LATERAL PEDICAL

GRAFT
INDEX
 INTRODUCTION
 TECHNIQUES FOR INCREASING THE ATTACHED
GINGIVA
 INDICATIONS
 CONTRAINDICATION
 ADVANTAGES
 DISADVANTAGES
 STEP BY STEP TECHNIQUE
 COMMON REASON FOR FAILURE
 PARTIAL FULL THICKNESS PEDICAL
 VARIANT TECHNIQUE
 CONCLUSION
INTRODUCTION
 Mucogingival surgery introduced by Friedman to
describe the surgical procedures for the correction
of the relationship between the gingiva and the oral
mucous membrane with reference to three specific
problems
• Associated with attached gingiva
• Associated with shallow vestibule
• Associated with frenum interfering with marginal
gingiva
In 1996 world workshop renamed mucogingival surgery
as periodontal plastic surgery
Peridontal plastic surgery
It is defined as a surgical procedure performed
to correct or eliminate anatomic
developmental traumatic deformities of the
gingiva or alveolar mucosa
Objectives
 Problems associated with attached
gingiva
 Problems associated with shallow
vestibule
 Problems associated with aberrant
frenum
Techniques for increasing
attached gingiva
 Gingival augmentation apical to the area of recession eg.
by
• free gingival autograft
• apically positioned flap
 Gingival augmentation coronal to the recession
• Free gingival autografts
• Free connective tissue autografts
• Pedical autograft
Laterally positioned
Coronally positioned
Semilunar pedical
• Subepithelial connective tissue graft
• Guided tissue regeneration
• Pouch and tunnel technique
Lateral pedical graft
Historical review
In 1956 Grupe and Warren developed an
original and unique procedure called the
sliding flap operation for covering the
isolated exposed root . And modified it
in 1966 to prevent the donor side
recession
INDICATIONS
 Sufficient tissue exist adjacent to the
area of recession
 Coverage limited to one or two teeth

 Suitable for recession with narrow

mesiodistal width
Contraindications
1. Insufficient keratinized tissue at the donor
site
2. Presence of deep interproximal pockets
3. Excessive root prominences
4. Deep or extensive root abrasion or erosion
5. Significant loss of interproximal bone height
6. Narrow vestibule
7. Multiple tooth involvement
Advantages
 One surgical site

 Good vascularity of the pedicle flap

 Ability to cover the denuded root

surface
Disadvantages
 Limited by the amount of adjacent
keratinized attached gingiva
 Possibility of recession at the donor site

 Dehiscence or fenestrations at the donor site

 Limited to one or two teeth with recession

Step by step procedure for following
the technique
I Preparation of recipient site
1. Root planing to remove the soft
cementum and reduce or eliminate the
prominent convexity of the root
Citric acid is burnished over the exposed
root surface to enhance the linkage
 1. View of the exposed root as
a result of recession

2. Basic incisions are outlined

The donor flap should be 1 1/2
Times the size of the recipient
Area to be covered & 3 to 4 times
Longer than it is wide
3. V – shape incision is
made
About the exposed root
With No. 15 scalpel blade

4. V – shaped incision
removed. give a beveled
incision on the opposite side
Of the donor area to permit
Overlap of flap
Preparation of donor site
5.coronal portion of pedicle
Flap begun

6. Final dissection of the

Pedicle is in apicoocclusal
direction
 Preparation of pedicle flap
7.flap is released & reflected,
Exposing the underlying
periosteum

8. If a full thickness flap were

Raised the underlying bone
Would have been exposed
9. Tension is placed on
the pedicle when the
positioning is attempted

10. a releasing incision

is made
11. In partial thickness
pedicle is sutured with
periosteum
Covering bone

12.cover aluminum foil

And place a soft perio pack.
Remove the pack and the
suture after one week
preop

Postop
A. Incisions given R. recipient tooth, D Donor tooth
F. flap, S. Split thickness dissection , E. exposed
bone
B. suturing after rotation of the flap lip is
retracted to immobilize the graft
 For multiple teeth

Tooth are easier to stabilize because of the increase

size of the flap.(better blood supply )
Common reasons for
failure
1.Tension at the base of the distal
incision , corrected by use of
releasing incision

2. Too narrow pedicle flap,

care to be taken to have the
Donor flap should be 1 1/2
Times wider
3. Bone exposed
resulting in
the dehiscence,

4. Excessive movement
because of poor
stabilization
Partial-full-thickness pedicle

Goldman et al.(1982)
Advantage of a full
thickness flap over the
denuded root surface
and at the same time
permitting coverage of
the exposed donor site
with periosteum

Initial view
2. V shaped incision over
exposed root begun

3. V shaped beveled
incision completed &
partial thickness flap
begun
Partial full thickness portion
completed
Flap is sutured with overlap
of the beveled incision
VARIANT TECHNIQUES

Obliquely placed flap

CONCLUSION
New techniques are
constantly being
developed and are slowly
incorporated into
periodontal practice.
Critical analysis of newly
presented techniques
should guide our
REFERENCES
 Michael G. Newman, Henry H. Takei,
Fermin A. Caranza; clinical
periodontology ; 9th edition; 2003
 Edwards S. Cohen ; Atlas of Cosmetic &
Recontructive periodontal surgery;
second edition 1994
 Louis F. Rose, Brian L. Mealey Robert;
Periodontics Medicine , Surgery
Implants 2004A