Modified Vertical Mattress Suturing Technique For Flap Approximation After Ramping ' A Modified Resective Osseous Surgical Procedure

Purpose of this study is to evaluate the efficacy ofmodified vertical mattress suturing technique for flapapproximation after ramping – a modification ofresective osseous surgical procedure. Eighteen patientsrequiring periodontal surgery for pocket therapy wereincluded in the study. The preoperative gingival andperiodontal conditions were evaluated and intraoralradiographs were taken to identify the osseous defect.Shallow Craters present in the interdental regionstowards the palatal surface were treated by ramping.On completion of the procedure, flaps wereapproximated for the final suturing. Suturing is doneby a modification of vertical mattress suturing methodusing 4-0 silk sutures. The surgical sites wereevaluated at the conclusion of the surgery, duringsuture removal and one month post-operative. Theoutcomes were evaluated in terms of patient’s comfort,surgical flap approximation, complications and post–operativerecessions. Complete closure of wound andgood flap approximation was achieved in all casesimmediately after the surgery. Except for three patientswith delayed wound healing at suture removal, allother patients displayed rapid healing without anydiscomfort. No noticeable defect was seen in thehealing of the interdental papilla on the buccal aspect.Embrasure spaces on the buccal surface werecompletely filled by interdental papilla during the onemonth review period. In patients undergoing resectiveosseous surgery by ramping that result in two differentplanes for flap approximation, the modified verticalmattress suturing technique proves to be a reliable andan effective method of suturing.surgery

Prevalence And Distribution of Vertical Osseous Defects In Patients Being Treated For Chronic Periodontitis.

Background: The aim of the study was to determine the prevalence and distribution of vertical osseous defects in patients who underwent open flap debridement. Methods: A total of 83 subjects were examined for prevalence of vertical defects using direct observation during periodontal surgery. All patients required periodontal surgery in one or more segments. The diagnosis of periodontitis was made after clinical and radiographic examination. Periodontal surgery was performed on each patient and full thickness mucoperiosteal flaps were elevated to gain access to root and osseous structures. The vertical osseous defects were explored surgically using mouth mirror, explorer and a periodontal probe. Results: A total of 141 vertical osseous defects were detected in the 677 teeth assessed during surgical exposure. Of these 81 vertical defects were found in the maxilla and 60 vertical defects were found in the mandible. Craters accounted for almost 44% of the total defects. The posterior maxilla had the highest percentage of teeth with vertical defects (26.23%) while the mandibular anterior segment had the lowest percentage of vertical defects. Conclusion: The posterior maxilla had the highest percentage of vertical osseous defects which can be explained by the fact that greater thickness of supporting bone allows formation of a greater number of infrabony defects. Craters were found to be the most common defect.