In this video, 2 cases are reviewed to provide some key tips on how to repair fenestration defects following extraction.
To start, it is important to remember, that whenever you encounter a periapical radiolucency which is expressing itself in the soft tissue, you can be fairly certain there will be a fenestration defect following extraction. So it is important to know in advance how you would approach this situation, and prepare accordingly.
In these cases, you want to use a sub-marginal incision and raise a semi-lunar flap (1) to expose the fenestration defect to access it and clean it out. The key point here is that, when possible, you need try to spare the marginal tissue and the papilla. The reason for this, is that if you didnt do this it will be almost impossible to reconstruct the area properly and healing will be compromised. You will see this in the second case presented, where the marginal tissue following extraction was kind of thin, which resulted in inadequate marginal gingiva retained for suturing.
Another key point in these cases, is that after placing allograft into the defect (in these cases DALI Mineralized Cortical Cancellous Bone Mix was used) you generally want to use a flexible collagen membrane, like OsseoSeal or Neomem FlexPlus, as opposed to a stiffer collagen membrane. While stiffer collagen membrane certainly have their own uses cases, in these situations you really need to have a membrane that will adapt well to the surrounding bone, and flexible, porcine-derived membranes are ideal for these cases.
References
- "A semilunar coronally positioned flap is described. The technique involves a semilunar incision made parallel to the free gingival margin of the facial tissue, and coronally positioning this tissue over the denuded root. This technique has the advantage over other coronally positioned flaps, in that no sutures are required, there is no tension on the flap, there is no shortening of the vestibule, and the existing papillae are not interfered with." Semilunar coronally repositioned flap J Clin Periodontol 1986 Mar;13(3):182-5. doi: 10.1111/j.1600-051x.1986.tb01456. Tarnow et al.
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