=, #9L0B, descri'ed a free transplantation of gingi"a. In -:;;, BA#60S de"eloped a tec%ni1 e (it% fr m cosa mem'rane in periodontal s rgical proced res t%at aimed to create 'ands of attac%ed gingi"a, enlarge t% "esti' lar forni2 4Ba'ers 9M 62tension of t%e "esti' lar forni2 tili&ing a gingi"al graft. Periodontics -:;;5 />CC?.

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root, ' t its maDor part is placed in an ,en"elope, pre"io sly created 'y an ndermining partial t%ic+ness incisi defect 40aet&+e P# Co"ering locali&ed areas of root e2pos re employing t%e ,en"elope, tec%ni1 e. 9 Periodontol -

AAB7605 AAB760 4-:.<?, p 'lis%ed an article in (%ic% t%ey introd ce ne( concepts, indications and proced res ( s rfaces and enlarge 'ands of attac%ed gingi"a com'ining a partial)t%ic+ness flap coronally positioned (it% a s 4Aanger #5 Aanger A S 'epit%elial connecti"e tiss e graft tec%ni1 e for root co"erage. 9 Periodontol -:.<5 <;>C-<

Aanger 3ec%ni1 e 4Co rtesy of Dr. Cla dio 9Mlio Aopes, !BICAS36A@?

3A0B@E4-:.;? descri'ed t%e tec%ni1 e of a semil nar flap coronally mo"ed and designated primarily to c recessions of 2 or =mm. 3%e tec%ni1 e in"ol"es a semil nar incision made parallel to t%e free gingi"al margin positioning t%is tiss e o"er t%e den ded root 43arno( DP Semil nar coronally repositioned flap. 9 Periodontol -:.;

In -::2, HA00IS proposed a tec%ni1 e root co"erage as follo(> do 'le papilla incisions, partial)t%ic+ness flap periosteal 'ed prepared, connecti"e tiss e s t ring, and do 'le papilla flap s t red o"er t%e graft 4HA00IS 09 9 P

In -::/, SHAB6A6C5 3I##633S, p 'lis%ed an article referring a'o t periodontal micros rgery. 3%e micros rgery tec%ni1 e 'y (%ic% normal "ision is en%anced t%ro g% magnification and t%e tec%ni1 es are eac% time less tra m predicta'ility and 1 ality of %ealing 4S%anelec DA5 3i''etts AS A perspecti"e on t%e f t re of periodontal mi -::;5 --> <.);.?.

According to MIAA60 9r5 AAA6B 4-::;? t%e periodontal plastic s rgery encompasses a m c% 'roader range of tre t%e follo(ing defects> t%e s%allo( "esti' le 4"esti' lar deepening?5 t%e a'errant fren m 4frenectomy?5 marg grafting?5 e2cessi"e gingi"al display 4cro(n lengt%ening?5 deficient ridges 4ridge a g mentation?5 ridge periodontally in"ol"ed teet% 4grafting e2traction sites?5 loss of interdental papillae 4papilla reconstr ction?5 ner mo"ement 4s rgical e2pos re?5 aest%etic defects aro nd dental implants 4'one andNor soft tiss e a gmentan de"elopment of periodontal plastic s rgery. Periodontology 2000 -::;5 -->C)2.?.

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