Periodontitis, also known as periodontal disease, is a common condition of the soft and bony tissue around the teeth that can lead to tooth loss and other serious complications. In the treatment of periodontitis, a commonly used surgical technique is the gingival flap, which consists of lifting and repositioning the gum tissue in a different position to allow access to the affected areas of teeth and bone.

The purpose of this article is to examine the use of the gingival flap in periodontal treatment and to evaluate the effectiveness of this surgical technique in reducing inflammation and regenerating affected tissue.

Gingival anatomy

The gingiva is a soft tissue that covers the bony crest of the jaw and mandible. The gum consists of two main layers: the epidermis and the dermis. The epidermis is the outer layer of the gum and contains epithelial cells and melanocytes, which produce pigment in the skin. The dermis is the inner layer of the gum and contains the blood vessels and nerves that provide nutrients and sensory information.

Periodontal disease

Periodontal disease is a chronic condition that affects the soft and bony tissues surrounding the teeth. The condition can be caused by a number of factors, including poor oral hygiene, smoking, diabetes and genetic predisposition. Symptoms of periodontal disease include bleeding gums, inflammation, pain and weakness of the teeth.

Periodontal treatment

Periodontal treatment can be achieved by several methods, including brushing and flossing, antibiotic therapy, scaling, root planing and periodontal surgery. Periodontal surgery can be used to treat advanced periodontal disease and can be performed using a number of techniques, including gingival flap.

Gingival flap

Gingival flap is a surgical technique used in periodontal treatment, which consists of lifting and reorienting gum tissue to a different position to allow access to the affected areas of teeth and bone. This technique can be used in a variety of periodontal surgical procedures, including bone regeneration and peri-implant treatment.

Effectiveness of the gingival flap

Gingival flap has been evaluated in a number of clinical studies and has demonstrated high efficacy in reducing gum inflammation and improving periodontal health.

In a study by Kuru et al (2015), gingival lambo was found to have significant efficacy in treating advanced periodontal disease and significantly reduced periodontal probing depth, indicating improved gum and bone health.

The gingival flap can also be used in bone regeneration, such as in bone augmentation procedures. In a study by Wang et al. (2018), it was found that gingival flap was effective in increasing the quantity and quality of bone tissue in bone augmentation cases.

However, the use of gingival flap may also be associated with some risks and complications. These include pain, inflammation, bleeding and infection. It is important for patients to be aware of these risks and to discuss available treatment options with their doctor.

The gingiva is the main soft tissue in the oral cavity, located close to the teeth, and plays a role in forming a tight seal around the alveolar bone to stabilize the dental units.

It is well vascularized and traversed by nerve threads, so it is sensitive to changes in the oral cavity.

It can also often suffer trauma, through mechanical, chemical or thermal injury from food.

In the event of trauma, the gums’ defence reaction takes the form of inflammation.

If left untreated, the inflammation spreads to the bone. It is good to know that retracted gums can be restored to their previous consistency and shape by sanitizing and removing irritating spines.

However, when the underlying bone is injured, it responds by resorption, an irreversible phenomenon.

Once the bone begins to lose density and volume, teeth are increasingly susceptible to significant migration and crowding of the socket.

Gingival flaps are performed when the bone needs to be uncovered or the tooth root needs to be accessed directly.

Most often, flaps are used to treat periodontal disease, especially if the initial treatment of regular hygiene does not bring improvement.

When we want to perform bone addition to augment a resorbed ridge, the procedure starts by performing flap to give us access to the underlying hard tissue.

Steps in performing a flap

• Anesthesia of the area to be explored

• Cutting the flap according to the chosen landmarks and detaching them to gain access to the tissue to be operated on.

• If thorough root canal hygiene of teeth affected by periodontal disease is desired, the doctor, after exposing the desired surface, will scrub and scour the tooth surfaces. The inflamed tissue will be removed and the sharp bone ridges will be recontoured so that they are level and do not constitute irritating spurs for the periodontium.

• After removal of dental plaque and calculus, the gingiva will be repositioned and anchored according to the original arrangement using sutures. The wires with which the lambo is sutured can be non-absorbable, meaning that a subsequent removal session is required every 7-10 days, or resorbable, which, as the name suggests, dissolve on their own.

To reduce postoperative discomfort, the doctor may indicate the administration of analgesic medication.

It is very important for the patient to maintain hygiene according to the dentist’s instructions, to prevent plaque and tartar deposits from reappearing or over-infection of the area that has been treated.

If the patient also suffers from other general or local pathologies which may favor the superinfection of the intervention area, antibiotic treatment will also be prescribed.

The gums may bleed slightly after the operation. If, however, the pain and bleeding are persistent and massive, the patient should consult the doctor who performed the operation as a matter of urgency.

For patients who are healing normally, the post-operative check-up will be at 7-10 days, which also coincides with the removal of the non-absorbable sutures.

Conclusion

Gingival flap is an effective surgical technique used in periodontal treatment.

This technique can be used in a variety of periodontal surgical procedures, including bone regeneration and per implant treatment. However, the use of gingival flap may also be associated with some risks and complications.

It is important for patients to discuss available treatment options with their doctor and consider the benefits and risks of each option before deciding on a surgical procedure.