CCR3 4 831 PDF
CCR3 4 831 PDF
CCR3 4 831 PDF
doi: 10.1002/ccr3.582
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New suture design in periodontal surgery V. Ronco & M. Dard
832 ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
V. Ronco & M. Dard New suture design in periodontal surgery
Figure 2. (A) Modified horizontal mattress sutures (for wide symmetric recession defects). (B) Modified horizontal mattress sutures (for
asymmetric recession defects).
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. 833
New suture design in periodontal surgery V. Ronco & M. Dard
the roots by coronal translation, that is, a tunnel prepara- within the resin before polishing (Fig. 7). A tunnel prepa-
tion was performed to release and displace the buccal gin- ration was then performed to allow the release and dis-
givo-papillary complex (Fig. 3). The recessions were wide placement of the buccal gingivo-papillary complex from
and symmetric at the upper canines, shallow and asym- the upper right canine to the upper right canine without
metric at the upper central incisors, and shallow and sym- any visible incision (Fig. 8). Connective tissue grafts were
metric at the upper left lateral incisor. harvested from the palate and trimmed to compensate for
Postoperatively, each involved tooth benefited from root concavities at upper left central incisor and canine
suspended vertical mattress sutures (6.0 polypropylene (Fig. 9).
sutures). Modified horizontal mattress were added at the Each involved tooth received modified vertical mattress
upper canines to compensate wideness (green arrows) suturing (6.0 polypropylene sutures). Modified horizontal
and at the upper central incisors to compensate asymme- mattress sutures were also added to compensate for reces-
try (blue arrows), as illustrated in Fig. 4. sion wideness (green arrows in Fig. 10) at the upper right
One week following suture removal, favorable soft tis- canine and upper left lateral incisor and canine and asym-
sue relocation and integrity could clearly be observed metry (blue arrow in Fig. 10) at the upper left central
(Fig. 5).
Clinical case 2
Preoperatively, this female patient complained about the
impaired esthetic aspect of her smile. She presented with
several Miller class I recession defects with resin recon-
structions at the upper right canine and at both upper left
incisors and upper left canine. We decided to surgically
cover the roots and align the gingival collars (Fig. 6).
At the beginning of treatment, resin material was
removed from the roots for biocompatibility reasons. This Figure 5. Case 1 – Clinical view 1 week after suture removal.
was followed by sculpting of a cemento-enamel-like line
834 ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
V. Ronco & M. Dard New suture design in periodontal surgery
Figure 8. Case 2 – Tunnel preparation. Figure 11. Case 2 – Clinical view at 1 week.
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. 835
New suture design in periodontal surgery V. Ronco & M. Dard
836 ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
V. Ronco & M. Dard New suture design in periodontal surgery
Scar formation can be related to iatrogenic suturing. The 5. Silverstein, L. H., G. M. Kurtzman, and P. C. Shatz. 2009.
importance of using both a refined suture material and an Suturing for optimal soft-tissue management. J. Oral.
appropriate suturing technique should therefore be empha- Implantol. 35:82–90.
sized [8, 14]. With particular respect to tissue integrity 6. Wong, M. E., J. O. Hollinger, and G. J. Pinero. 1996.
preservation, 6.0 or 7.0 polypropylene monofilament Integrated processes responsible for soft tissue healing.
anchored sutures seem to be particularly effective. Anchor- Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod.
age at the tooth contact point drastically reduces mechani- 82:475–492.
cal contact between the sling and the tissues. In addition, 7. Silverstein, L. H., G. M. Kurtzman, and D. Kurtzman.
the characteristics of polypropylene monofilament are such 2007. Suturing for optimal soft tissue management. Gen.
that the tissue heals over the sutures leaving very little Dent. 55:95–100.
visible evidence, even immediately after suture removal 8. Zuhr, O., S. F. Rebele, T. Thalmair, S. Fickl, and M. B.
[15–17]. After suture removal, there remains little or no Hürzeler 2009. A modified suture technique for plastic
evidence of visible cleft [18]. However, follow-up control periodontal and implant surgery – the double-crossed
visits remain necessary to assess whether any abnormal soft suture. Eur. J. Esthet. Dent. 4:338–347.
tissue aspects appear in the long term. 9. Pini Prato, G. P., C. Baldi, M. Nieri, D. Franseschi, P.
In conclusion, the combination of sutures in the Cortellini, C. Clauser, R. Rotundo, and L. Muzzi 2005.
Coronally advanced flap: the post-surgical position of the
approach described could be applied in a large variety of
gingival margin is an important factor for achieving
challenging clinical situations where tunneling flap prepa-
complete root coverage. J. Periodontol. 76:713–722.
ration is indicated. The technique seems to offer the
10. Lindhe, J., and S. Nyman. 1980. Alterations of the position
ability to move, harmonize, and stabilize the gingivo-
of the marginal soft tissue following periodontal surgery.
papillary complex in the desired position along the
J. Clin. Periodontol. 7:525–530.
cemento-enamel junction, while soft tissue integrity and
11. Nieri, M1., R. Rotundo, D. Franceschi, F. Cairo, P.
vascular potential are preserved. An extended follow-up
Cortellini, G. Pini Prato, et al. 2009. Factors affecting the
would be ideal to assess the long-term stability of the
outcome of the coronally advanced flap procedure: a
repositioned soft tissues and comparison with the already
Bayesian network analysis. J. Periodontol. 80:405–410.
published suturing techniques.
12. Lassere, B. 1983. [The vertical mattress suture in
periodontal flap surgery]. Inf. Dent. 65:3825–3830.
Conflict of Interest 13. Velvart, P., U. Ebner-Zimmermann, and J. P. Ebner. 2003.
Comparison of papilla healing following sulcular full-
None declared. thickness flap and papilla base flap in endodontic surgery.
Int. Endod. J. 36:653–659.
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