ABSTRACT
@#With the increasing demand for beauty, the treatment of gingival recession has become a common request among patients. Clinically, gingival recession is mainly treated by surgery. The common surgical methods include free gingival grafting, pedicled flap technology and double flap technology (subepithelial connective tissue transplantation combined with coronally advanced flaps). If patients with indications are selected, satisfactory surgical results will be obtained. However, there are still some shortcomings in the above mentioned methods, such as the root coverage effect not being satisfactory. In recent years, researchers have put forward some improved schemes to minimize the shortcomings of the above methods to treat different degrees of gingival recession. A gingival unit graft containing gingival papilla and free gingiva can improve the blood supply of the recipient area and improve the effect of root coverage. It can obtain better root coverage for slight retraction, widening of the angular gingiva and deepening of the vestibular sulcus, but there may be issues with inconsistent color and shape of the gingiva after surgery, as well as poor aesthetic effects. Modified coronally advanced flaps, flaps prepared by the technique of half-thickness, full-thickness and half-thickness, and modified coronally advanced envelope flap technology are designed with the most serious retraction teeth as the center in the case of multiple gingival retractions, both of which can improve the effect of root covering. Tunnel technology and modified tunnel technology, without severing the gingival papilla and tunneling the gingival flap to accommodate the graft, can effectively reduce tissue damage and promote wound healing. This paper reviews the literature and summarizes the outcome of the modified surgery techniques in the treatment of gingival recession. These treatment options for gingival recession are proposed with the aim of improving clinical work, and some suggestions for the treatment of gingival recession to achieve a stable root coverage effect are put forward. In the future, the development direction of mucogingival surgery is to reduce trauma and have a stable curative effect.
ABSTRACT
OBJECTIVES@#This prospective study was performed to evaluate whether the distal-triangular flap was a practical alternative surgical approach for extracting mandibular third molars.@*METHODS@#Sixty participants with impacted mandibular third molars were randomly divided into three groups: group A, distal-triangular flap; group B, Szmyd flap; and group C, envelope flap. The impacted third molars were extracted by the corresponding flapping method. During a three-month follow-up observation after the extraction, the postoperative pain, swelling, mouth opening, and periodontal status were recorded and analyzed by ANOVA and chi-square tests.@*RESULTS@#The 60 participants had successful extraction and 3-month follow-up observation. No participant suffered from postoperative infections, lower lip disorder, or tongue sensory disorders. No statistical differences were found in the postoperative symptoms and signs of the three flap designs, such as postoperative pain, swelling, mouth opening, and periodontal status (@*CONCLUSIONS@#The distal-triangular flap was as safe and reliable as the Szmyd and envelope flaps but more advantageous because of its convenient operative field exposure and low requirement for the patient's mouth opening. Thus, the distal-triangular flap is one of the alternative flap options for extracting impacted mandibular third molars.
Subject(s)
Humans , Mandible/surgery , Molar, Third/surgery , Prospective Studies , Tooth Extraction , Tooth, Impacted/surgeryABSTRACT
Objective To evaluate effects of two different flap designs (envelope flap and triangular flap) on complica?tions after the mandibular third molar surgery. Methods A randomized, self controlled clinical trial design was selected for 52 patients treated in the outpatient surgery of Stomatological Hospital Affiliated to Tianjin Medical University. Patients were treated with envelope flap design for lower third molar removal in one side and triangular flap on the other side. VAS scores were used to evaluate postoperative pain. The postoperative swelling was evaluated by patient`subjective index. The degree of the upper and lower incisor distance was used to evaluate trismus. Data of postoperative swelling, pain and trismus were re?corded 1, 2 and 7 days after surgery. Data of postoperative wound dehiscence, bleeding situation and alveolitis were also re?corded and compared between two groups. Results There were no significant differences in postoperative pain after 1, 2 and 7 days between two flap designs (P>0.05). After 1 and 2 days there was more severe facial swelling in triangular flap group than that of envelope flap group (Z=2.005, Z=2.017, P0.05). There were no signifi?cant differences in postoperative pain, alveolitis, bleeding and wound dehiscence between two groups (P > 0.05). Conclu?sion The envelope flap is more conductive to the early recovery in patients after surgery, but in the long term there is no ob?vious difference between the two flap designs.