Coronally positioned flap

Coronally Positioned Flap

The coronally positioned flap (CPF) is a periodontal surgical technique primarily used in the treatment of gingival recession. This procedure aims to cover exposed root surfaces, improve esthetics, and reduce root sensitivity by repositioning the gingival tissue coronally over the denuded root.

Indications

The CPF is indicated in cases of:

• Gingival recession
• Root sensitivity
• Esthetic concerns due to exposed roots
• Shallow recession defects

Contraindications

Contraindications for CPF include:

• Inadequate keratinized tissue
• Poor oral hygiene
• Active periodontal disease
• Deep recession defects

Surgical Technique

The CPF procedure involves several key steps:

Initial Preparation

1. Patient Evaluation: Assess the extent of gingival recession and the amount of keratinized tissue available. 2. Anesthesia: Administer local anesthesia to the surgical site.

Incision and Flap Design

1. Incision: A horizontal incision is made at the level of the cementoenamel junction (CEJ) of the affected tooth. 2. Vertical Incisions: Two vertical releasing incisions are made at the mesial and distal ends of the horizontal incision. 3. Flap Elevation: A full-thickness flap is elevated to expose the root surface and the underlying bone.

Root Preparation

1. Root Planing: The exposed root surface is thoroughly planed to remove any plaque, calculus, and diseased cementum. 2. Root Conditioning: Application of root conditioning agents such as EDTA may be used to enhance connective tissue attachment.

Flap Repositioning and Suturing

1. Flap Repositioning: The flap is repositioned coronally to cover the exposed root surface. 2. Suturing: The flap is secured in place using interrupted or sling sutures.

Postoperative Care

1. Antibiotics and Analgesics: Prescribe as necessary to prevent infection and manage pain. 2. Oral Hygiene Instructions: Advise the patient on gentle brushing techniques and the use of antimicrobial mouth rinses. 3. Follow-up Visits: Schedule follow-up appointments to monitor healing and ensure successful root coverage.

Advantages

• Minimally invasive
• High success rate for root coverage
• Improved esthetics
• Reduced root sensitivity

Disadvantages

• Limited to shallow recession defects
• Requires adequate keratinized tissue
• Technique-sensitive

Complications

Potential complications include:

• Flap necrosis
• Incomplete root coverage
• Postoperative infection

See Also

• Periodontal surgery
• Gingival graft
• Connective tissue graft

References

• Zucchelli, G., & De Sanctis, M. (2000). Treatment of multiple recession-type defects in patients with esthetic demands. Journal of Periodontology, 71(9), 1506-1514.
• Cairo, F., Nieri, M., & Pagliaro, U. (2014). Efficacy of periodontal plastic surgery procedures in the treatment of localized gingival recessions. Journal of Clinical Periodontology, 41(S15), S44-S62.