Surgical Modification of the Gingival Biotype - Dental Online College
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Surgical Modification of the Gingival Biotype

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Duration:

23:35

Surgeon:

Prof. Dr. Wachtel

Professor Dr. Wachtel, Munich/Germany, demonstrates the gingiva thickening and coverage of gingival recession defects in the lower anterior region using the modified tunnel technique.

In this case, an extended Miller class II recession defect has developed at tooth 41. For treatment planning as a whole, the patient's thin gingiva must be taken into consideration. The aim of this surgical procedure is to modify the existing thin gingival phenotype using a subepithelial connective tissue graft, so that a thicker gingiva is established. The secondary aim is the recession coverage which possibly has to be completed in a further treatment session.

The patient’s thin gingiva needs to be considered for the successful coverage of recession defects in the lower anterior region, especially at tooth 41, where an extended Miller II defect is noticeable. In this case, the modified tunnel technique is used to thicken the gingiva and cover recession defects. For this purpose, Professor Wachtel applies a subepithelial connective tissue graft, which is taken from the palate and inserted into a tunnel flap in the lower anterior jaw area. The surgeon first establishes access to the palatal donor tissue using a single-incision technique. Professor Wachtel then performs a marginal incision in the lower anterior jaw and lifts the interdental papillae as a whole using an elevator. Undermining, labial preparation is conducted to lift a split flap apical of the recessions, for which greater mobility is achieved by continuing beyond the mucogingival junction. Following conditioning of the exposed root surfaces using Straumann PrefGel (EDTA-Gel) and the application of Straumann Emdogain onto the root surfaces and into the tunnel, the graft is inserted into the recipient bed using auxiliary Gore-sutures, which will be removed after graft fixation. The flap and graft are secured using modified sling sutures that go around the contact points of the anterior dentition. These sutures secure flap and graft in a coronally advanced position allowing for the coverage of the recession defects. To ensure proper healing conditions the sutures should be placed without any tension. Another session may be needed to completely cover the extended defect on tooth 41. The thickening of the gingiva achieved through this surgery provides the basis if subsequent coverage of recession defects is needed.

Content of the expert video

Once the connective tissue graft has been taken, primary closure of the donor region is performed using cross suturing.
Once the connective tissue graft has been taken, primary closure of the donor region is performed using cross suturing.
When the marginal incision is performed, the periodontal fibres are separated cleanly using microsurgical instruments.
When the marginal incision is performed, the periodontal fibres are separated cleanly using microsurgical instruments.
The application of Straumann Emdogain in the recipient bed results in improved healing of the wound and restoration of the periodontium.
The application of Straumann Emdogain in the recipient bed results in improved healing of the wound and restoration of the periodontium.
The graft is drawn into the tunnel using suturing.
The graft is drawn into the tunnel using suturing.
Using sling sutures, the graft is secured in a coronal position.
Using sling sutures, the graft is secured in a coronal position.

The expert

Prof. Dr. Hannes Wachtel

Spezialist für Parodontologie in der Bolz/Wachtel Dental Clinic in München

  • Mitherausgeber und im Beirat zahlreicher Fachzeitschriften
  • Referent auf nationaler und internationaler Ebene in den Bereichen Parodontologie, plastische Parodontalchirurgie, parodontale und ossäre Regeneration, Implantologie und Ästhetik
  • Verfasser zahlreicher Publikationen und Buchbeiträgen
  • Mitgründer des Privatinstituts für Parodontologie und Implantologie in München (IPI) und der Bolz/Wachtel dental clinic
  • Lehrauftrag Charité Medizin Berlin und Universität Göteborg, Schweden
...more »
  • CAMLOG
  • Align Technology Inc.
  • BEGO Implant Systems GmbH & Co. KG
  • Kuraray
  • Dentsply Sirona Implants
  • CLINICAL HOUSE EUROPE
  • IDI-PARO
  • DSI DentaScience Institute®
  • IPI München
  • Mectron
  • Henry Schein
  • Komet/Gebr. Brasseler GmbH &Co KG
  • DZR
  • Sirona
  • botiss dental Gmbh
  • W&H Deutschland GmbH
  • Zimmer Dental
  • Health AG

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The Dental Online College is an online learning platform for dental surgeons and students. This service focuses on providing superior-quality professional training videos in the area of dental medicine that can be called up from an Internet platform. As a professional online training platform, the Dental Online College provides dental surgeons and students with instruction in surgical procedure, demonstrating challenging surgical techniques using easy to understand videos, and including interviews that provide further detail, video presentations, and documentation on performing the procedures in question.

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