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ePaper created 2015-03-10, 11:16:47 | version 1.33.01
68 — issue 1/2015 Periodontics Article Editorial note: A complete list of references is available from the publisher. tures. Considering the need to preserve the donor site, which is left exposed, Scharf et al. described a modification of this technique that preserves the epithe- lium of the donorsite via dissection of the palatal flap.12 This allows tissue coaptation and suturing of the donor site after flap tucking. This modification reduces the morbidity associated with the original technique5 and improves postoperative masticatory capacity.13 It is, however, important to highlight that in order to achieve a good postoper- ativeoutcome,surgicaltechniquesinvolv- ing pedicle flaps are strictly dependent upon the skills and dexterity of the sur- geon, who must be meticulous during tis- sue manipulation. Therefore, the use of thismodifiedrollenvelopetechniquemay beregardedasafeasibleapproachthatal- lows for a less morbid postoperative re- covery owing to flap coaptation without areas of exposed connective tissue. Re- duced graft healing time is anotherfactor that improves the quality of the grafted area, with reduced risk of loss of buccal sulcusdepth,whichinthepresentcasere- port led to adequate implant-supported prosthetic rehabilitation. Several techniques describe possible waystorepairanOAF,leavingthesurgeon todecideonthemostappropriatemethod for each case, taking into consideration factors such as the size of the fistula and the duration of the infection.6 Alongside the development of periodontal plastic surgery, new techniques have been re- ported in the literature for the closure of OAFs using a cutaneous flap from the an- gular artery,9 grafting of polyurethane foam-based biodegradable materials1 and resorbablerootanalogs.10Thebuccalpedi- cle flap technique combined with the Bichat’sfatpadhasshowngoodfunctional results;3 however, it causes loss of buccal sulcus depth, which may interfere with future prosthetic rehabilitation.6 Among the periodontal plastic surger- ies that aim to increase tissue volume in theedentulousalveolarridgeistherollen- velopeflapdescribedbyAbramsetal.This procedure entails the preparation of a pedicle flap on the palatal aspect of the ridge with the same dimensions as the de- fecttobecorrected.11Theepitheliumisre- moved and the pedicle flap is tucked into the pocket created between the connec- tive tissue and the periosteum of the buc- calregion,whichisthenstabilizedwithsu- Fig. 8 Removal of the fistular epithelium. Fig. 9 Immediate post-op result. Fig. 10 The situation at the six-month follow-up. Fig.8 Fig.9 Fig.10 Conclusion The clinical analysis confirmed adequate tissuequalitywithcompleteclosureofthe OAF, with no relapse and no loss of sulcus depth or keratinized tissue.