Fate of pocket epithelium in an apically positioned flap.
The fate of periodontal pocket epithelium when sulcular incisions are used in apically positioned flap surgery was investigated by serial histology. Human subjects received apically positioned flap segments on the facial aspect of anterior teeth timed to give 1, 3, 5, 7, 21 and 35 days of healing on the day of extraction. Companion surgeries for comparison consisted of similar flaps, but utilized an inverse bevel primary incision. Assessment of the sulcular incision specimens revealed that epithelial degeneration and dissolution occurred within 7 days and resulted in a collagen-to-collagen attachment of the periodontal flap to the alveolar bone. The inverse bevel incision was consistently effective in removing the pocket epithelium and resulted in healing by a connective tissue union of the flap to the alveolar bone. By 21 days of healing, the 2 surgical methods were indistinguishable histologically. On the basis of this investigation, it is suggested that the inverse bevel primary incision traditionally advocated for apically positioned flap surgeries may be replaced by the more rapid and simple sulcular incision as the preferred technique.
Department of Periodontology, University of Missouri, Kansas City School of Dentistry 64108.
D J
DJ
Pippin
D000539:Alveolar Process / Q000473:pathology; D003238:Connective Tissue / Q000473:pathology; D004848:Epithelium / Q000473:pathology / Q000601:surgery; D006097:Granulation Tissue / Q000473:pathology; D006801:Humans; D009504:Neutrophils / Q000473:pathology; D010514:Periodontal Pocket / Q000473:pathology / Q000601:surgery*; D010518:Periodontitis / Q000601:surgery*; D010519:Periodontium / Q000473:pathology* / Q000601:surgery; D013524:Surgical Flaps / Q000379:methods; D013997:Time Factors; D014945:Wound Healing