عملية علاج اللثة Root coverage بتقنية Papilla Tunnel (كركتيري)

اخواني واخواتي السلام عليكم

ساقوم بشرح تقنية جديدة وسهلة لتغطية الجدور المتعرية في قسم علاج اللثه


في هدا الاسلوب سوف نقوم بتغطية الجدور لاسنان متجاورة معتمدين على النتوء (papila) و النفق (Tunel)



بأستخدام نسيج طبيعي من نوع AlloDerm
خيوط 6.0 polypropylene sutures
Cutting Intrasulcular Knife
microsurgical elevator



The pouch preparation begins with making papillary
incisions approximately 3mm apical to the tip of the papilla between
the lateral and canine and between the two premolars,





Denude the remaining facial papillary tissue coronal to the incised papillae to serve as a recipient site for flap advancement.





Using an End Cutting Intrasulcular Knife or similar
microsurgical instrument, make sulcular incisions around each tooth
with recession defects, extending laterally one additional tooth mesial
and distal to facilitate flap mobilization.




A microsurgical elevator is used to lift the
tunneled papillae and elevate a mucoperiosteal pouch just past the
mucogingival junction.





Using a Modified Orban Knife, sharp dissect
immediately supraperiosteally to mobilize and extend the pouch 12-15mm
from the gingival margin.





Lift the intact papillary tissue distal to the central incisor, between the canine and
premolar and mesial to the molar, completely from the osseous crest using a Younger-Good curette or similar instrument.





Trim the AlloDerm graft to fit from the distal of
the central incisor to the mesial of the molar, extending roughly 8mm
tall. The graft is inserted into the pouch preparation under the intact
papilla using a Younger-Goode 7/8 curette or similar instrument.
Position the graft with the reticular (connective tissue) side facing
bone.





The graft should be advanced to extend from under the most mesial intact papilla to under the most distal papilla.





Place individual sling sutures, engaging only the graft, around each tooth tied on the palatal.





The graft is sutured independent of the overlying
flap and carefully positioned at the cementoenamel junction (CEJ). The
sling suture should draw the graft under the intact papillae on the
distal of the central and mesial of the molar.





Coronally position the flap completely over the graft and stabilize with individual sling sutures tied on the facial.





The flap should completely cover the graft and be positioned at the CEJ.




Place an interrupted suture through the incised
papilla between the lateral and canine as well as the two premolars to
secure over denuded beds.





Post operatively, an increase in root coverage and attached gingiva are observed.

للفائده