Gingival extension

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Gingival extension ( lat. Gingival gum ; extensio , expansion) is a treatment method in dentistry to broaden the keratinized (secured) gingiva. It is carried out in the run-up to the incorporation of dentures (preprosthetics), when fitting dental implants and when teeth have been damaged by gum recession ( gingival recession ).

Vestibuloplasty

These methods were previously known as vestibuloplasty. Although the same methods can be used from a surgical point of view, they were later divided into

  • Vestibuloplasty (e.g. preprosthetic for an edentulous jaw with the aim of better holding the prosthesis) and
  • Gingiva extension (with the aim of tooth preservation or aesthetic improvement in the visible area of ​​teeth or implants).

Two fundamentally different procedures were developed: 1. with a flap pedunculated towards the lip (labially pedunculated) according to Clark 2. with a flap pedunculated at the gum margin (marginal pedunculated) according to Edlan and Mejchar.

Free palatal graft

Both procedures have been further developed. From Clark's vestibuloplasty, the gingival extension operation with free palatal mucosal transplant (FST) developed. First, an incision is made along the mucogingival border . An apical relief incision is now dispensed with. A mucosal flap is prepared while protecting the periosteum ( split flap ), which is displaced apically . To match the recipient region created in this way (graft bed), a graft is removed from the extraction point on the palate and sutured or glued in the graft bed. Investigations on very thin, thin, medium and thick grafts showed that thin grafts tend to shrink but grow better. Thick ones, on the other hand, grow poorly and do not shrink much. The optimal thickness was determined to be 0.75 mm, which the Mörmann mucotome realizes with mechanical removal. Previously used dressings were shown in scientific papers as mechanical disruptive factors and dirt reservoirs, so that postoperative use of chlorhexidine rinsing is more likely than the dressing. Rather small areas are covered with one operation. The expected success of the operation is very certain if it is carried out correctly. Cosmetically, however, the process is not always entirely satisfactory.

Modification according to Schmid and Mörmann

With the Edlan process, which originally required a high level of operational skill, a workable process was created through modifications by Schmid and Mörmann - with an equally sure expectation of success. The possibility of covering broad areas of recession at once is advantageous. Critics complain about the lack of keratinization in the newly created gingival area.

See also: Teeth-supporting apparatus

swell

L. Flores-de-Jacoby: "Parodontologie" in: N. Schwenzer (ed.): Zahn-, Oral- und Kieferheilkunde , Vol. 5, Thieme, Stuttgart, New York, 1987, p. 323 ff.

Individual evidence

  1. ↑ I. Mieler, p Kubetschek: [The Edlan / Mejchar surgical method and its modifications]. In: Dental, oral and maxillofacial medicine with Zentralblatt. Volume 74, Number 3, 1986, pp. 249-258, ISSN  0303-6464 . PMID 2941939 .
  2. ↑ MA Marxer, KH Rateitschak, A. Hefti: [Free mucosal transplant: the Edlan-Mejchar operation. A comparison]. In: Swiss monthly journal for dentistry = Revue mensuelle suisse d'odonto-stomatologie / SSO. Volume 92, Number 1, January 1982, pp. 75-82, ISSN  0036-7702 . PMID 6950514 .
  3. ^ W. Mörmann, MO Schmid, JP Bernimoulin: [Fluorescence angiographic studies of blood circulation in split mucosal flaps in the Edlan and Mejchar vestibuloplasty]. In: German dental journal. Volume 31, Number 7, July 1976, pp. 560-565, ISSN  0012-1029 . PMID 1065576 .
  4. ^ MO Schmid, W. Mörmann, A. Bachmann: Mucogingival surgery. The subperiosteal vestibule extension. Clinical results 2 years after surgery. In: Journal of Clinical Periodontology . Volume 6, Number 1, February 1979, pp. 22-32, ISSN  0303-6979 . PMID 285079 .