Important Notes:

• Recession on tooth 14 (tooth 26), particularly the mesial root;

• Implant on the second bicuspid area.

 

 

 

 

FULL & SPLIT THICKNESS FLAP

 

Raise a full thickness flap to mucogingival junction, split thickness beyond it

 

 

ROOT

 

Plane the root (mechanical debridement) to remove any debris expose the smear layer (click here) of the dentinal tubules & the cementum

 

Root conditioning with tetracyclin mixed with lidocain, for 3 minutes (1'29''):

opens dentin tubules, desinfects the root & promotes fibroblasts growth

 

 

6 0 PTFE suture politetrafluorethylene

 

Suture the mesial vertical incision first, rotating your pedicle to its final position (2'22'')

 

Only after that we go for the vertical mattress sling suture (2'27'')using the back of the tooth involved. 

Vertical mattress sling suture: enters at the base of the mesial papilla (on the buccal aspect), passes under the mesial proximal contact point; it goes around the back of the tooth (palatal side), passes under the distal contact point; it enters the base of the distal papilla (on the inner aspect of the flap), after which it passes again under the distal contact point, around the back of the tooth, passing then under the mesial contact point, never perforating tissue.

 

We only tighten on the second pass, & on the second pass we don’t perforate the flap

 

Only after this we finish the closing of the mesial vertical incision

 

And finally a single suture at the distal to do further advancement, it goes in the interproximal, perforates the palate & get back to the flap.

 

The distal part corresponding to the donor site is left to heal by second intention.