4 VISTA PERIOSTEAL ELEVATORS

(25')

1 & 2 straight

2 & 4 bayonet

 

Bone sounding on the buccal and interproximal area to establish Miller class.

 

This is a Miller class I case.

 

 

Debride the outer area of the cementum, even before reflecting any flaps.

 

Root conditioning with tetracyclin, for 3 minutes.  

 

VISTA TECHNIQUE

2 vestibular incisions, one mesial and the other distal, approximately one tooth apart from the teeth involved.

Vista 3 & 4 periosteal elevators (bayonet).

Extend the flap all the way through connecting both incisions.

Then extend the flap to the sulcus of each tooth, making sure there is enough release of the flap to be able to advance it coronally.

 

 

The adequate sized graft is placed through one of the vertical incisions all the way through to the other. In this case Perioderm was utilized.

 

 

 

 

SUTURE

(2'30'')

After placing the Perioderm graft, a vertical sling mattress continuous suture is used.

It starts close to the mesial vertical incision, it enters the buccal, beyond the mucogingival junction, grabs the graft (in this case Perioderm, it comes out on the buccal at the base of the papilla. It then perforates the papilla again, 1mm above where it had come out. It slings on the back (palatal) of the mesial involved tooth, coming out on its distal aspect withou perforating the papilla. It enters then the sulcus, deeply, going beyond the mucogiingival junction and coming out of it, at tha same level of the first entrance.

 

 

Horizontal criss-cross suture to close the vertical incisions.