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Adh'sion SILVIO ANTONIO DOS SANTOS PE EI A, D.D.S., MSc.D. Nouvelles Assistant Professor, Periodontology Department, Fac lty of Dentistry, !ni"ersity Camilo Castelo #ranco, S$o Pa lo annuel ED!A Congr(s DO SA"A#C$!%&I , D.D.S., MSc.D., PH.D. Professor and C%airman, Periodontology Department, Fac lty of Dentistry, !ni"ersity Camilo Castelo #ranco, S$o Actes de la S&$AD
In t%e 'eginning of t%e cent ry, t%e s rgical treatment (as not attracti"e to clinicians, not (ell)accepte npredicta'ility of gooden res lts. Enseigne)ents histoire de In t%e l*odontologie 'eginning of t%e cent ry, (e also didn*t +no( m c% a'o t t%e etiologic agent of ,al"eolar pyorr%ea,.
Petite de and clinician 0o'icse+, (as t%e first to descri'e t%e radical tec%ni1 e of gingi"ectomy In -../, t%e histoire researc%er dentaire meas l*art red t%e poc+et dept% to determinate t%e line (%ere t%e gingi"al tiss e (o ld 'e e2cised. After t%is pro +,--#+,.incision on eac% toot%, %e incised t%e tiss e to 'e remo"ed on t%e la'ial and ling al s rfaces of t%e s rgical are interdental gingi"a (as e2cised and t%e remaining tiss e (as remo"ed (it% c rettes. 3%e remo"al of t%e $istoire du ca/inet of t%e dentaire s rgery. 3%e follo(ing s rgical p%ase consisted on remo"ing t%e 'one tiss e (it% s rgical drills. 3%e s r iodine dye and t%e patient instr cted to mo t%(as% (it% an antiseptic sol tion 4Stern I#5 6"erett F75 0o'icse+ Actes IA$D 0--s rgical treatment of periodontal disease. 9 Periodontol -:;<5 =;>2;<)2;.?.
According to Stern et al. 4-:;<?, S. 0o'icse+ %ad some remar+a'le insig%ts a'o t t%e periodontal disease tre infl enced t%e de"elopment of s rgical periodontal tec%ni1 es in t%e (orld. 3%e nat re of %is contri' tion is neit% as (e +no(, ' t rat%er t%e radical gingi"ectomy (%ic% is an e2cision of t%e gingi"a, e2posing t%e marginal and to remo"e gran lation tiss e and c%ange t%e s%ape of t%is 'one 'y a proper instr mentation 4Stern I#5 6"erett pioneer in t%e s rgical treatment of periodontal disease. 9 Periodontol -:;<5 =;>2;<)2;.?.
7@ADMAB 4-:<0? introd ced t%e concept on t%e de"elopment and importance of p%ysiologic conto rs of t%e tiss poc+ets, t%e control of gingi"al inflammation and t%e re)esta'lis%ment of p%ysiologic f nction of periodontal tiss t%e s ccess of periodontal treatment. So, t%e con1 est of an e2cellent 'acterial pla1 e mec%anic control perform rele"ant aspect for t%e maintenance of t%e o'tained res lts 47oldman HM 3%e de"elopment of p%ysiologic gingi"a S rg @ral Med @ral Pat%ol -:<05 =>.C:)...?.
3%e gingi"ectomy proced re as it is sed today (as descri'ed in -:<- 'y Henry M 7oldman. In gingi"ectomy te faces t%e toot% is e2cised do(n to t%e 'ase of t%e poc+et in order to incl de t%e D nctional epit%eli m, lea"ing pa t%e al"eolar crest.
In -:-;, Aeonard Eidman in t%e entitled monograp% ,3%e @perati"e 3reatment of Pyorr%ea Al"eolaris, (as one o in detail t%e se of flaps to eliminate periodontal poc+ets.
A m coperiosteal flap is lifted e2posing t%e in"ol"ed 'one and soft tiss e5 a complete remo"al of gran lation reac res%aping s%o ld 'e performed for t(o reasons> -? to eliminate of s%arp tips of 'one tiss e, and 2? to elimi displaced flap is first mentioned 46"erett F5 Eaer%a g 95 Eidman A Aeonard Eidman> s rgical treatment of p -:C-5 /2><C-)<C:?.
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Historically, osseo s s rgery (as performed for t%e primary p rpose of eliminating necrotic or infected 'one reconstr cti"e periodontal s rgery. 2ed Mal"ern> Aea Fe'iger, -::/, p.2<:?.
In -:=<, 8ronfeld, in t%e researc% ,Condition of t%e #one 3iss e of t%e Al"eolar Process 'elo( t%e Per scientifically, t%ro g% %istological st dies t%at t%e 'one tiss e of al"eolar process adDacent to t%e perio c%aracteristics of necrotic 'one 48ronfeld 0 9 Periodontol -:=<5 ;>22?.
HI0SCHF6AD 4-:<2? proposed t%e tec%ni1 e of s 'gingi"al c rettage in order to eliminate or to red ce poc+et d inflammatory process in t%e tiss es and s 'se1 ent %ealing. 3%e proced re (as e2ec ted nder local anest%esi order to remo"e t%e lcerated epit%eli m of t%e poc+et 4Hirsc%feld A S 'gingi"al c rettage in periodontal tre //>=0-)=-/?.
According to 0@#IBS@B 4-:;;?, t%e periodontal poc+ets adDacent to distal root s rfaces of t%e second and periodontal t%erapy of diffic lt sol tion and t%ey %a"e 'een denied fre1 ently for many periodontists. 3%e period of molars can 'e e2tremely deep d e to t%e anatomy of t%is area. E%en t%e poc+et 'ecomes deeper, t%at dept% t%e inaccessi'ility of t%e area leads to t%e ina'ility in t%e mec%anical control of 'acterial pla1 e e2ec ted 'y aspects, %e de"eloped t%e Distal Eedge proced re in order to treat periodontal poc+ets adDacent to t%e dis tec%ni1 e ses internal 'e"el incisions and it %as as o'Decti"es> to o'tain access to t%e 'one tiss e, to preser periodontal poc+ets, to red ce t%e %ealing period and to minimi&e t%e postoperati"e pain 40o'inson 06 3%e />2<;)2;/?.
0AMF9@0D5 BISSA6 4-:C/?, concerned a'o t 'one tiss e preser"ing, o'taining a perfect clos re of t%e flaps facilitating t%e oral %ygiene e2ec ted 'y t%e patient, t%ey modified t%e tec%ni1 e initially descri'ed 'y Eid conser"ati"e proced re. 3%e c%anges (ere> primer incision is an in"erse 'e"eled, partial)t%ic+ness, t%inning inci of t%e toot% and directed to(ard t%e crest of 'one, and intra)s lc lar 4secondary? incision (as performed aro nd t%e flaps t%e loosened collar of tiss e (as remo"ed at t%e al"eolar crest. 3%ese modifications try to maintain t%e aest%etics, g arantee t%e repairing t%ro g% long D ncional epit%eli m, 'esides facilitate t%e mec%anical control of patient 40amfDord SP5 Bissle 00 3%e modified Eidman operation. 9 Periodontol -:C/> /<>;0-);0C?.
According to 3A86I et al. 4-:.<?, t%e most common postoperati"e pro'lem associated (it% grafting proced
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In -:/:, SCHA!760 (as one of t%e first researc%ers t%at descri'ed t%e principles of resecti"e osseo s s rgery 'one (%ere it co ld 'e esta'lis%ed t%e p%ysiologic conto rs (it%o t attac%ment loss, elimination of interdental c t%e o'Decti"e of eliminating periodontal poc+ets and reac%ing a p%ysiologic gingi"al and osseo s arc%itect re afte A 'asic principle in periodontal s rgery. @ral S rg @ral Med @ral Pat%ol -:/:5 2>=-;)=2<?.
F0I6DMAB 4-:<<? introd ced t%e terms ,osteoplasty, and ,ostectomy,, designed to define t%e red ction and s pporting 'one, respecti"ely 4Friedman B @steoplasty and ostectomy. 9 Periodontol -:<<5 2;>2<C)2;:?.
For 7@ADMAB5 C@H6B 4-:<.?, a classification of 'one defects is necessary not only for academic p rposes ' t al of treatment met%ods. #ased on t%ese aspects, t%ey s ggested a classification of 'one defects 'ased on t% remaining 'one (alls. 3%ese can 'e classified in defects of t%ree, t(o or one 'one (alls and com'inations. 3%is esta'lis%ment of t%e periodontal t%erapy 47oldman HM, Co%en DE 3%e infra'ony poc+et> classification and 2:>2C2)2:-?.
In -:<., 7AIC8MAB (it% t%e o'Decti"e to facilitate and to select t%e proper treatment to 'e performed, propo pro'lems. In t%e %ori&ontal aspect, 1 alified it in> 7rade I ) incipient lesion5 7rade II ) partial destr ction of f rcation area5 7rade III ) total destr ction of t%e s pporting str ct res of t%e f rcation area, allo(ing t%e inserti t%e clinical e2pos re of t%e f rca5 7rade IF ) t%e same as 7rade III pl s t%e clinical e2pos re of t%e f rcation are la sal d y la enfermedad. 0econocimiento de la enfermedad periodontal en la prGctica de la odontologHa general. # enos Aires> M ndi -:;- p.<=2)</0?.
3%e e2istence of intra'ony defect cases (it% potential to 'e reconstit ted, stim lated t%e appearance and de" sed 'one grafts (it% ind ctor potential capa'le to stim late t%e osteogenesis, cementogenesis and format ligament. In -:;<, BA#60S5 @*A6A0I, de"eloped t%e tec%ni1 e of a togeno s 'one graft to treat t%ree (alls 'on are easy)o'tained, compati'le (it% t%e recei"ing tiss es and (it% ind cti"e perspecti"es 4Ba'ers CA5 @*leary 39 t%e treatment of osseo s defects. 9 Periodontol -:;<5 =;><)-/?.
6E6B 4-:;<? presented t%e 'one s(aging tec%ni1 e. It is necessary t%e e2istence of a prost%etic space adDacen 'one tiss e adDacent to t%e defect is mo"ed and pressed to(ards t%e root s rface (it%o t 'een fract red entire tec%ni1 e is indicated for t%e treatment of 'one saliencies, 'if rcations and 'one defects of t%ree (alls 46(en -:;<5 =;><C)=;?.
D e to t%e diffic lties (%en sing a togeno s 'one grafts in relation to t%e occ rrence of 'one se1 estrations ( sed and t%e diffic lty of o'taining 'one marro( and ade1 ate 1 antities of cancello s 'one intraorally, 0@# osseo s coag l m tec%ni1 e for 'one ind ction, sing small particles of cortical 'one (it% some cancello s 'one, t%e donor site. 3%e 'one tiss e o'tained is mi2ed (it% 'lood and its 'ecomes an 'one coag l m. It is no( collec into t%e interior of a 'one defect 40o'inson, 06 @sseo s coag l m for 'one ind ction. 9 Periodontol -:;:5 /0><0=
According to SCHAAAH@0B et al. 4-:C0?, efforts %a"e 'een made to regenerate t%e portions of lost 'one tiss e d diseases. E%ile fa"ora'le res lts %a"e 'een reac%ed (it% se"eral types of 'one grafts, t%ere are gro(ing e"idence marro( 'one 4from t%e iliac crest? is 'est material a"aila'le for 'one graft p rposes 4Sc%all%orn 075 Hiatt, E periodontal t%erapy. 9 Periodontol -:C05 /-><;;)<.0?.
According to DI6M et al. 4-:C2?, t%e 'iggest o'Decti"e of t%e periodontal t%erapy %as 'een t%e de"elopment o regeneration of periodontal lost tiss es. A 'ig n m'er of researc%ers %as 'een relating an apparent osteogenic minerali&ed dental fragments and particles of 'one tiss e. 3%ey de"eloped a tec%ni1 e to red ce 'one fragment smaller particles, prod ced 'y trit ration for ;0 seconds in mec%anical amalgamator 4Diem C05 #o(ers 7M5 tec%ni1 e for osseo s implants. 9 Periodontol -:C25 /=>2:<)2:C?.
HIA335 SCHAAAH@0B 4-:C=?, p 'lis%ed an article demonstrating, clinically, t%at t%e t 'erosity, edent lo s are
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I@!B760 4-:02? (as one of t%e first clinical researc%ers to descri'e a s rgical tec%ni1 e to restore t%e los proced re consisted in scaling t%e root s rfaces to remo"e dental calc l s, treat it (it% lactic acid, dry t%e s rf alco%olic sol tion, place on t%e root and 'one defect a piece of 9apanese paper soa+ed in cell loid li1 id, s pre"enting all possi'ilities of t%e paper getting o t of position and, finally, s t re t%e flaps of t%e s rgical (o nd cl ' t%e Paris. Dental Cosmos -:0/5 /;>=:?.
In -:.2, BIMAB et al., tested t%e %ypot%esis t%at ne( connecti"e tiss e attac%ment co ld 'e o'tained on a pre" s rface t%ro g% cells originating from t%e periodontal ligament. 3%ey demonstrated 'y %istological st dies a inserting principal fi'ers formed on t%e pre"io sly diseased root s rface (%en a periodontal s rgery tec%ni1 e (a 4(%ic% d ring t%e (o nd %ealing did not allo( t%e dentogingi"al epit%eli m and t%e gingi"al connecti"e tiss e prepared root s rface?4Byman S5 Aind%e 95 8arring 35 0ylander H Be( attac%ment follo(ing s rgical treatment Clin Periodontol -:.25 :>2:0)2:<?.
7@ADMAB, in -:<=, affirmed t%at t%ere are t%ree specific pro'lems t%at in"ol"e t%e interrelation 'et(een t%e ging first consists of periodontal poc+ets t%at e2tend 'eyond t%e attac%ed gingi"a reac%ing t%e al"eolar m cosa. 3%e fren l m t%at can transmit tension for t%e gingi"al margins and ca se recessions. 3%e t%ird, t%e f nctional con promotes a decrease of attac%ed gingi"a le"els 47oldman HM Periodontia. =ed St Ao is> CF Mos'y -:<=?.
In -:;/, @@0B de"eloped a tec%ni1 e for repositioning t%e fren m in periodontal pro'lems 4Corn H Cir rgia 7oldman HM5 Co%en E Periodontia ;ed 3rad. 9osJ A i& Freire de Andrade, 0io de 9aneiro> 7 ana'ara 8oogan, -:.
According to BA#60S 4-:</?, (%en t%e apical point of periodontal poc+et migrates apically 'eyond t%e m coging to create diffic lties d ring t%e periodontal treatment d e to t%e str ct ral differences 'et(een t%e attac%ed g #ased on t%ese aspects, t%e a t%or (as one of t%e first a t%ors to relate t%e necessity of preser"ing t%e strip s rgical tec%ni1 e for repositioning t%e attac%ed gingi"a in relation to t%e 'one crest of t%e al"eolar process. A f t%e reaction of e2istent gran lation in t%e area is eliminated, t%e flap is no( apically repositioned along t%e marg 'elo( t%e original position and, finally, s t red 4Ba'ers CA 0epositioning t%e attac%ed gingi"a. 9 Periodontol -:</
A0IA!D@5 3I006AA 4-:<C?, modified t%e BA#60*s tec%ni1 e 4-:</?, introd cing t%e concept of t%e t(o "ertical in allo(s to preser"e or to increase t%e strip of attac%ed gingi"a alt%o g% t%e periodontal poc+et is apically positio 'eca se a ne( 'and of attac%ed gingi"a is formed coronally to t%e replaced attac%ed gingi"a 4Aria do AA5 3yrrel t%e &one of attac%ed gingi"a. 9 Periodontol -:<C5 2.>-0;)--0?.
F0I6DMAB 4-:;2? Proposed t%e term ,apically repositioned flap,, instead of t%e term ,attac%ed gingi"a rep BA#60S, in -:</ 4Friedman B M cogingi"al s rgery> t%e apically repositioned flap. 9 Periodontol -:;25 ==>=2.)=
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C@0B 4-:;/'? and 70!P6 4-:;;?, proposed different modifications in t%e tec%ni1 e of lateral sliding of t%e flap. ) c t'ac+ incision 4Corn H Periodontics -:;/'5 2>22:?.
) s 'marginal incision 47r pe H6, Modified tec%ni1 e for t%e sliding flap operation. 9 Periodontol -:;;5 =C>/:-)/
For C@H6B5 0@SS 4-:;.?, t%e lateral sliding of t%e flap and t%e flap mo"ed laterally from edent lo s areas are donor area. 3%ese displacement tec%ni1 es re1 ire a 'and of attac%ed gingi"a e1 al or lig%tly larger t%an t%e nec Fre1 ently, an ins fficient or a'sent 'and of attac%ed gingi"a in t%e adDacent toot% red ces t%e predicta'ility o aspects, t%ey de"eloped t%e tec%ni1 e of do 'le papilla laterally positioned flaps. 3%e flap is formed 'y s t ring t to 'e co"ered 4Co%en DE5 0oss S6 3%e do 'le papillae repositioned)flap in periodontal t%erapy. 9 Periodontol -:;
B@0#607 in -:2; (as t%e first to report t%e coronally repositioned flap in order to co"er root s rfaces. In -:C< tec%ni1 e (it% t%e same goal ' t com'ining t%e se of a free gingi"al graft 2 mont%s prior to t%e coronally repo performed t%ro g% t(o "ertical parallel incisions lea"ing reac%ing t%e al"eolar m cosa, o'taining a enlarged 'and 9P5 AKsc%er #5 MK%lemann H0 Coronally repositioned periodontal flap> clinical e"al ation after one year. 9 Clin Per
In -:;=, #9L0B, descri'ed a free transplantation of gingi"a. In -:;;, BA#60S de"eloped a tec%ni1 e (it% fr m cosa mem'rane in periodontal s rgical proced res t%at aimed to create 'ands of attac%ed gingi"a, enlarge t% "esti' lar forni2 4Ba'ers 9M 62tension of t%e "esti' lar forni2 tili&ing a gingi"al graft. Periodontics -:;;5 />CC?.
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root, ' t its maDor part is placed in an ,en"elope, pre"io sly created 'y an ndermining partial t%ic+ness incisi defect 40aet&+e P# Co"ering locali&ed areas of root e2pos re employing t%e ,en"elope, tec%ni1 e. 9 Periodontol -
AAB7605 AAB760 4-:.<?, p 'lis%ed an article in (%ic% t%ey introd ce ne( concepts, indications and proced res ( s rfaces and enlarge 'ands of attac%ed gingi"a com'ining a partial)t%ic+ness flap coronally positioned (it% a s 4Aanger #5 Aanger A S 'epit%elial connecti"e tiss e graft tec%ni1 e for root co"erage. 9 Periodontol -:.<5 <;>C-<
Aanger 3ec%ni1 e 4Co rtesy of Dr. Cla dio 9Mlio Aopes, !BICAS36A@?
3A0B@E4-:.;? descri'ed t%e tec%ni1 e of a semil nar flap coronally mo"ed and designated primarily to c recessions of 2 or =mm. 3%e tec%ni1 e in"ol"es a semil nar incision made parallel to t%e free gingi"al margin positioning t%is tiss e o"er t%e den ded root 43arno( DP Semil nar coronally repositioned flap. 9 Periodontol -:.;
In -::2, HA00IS proposed a tec%ni1 e root co"erage as follo(> do 'le papilla incisions, partial)t%ic+ness flap periosteal 'ed prepared, connecti"e tiss e s t ring, and do 'le papilla flap s t red o"er t%e graft 4HA00IS 09 9 P
In -::/, SHAB6A6C5 3I##633S, p 'lis%ed an article referring a'o t periodontal micros rgery. 3%e micros rgery tec%ni1 e 'y (%ic% normal "ision is en%anced t%ro g% magnification and t%e tec%ni1 es are eac% time less tra m predicta'ility and 1 ality of %ealing 4S%anelec DA5 3i''etts AS A perspecti"e on t%e f t re of periodontal mi -::;5 --> <.);.?.
According to MIAA60 9r5 AAA6B 4-::;? t%e periodontal plastic s rgery encompasses a m c% 'roader range of tre t%e follo(ing defects> t%e s%allo( "esti' le 4"esti' lar deepening?5 t%e a'errant fren m 4frenectomy?5 marg grafting?5 e2cessi"e gingi"al display 4cro(n lengt%ening?5 deficient ridges 4ridge a g mentation?5 ridge periodontally in"ol"ed teet% 4grafting e2traction sites?5 loss of interdental papillae 4papilla reconstr ction?5 ner mo"ement 4s rgical e2pos re?5 aest%etic defects aro nd dental implants 4'one andNor soft tiss e a gmentan de"elopment of periodontal plastic s rgery. Periodontology 2000 -::;5 -->C)2.?.
Ae site Ee' de la SFHAD est ne rJalisation d Ser"ice informati1 e de la #I! SantJ 4#i'liot%1 e Inter n 3e2tes et images O 200. S&$AD ) 0eprod ction interdite sans a torisation
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