BEDAH MUKOGINGIVAL

drg. Citra Lestari, MDSc., Sp. Perio

 TUJUAN BEDAH MUKOGINGIVAL
1. Menciptakan zona gingiva cekat yang adekuat
Mengapa terjadi zona yang inadekuat?
- Dasar saku berada dekat, pada atau apikal Batas mukosa gingival
- Perlekatan frenulum/otot yang mencapai saku periodontal
- Resesi yang menyebabkan tersingkapnya permukaan akar gigi
2. Menutup kembali akar gigi yang tersingkap karena resesi gingiva
3. Menciptakan vestibulum yang cukup dalam
TEKNIK BEDAH MUKOGINGIVAL UNTUK MEMPERLEBAR GINGIVA
CEKAT
1. Cangkok Gingiva Bebas
• Cangkok gingiva konvensional
• Cangkok jaringan ikat epitel
• Cangkok Jaringan ikat subepitel

2. Flep Posisi Apikal

 Cangkok Gingiva Bebas
Tahapan prosedur :
- Anestesi
- Penyingkiran saku periodontal
- Mempersiapkan sisi resipien
- Pengambilan cangkok dari sisi donor
- Penempatan dan imobilisasi cangkok
- Pemasangan pembalut periodontal
 Cangkok Gingiva Bebas

Inadequate attached gingiva Muscle dissected back and sutured,

and associated recession creating bed for new graft

Ukur dengan
almunium foil
Outline in roof of mouth of
the donor site
Graft removed from roof, leaving a
skinned knee appearance
 Dressing placed over site Gingiva removed from palate

Graft glued to position on bed Final healing of graft, restoring

band of hard gum
 Ten days after an FGG used
A class II GR, 3 mm in height and 4 mm
for covering the GR
in width on a mandibular left central
incisor.

One year after an FGG for covering

the class II GR
Apa masalah pada cangkok gingiva bebas sehingga para
ahli mengembangkan teknik variasi?
1. Luka pada sisi donor yang lebar menyebabkan rasa
kurang nyaman bagi pasien
2. Warna cangkok yang sedikit berbeda dengan jaringan
sekitarnya

Contoh variasi :
1. Cangkok jaringan ikat bebas
2. Cangkok jaringan ikat subepitel
CANGKOK JARINGAN IKAT BEBAS

Note: patient exhibits generalized

gingival recession in upper and
lower right, anterior, and left
hextants. The cause of these
defect is identified to be tooth
brush abrasion. Many of these
defects has been filled with
composites and were popping off
during flossing.
 Note: Scale and root plane
thoroughly to prepare the root
surface for graft adaptation. Split
thickness flap with vertical
releasing incision perform. Flap is
reflected leaving the periosteum
with blood vessel open to supply
nutrient to the graft. Now the
recipient site is ready to receive
the connective tissue graft from
the donor site
Note: connective tissue harvested
from the palatal area on the
between the first premolar and the
mesial half of the first molar is
usually a preferred donor site.
The graft consists of connective
tissue only, no epithelium is
removed except for the small 1-
2mm width at the top of the graft.
This portion of epithelium needed
to be trim as to avoid cleft in the
healing area.
Notes: Graft adapted and sling sutured
with resorbable resolut suture. The apical
area of the graft also stabilized with
subperiosteal suture. Finally, the split
thickness flap is coronally reposition as to
fully cover the graft. The graft now is
sandwiched with two sources of blood
supply for feeding, from the flap and
from the periosteum. Final suture
performed with goretex suture.
Seven days postop healing

Nine months postop healing

Figure 2. Patient with a high smile that
Figure 5A. Primary closure of the palatal
exposes a discrepant architecture of the
donor site with 5-0 gut sutures.
gingival margins due to recession.

Figure 5B. One-week healing of the palate

Figure 4A. Palatal donor site for a connective
illustrating typical slight connective tissue
tissue graft. The graft has been removed and a
exposure with minimal discomfort for the
strip of connective tissue approximately 1.5
patient.
mm wide has been left coronal to the donor
site to aid in primary closure.

Figure 6A. Slight wide recession on Nos. 7 and

Figure 4B. The connective tissue graft free of 8 with moderately wide recession and a lack
epithelium. of attached gingiva on No. 9.
Figure 6B. Incisions and split thickness flap Figure 6D. Six-0, 7-0, and 9-0 microsutures
with papillary preservation. used for flap closure and graft stability.

Figure 6E. One-year result with root coverage

to the cementoenamel junction, increased
Figure 6C. Connective tissue graft in place on dimensions of the gingiva, and inconspicuous
Nos. 8 and 9. Coronally positioned flap blending of the grafted tissue into the site.
planned for No. 7.
 FLEP POSISI APIKAL
TAHAPAN PROSEDUR
Penempatan flep sebelum dijahit :
- Sedikit koronal dari tepi tulang alveolar
- Pada tepi tulang alveolar
- 2mm apikal dari tepi tulang alveolar
RUMUS PRAKIRAAN LEBAR GINGIVA CEKAT PASCA BEDAH
- Kedalaman saku pra-bedah = 5 mm
- Lebar gingiva berkeratin = 6 mm
- Berapa prakiraan lebar gingiva cekat pasca bedah
- KS prabedah/2 + lebar gingiva cekat prabedah
FLEP POSISI APIKAL
TEKNIK BEDAH MUKOGINGIVA UNTUK MENUTUP AKAR GIGI YG
TERSINGKAP KARENA RESESI GINGIVA
• FLEP POSISI KORONAL
FLEP POSISI KORONAL SEMILUNAR
• FLEP POSISI LATERAL
 FLEP POSISI PAPILA GANDA
 KOMBINASI FLEP PAPILA GANDA DENGAN CANGKOK GINGIVA
BEBAS
• CANGKOK GINGIVA BEBAS
 CANGKOK JARINGAN IKAT SUBEPITEL
• TEKNIK REGENERASI JARINGAN TERARAH
 FLEP POSISI KORONAL
• TAHAPAN PROSEDUR :
1. Anestesi
2. Insisi krevikular
3. Insisi vertikal
4. Pembukaan flep
5. Penempatan flep
6. Penjahitan
7. Pemasangan pembalut periodontal
FLEP POSISI KORONAL
Figure 1. Clinical measurements on the
recession-involved tooth: AA’ = BB’= CC’= X =
recession depth; area of de-epithelization is Figure 3. Incision design: recreation of papilla
colored in red. and de-epithelialization of the current papilla.

Figure 2. Pretreatment view of surgery site on

tooth No. 12 with 6 mm of recession. Figure 3. Incision design: recreation of papilla
and de-epithelialization of the current papilla.
Figure 4. Releasing of the flap: full thickness
then partial thickness at the vestibule; no Figure 6. Application of EMD: root
tension. conditioning; dry and apply EMD.

Figure 5. Scaling and root planning:

odontoplasty if necessary; remove any Figure 7. Securing the flap: coronally position
composite if present. the flap without tension and match the newly
created papilla to the existing papilla.
Figure 8. Result at 1 week following surgery.
Figure 9. Result at 6 months following surgery.

Figure 10. Result at 4 years following surgery.

FLEP POSISI KORONAL SEMILUNAR (TEKNIK
TARNOW)
 FLEP POSISI LATERAL
• TAHAPAN PROSEDUR :
1. Anestesi
2. Penyiapan resipien
3. Insisi krevikular
4. Pembukaan flep
5. Penempatan flep
6. Penjahitan
7. Pemasangan pembalut periodontal
 CANGKOK GINGIVA BEBAS
(TEKNIK MILLER)
• TAHAPAN PROSEDUR
1. Anestesi
2. Penyiapan sisi resipien
3. Pengambilan donor
4. Penjahitan
5. Pemasangan pembalut periodontal

• Beda penempatannya dengan yang dilakukan untuk tujuan

memperlebar gingiva cekat
 CANGKOK JARINGAN IKAT SUBEPITEL (TEKNIK
LANGER)
• TAHAPAN PROSEDUR
1. Anestesi
2. Insisi dan pembukaan flep
3. Penyerutan akar
4. Pengambilan jaringan cangkok
5. Penempatan jaringan cangkok
6. Penutupan flep
7. Pemasangan pembalut periodontal
TEKNIK LANGER
 REGENERASI JARINGAN TERARAH
• TAHAPAN PROSEDUR
1. Anestesi
2. Insisi dan pembukaan flep
3. Penyerutan akar
4. Penyiapan membran
5. Penjahitan membran
6. Penutupan flep
7. Penjahitan flep