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Rough surfaces of dental implants, when exposed to the oral environment, are conducive to biofilm colonization and can predispose the affected implant to periimplantitis. Recession coverage using soft-tissue grafts is one of the treatment modalities used for the treatment of exposed implant threads. Recession coverage on the palatal aspect of maxillary implants is difficult due to the firm nature of the palatal mucosa and, consequently has not been widely documented in the literature. This case report documents a novel double-pedicle technique for palatal recession coverage on a dental implant. Two pedicle grafts were obtained from either side of the implant with the mucosal recession: a full-thickness lateral-pedicle graft from the distal aspect and a subepithelial connective tissue pedicle from the mesial aspect. The connective tissue pedicle was stabilized first on the area of mucosal recession and was then covered with the distal full-thickness lateral pedicle. Complete recession coverage was obtained, and the result was observed to be clinically stable after 18 months of follow-up. The technique demonstrated in this report can be a useful tool for the treatment of localized palatal recessions on dental implants. [ABSTRACT FROM AUTHOR]

Rough surfaces of dental implants, when exposed to the oral environment, are conducive to biofilm colonization and can predispose the affected implant to periimplantitis. Recession coverage using soft-tissue grafts is one of the treatment modalities used for the treatment of exposed implant threads. Recession coverage on the palatal aspect of maxillary implants is difficult due to the firm nature of the palatal mucosa and, consequently has not been widely documented in the literature. This case report documents a novel double-pedicle technique for palatal recession coverage on a dental implant. Two pedicle grafts were obtained from either side of the implant with the mucosal recession: a full-thickness lateral-pedicle graft from the distal aspect and a subepithelial connective tissue pedicle from the mesial aspect. The connective tissue pedicle was stabilized first on the area of mucosal recession and was then covered with the distal full-thickness lateral pedicle. Complete recession coverage was obtained, and the result was observed to be clinically stable after 18 months of follow-up. The technique demonstrated in this report can be a useful tool for the treatment of localized palatal recessions on dental implants.

The frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. The frena may jeopardize the gingival health when they are attached too closely to the gingival margin, either due to an interference in the plaque control or due to a muscle pull. In addition to this, the maxillary frenum may present esthetic problems or compromise the orthodontic result in the midline diastema cases, thus causing a recurrence after the treatment. Archer's “classical frenectomy” is an extensive procedure including the excision of fibers, interdental papilla, and exposure of the alveolar bone up to the palatine papilla. The resultant delayed healing, loss of the interdental papilla, and abnormal scar led toward the conservative approaches such as Edward's frenectomy, frenum relocation by Z-plasty, and free gingival graft, with their technical and esthetic limitations. A better approach in frenectomy to make a primary closure in the midline and to avoid an unesthetic scar by creating a zone of the attached gingiva is assisted with a lateral pedicle graft. A case series of this technique with its distinct advantages is presented.

The frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. The frena may jeopardize the gingival health when they are attached too closely to the gingival margin, either due to an interference in the plaque control or due to a muscle pull. In addition to this, the maxillary frenum may present esthetic problems or compromise the orthodontic result in the midline diastema cases, thus causing a recurrence after the treatment. Archer's "classical frenectomy" is an extensive procedure including the excision of fibers, interdental papilla, and exposure of the alveolar bone up to the palatine papilla. The resultant delayed healing, loss of the interdental papilla, and abnormal scar led toward the conservative approaches such as Edward's frenectomy, frenum relocation by Z-plasty, and free gingival graft, with their technical and esthetic limitations. A better approach in frenectomy to make a primary closure in the midline and to avoid an unesthetic scar by creating a zone of the attached gingiva is assisted with a lateral pedicle graft. A case series of this technique with its distinct advantages is presented. [ABSTRACT FROM AUTHOR]

The pyogenic granuloma, one of the gingival lesions, has recurrence rate of 16%. To minimize the recurrence rate, it must be completely excised. Complete surgical excision can result in residual gingival defect. McCrea repaired residual gingival defect by subepithelial connective tissue graft with lateral mucogingival pedicle flap, and Choudhary et al. managed residual gingival defect by subepithelial connective tissue graft only. The aim of this case report was to use lateral pedicle graft for repair of residual gingival defect following complete surgical excision of a pyogenic granuloma. A patient with pyogenic granuloma on labial surface of maxillary central incisors was treated by complete surgical excision, and residual gingival defect was repaired by lateral pedicle graft. A lateral pedicle graft was raised as full-thickness up to mucogingival line and partial-thickness apical to mucogingival line from the left side of residual gingival defect. After 6 months, no recurrence was noticed. Thus, lateral pedicle graft can be potentially used for repair of residual gingival defect following complete surgical excision of a pyogenic granuloma.

An aberrant frenum is postulated to create functional and aesthetic problems. Archer′s ′classical frenectomy′ is an extensive procedure including the excision of fibers, interdental papilla, and exposure of alveolar bone up to the palatine papilla. The resultant delayed healing, loss of interdental papilla, and abnormal scar led towards the conservative approaches like Edward′s frenectomy, frenum relocation by Z-plasty and free gingival graft; with their technical and aesthetic limitations. A better approach to make a primary closure in midline and to avoid anesthetic scar by creating a zone of attached gingiva, frenectomy is assisted with lateral pedicle graft. The interdental papilla is left surgically undisturbed and healing takes place by primary intention. Miller, in his study on 27 subjects, suggested that the newly created zone of attached gingiva might have bracing effect inhibiting reopening of diastema. A case series of this technique with its distinct advantages is presented.

The treatment of gingival recession defects is indicated for esthetic and functional reasons to reduce root sensitivity, to remove muscle pull, to create or augment keratinized tissue, and to prevent disease progression. The presence of sufficient amount of periosteum adjacent to gingival recession defects makes it a suitable graft. The adult human periosteum is a highly vascular connective tissue with immense regenerative potential. It contains fibroblasts, osteogenic progenitor cells, and stem cells as a result of which it has the ability to differentiate into fibroblast, osteoblast, chondrocytes, adipocytes, and skeletal myocytes. The tissue provided by these cells includes cementum with periodontal ligament fibers and bone. Therefore, in the present case, periosteum has been used as a lateral pedicle graft for the coverage of the single tooth gingival recession (mandibular central incisor). The procedure is justified by the evidence that periosteum is capable of proliferation and osteogenesis after injury. [ABSTRACT FROM AUTHOR]

The pyogenic granuloma, one of the gingival lesions, has recurrence rate of 16%. To minimize the recurrence rate, it must be completely excised. Complete surgical excision can result in residual gingival defect. McCrea repaired residual gingival defect by subepithelial connective tissue graft with lateral mucogingival pedicle flap, and Choudhary et al. managed residual gingival defect by subepithelial connective tissue graft only. The aim of this case report was to use lateral pedicle graft for repair of residual gingival defect following complete surgical excision of a pyogenic granuloma. A patient with pyogenic granuloma on labial surface of maxillary central incisors was treated by complete surgical excision, and residual gingival defect was repaired by lateral pedicle graft. A lateral pedicle graft was raised as full-thickness up to mucogingival line and partial-thickness apical to mucogingival line from the left side of residual gingival defect. After 6 months, no recurrence was noticed. Thus, lateral pedicle graft can be potentially used for repair of residual gingival defect following complete surgical excision of a pyogenic granuloma. [ABSTRACT FROM AUTHOR]

Gingival recession in its localized or generalized form is undesirable condition resulting in root exposure causes of root hypersensitivity, Shallow root caries lesions, and cervical abrasions. Complete root coverage is primarily indicated for esthetic/cosmetic demands which can be satisfied by soft tissue grafts, the thickness and colour of which should not be distinguishable from those of adjacent soft tissue. This article puts an emphasis on case report in which a lateral pedicle graft technique has been used for root coverage in relation to mandibular right incisor. [ABSTRACT FROM AUTHOR]

Abstract: Background: Various periodontal plastic procedures are available for treatment of localized gingival recessions. However, in the mirage of newer techniques and materials available, it is difficult for clinicians to decide on the treatment modality. Pioneering techniques provide a cost effective and effective means of maintaining esthetics in recession cases. Materials and methods: Twenty-two subjects with localized gingival recessions were divided in equal groups and treated with lateral pedicle graft (Group A) and Free mucosal graft (Group B). Clinical parameters of length and width of recession and apico coronal length of keratinized gingiva (ACKG) was measured at baseline, 30 and 90 days. Root coverage percentage was calculated. Results: Both groups were effective in recession coverage and gain in ACKG. Root coverage gained in Group A was 65.0 ± 25.2% and for Group B was 61.6 ± 20.5%. Conclusion: Lateral pedicle graft and Free mucosal graft provide not only effective means of gaining in root coverage of localized gingival recession cases but also result in gain of ACKG. These techniques remain an important part of periodontal plastic surgery. [Copyright &y& Elsevier]

An aberrant frenum is postulated to create functional and aesthetic problems. Archer's 'classical frenectomy' is an extensive procedure including the excision of fibers, interdental papilla, and exposure of alveolar bone up to the palatine papilla. The resultant delayed healing, loss of interdental papilla, and abnormal scar led towards the conservative approaches like Edward's frenectomy, frenum relocation by Z-plasty and free gingival graft; with their technical and aesthetic limitations. A better approach to make a primary closure in midline and to avoid anesthetic scar by creating a zone of attached gingiva, frenectomy is assisted with lateral pedicle graft. The interdental papilla is left surgically undisturbed and healing takes place by primary intention. Miller, in his study on 27 subjects, suggested that the newly created zone of attached gingiva might have bracing effect inhibiting reopening of diastema. A case series of this technique with its distinct advantages is presented. [ABSTRACT FROM AUTHOR]