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Microscope-Assisted Periodontal and Peri-implant Plastic Surgery

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Microsurgery in Periodontal and Implant Dentistry

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Abstract

The use of microsurgical principles and procedures provides clinically relevant advantages over conventional macrosurgical concepts for plastic esthetic periodontal surgery. The term “periodontal microsurgery” proposed by Shanelec refers to a procedure that has advantages in periodontal surgery. The combination of an improved visual precision with the use of microsurgical tools specifically designed for this procedure allows more precise and less damaging manipulation of both soft and hard tissues and more capacity to properly debride the defect and the root surface, which increases the chances of healing by primary intention. Microsurgical procedures from incision to the final closure of the surgical wound have less extensive flap designs and enhanced vision fields that facilitate identification of defects and anatomical landmarks. Visual acuity is enhanced by both magnification and illumination when performing periodontal surgical procedures with the aid of an operating microscope (OM). Current evidence supports the benefits of OM and outcome superiority of periodontal surgical therapy with the use of OM for root coverage. It is not easy to move out of the comfort zone, especially when significant changes to the daily practice need to be implemented. This is one of the main reasons for limited use of microscopes in the periodontal field. Great determination, effort, and dedication are required to incorporate microscopy into practice; however, after it is accomplished, there is no turning back. Moreover, it takes clinical performance to a new level. The purpose of this chapter was to present the clinical experience with the use of the microscope in periodontal and peri-implant surgery.

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Author information

Authors and Affiliations

  1. Prosthodontics Program, School of Dentistry, Faculty of Medicine, University of Desarrollo UDD, Santiago, Chile

    Juan Carlos Duran

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  1. Juan Carlos Duran
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Correspondence to Juan Carlos Duran .

Editor information

Editors and Affiliations

  1. School of Dentistry, University of Michigan, Ann Arbor, MI, USA

    Hsun-Liang (Albert) Chan

  2. School of Dentistry, University of Michigan, Ann Abor, MI, USA

    Diego Velasquez-Plata

1 Electronic Supplementary Material

Based on the type of intervention, magnifications of 8× to 20× are considered ideal depending on periodontal microsurgery. The anatomical papilla are de-epithelized (MP4 39,846 kb)

Clear magnified vision and preserved, thus reducing trauma and facilitating accurate wound closure (MP4 65,740 kb)

504513_1_En_7_MOESM3_ESM.mov

A vertical incision should be performed in the inter-root concavities and should have a slight divergence (MOV 73,262 kb)

Very small needles should be inserted in the gingiva close to the area where knots will be tied (MP4 41,957 kb)

The simple interrupted suture technique seems to be simple, executing it in a reproducible and systematic manner with consistent and symmetrical bite size is challenging (MP4 40,709 kb)

Point-of-contact sling sutures, the needle is passed below the contact point and the short end is used to interweave it with the long end that goes in the palatal direction. The knot is tied at the coronal end toward the buccal or palatal area, taking care that the occlusion does not touch the knot and break it postoperatively (MOV 57,250 kb)

Treatment of single gingival recessions. Trapezoidal flap (CAF with vertical incisions) (MP4 175,579 kb)

Treatment of single gingival recessions. Laterally moved CAF (MP4 197,611 kb)

Treatment of single gingival recessions. Envelope without incision (MP4 173,370 kb)

Treatment of multiple gingival recessions. CAF in envelope (MP4 165,276 kb)

Treatment of multiple gingival recessions: Modified tunnel (MP4 218,067 kb)

Treatment of multiple gingival recessions: Modified tunnel (MP4 142,352 kb)

Microscope-assisted autograft harvesting, connective tissue graft (de-epithelialized epithelium) (MP4 77,888 kb)

The use of a 20× high magnification microscope is essential because it allows us to clearly differentiate between tissues, enamel and dentin, root surface, presence of cervical lesions, cavities, and restorations (MP4 29,405 kb)

After testing the adaptation of prothesis guide to the mouth (MP4 22,779 kb)

Coronal advanced flap technique with a connective tissue graft (CAF + CTG) was used in teeth 3.2, 3.3, 3.4, 3.5, and 3.6 (MP4 163,802 kb)

Video 3

A vertical incision should be performed in the inter-root concavities and should have a slight divergence (MOV 73,262 kb)

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Duran, J.C. (2022). Microscope-Assisted Periodontal and Peri-implant Plastic Surgery. In: Chan, HL.(., Velasquez-Plata, D. (eds) Microsurgery in Periodontal and Implant Dentistry. Springer, Cham. https://doi.org/10.1007/978-3-030-96874-8_7

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  • DOI: https://doi.org/10.1007/978-3-030-96874-8_7

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-030-96874-8

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