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Pinhole Surgical Technique: historical perspectives


Pinhole Surgical Technique: historical perspectives

The objective of this paper is to present the history of mucogingival surgery from past to present and describe, according to a historical perspective, the introduction of a new procedure without incisions and sutures for the new root coverage, called Surgical Technique Pinhole - Pinhole Surgical Technique ™ (PST ™).

History of gum grafts
In the history of the most important innovations and major developments related to mucogingival surgery, the new procedure called Pinhole Surgical Technique (PST), Surgical Technique Pinhole in free translation; it is considered an absolutely relevant innovation. This technique, which uses scalpels or suture points to new root coverage, is based on the principle of mini-invasive surgery in periodontics introduced in 1992 by Tibbetts and Shanelec.

The PST, understood as a new microsurgical procedure can be considered one of the most recent discoveries in the evolution of soft tissue surgery since the introduction of plastic surgery 2,600 years ago. Precisely for this reason, one cannot conduct a historical study of mucogingival surgery without considering the history of plastic surgery.

The first plastic surgery date back to 600 BC, as reported in the pages of Sushruta Samhita, an ayurvedic collection depicting plastic surgery operations on the nose, ears and lábios1. The Kangra district of Himachal Pradesh, India went ahead with the ancient heritage of the techniques of surgery and became famous by the presence of known plastic surgeons. A description of the seventeenth century reports a transaction as follows: "The patient's nose was cut off as punishment for adultery. A wax layer has been adapted to the nose mold. It was consequently flat and supported on the front and a line around the wax was designed. The operator dissected the amount of skin necessary to cover it, leaving a small patch between the eyes. Thus, the circulation was preserved until there was a union between tissues "2

The descriptions of surgical techniques of Sushruta Samhita-were translated into Arabic in the eighth century. Such practices came to Europe, specifically to Italy in 1400 and were incorporated into the method of Gustavo Branca.3

The Italian medicine was influenced by in-depth knowledge of the vascular anatomy that date back to the Renaissance. Combining, therefore, methods of Sushruta Samhita-to new knowledge in the vascular field, White developed reconstruction techniques of face and nose with flaps from the cheekbones or arm.

Later, in 1597, Gasparo Tagliacozzi, Bologna, published De curtorum surgery per insitionem, your manual for the surgical reconstruction of the wounds on the face of soldados.4 described the reconstruction of the nose using skin of the arm and the replacement of the ears and lips with pedicle flaps. In 1804, Giuseppe Baronio, of Milan, published Degli innesti animali (Animals grafts): This is the first reference to autogenous grafts of skin coming from the same indivíduo.5 hundred years later, in 1906, Iginio Tansini, 5 also in Milan , held the first muscle flap to re-cover a large residual defect of a mastectomia.6 surgery

These procedures were not introduced as a daily routine in America until 1970.

The history of gingival grafts follows a similar path. In 1912 Robert Neumann discovered the mucogingival flap, 7 demonstrating that he was still vital when it was not separated from the vascular support. For several decades, the flap repositioned apically was used to create iatrogenic gingival recessions to treat periodontal pockets. In 1956, Grupe and Warren expanded the retail concept with the flap repositioned laterally to the resolution of recessions; 8 this flap was a direct descendant of the pedicle flap of White. The biggest limitation of pedicle flaps was the meager amount of adjacent tissue donation and possible loss of gum tissue in donor regions. However, this was the first technique able to get a new satisfactory root coverage.

The free gingival grafts, in which, therefore, vascular support was dissected, were first described in 1939 by William Younger The free gingival graft was rediscovered by King, Pennell and Bjorn in the early 1960s and has become popular in the late same decade by Sullivan and Atkins.9-12 In any case, such a procedure was not able to give a new predictable root coverage and usually was accompanied by morbidity of the patient due to the removal of palatal region.

It was a relief when, in 1985, was introduced by Langer and Calagna graft subepitelial.13 This new proposal, next to the tunnel technique proposed by Nelson and Raetzke, always in 1985, has a new, more predictable and less invasive root coverage. 14,15,16

In the last decade has introduced a revolution in the medical surgery field, which made necessary a new formation for thousands of surgeons and rearranging the rooms cirúrgicas.17 This revolution is due to the introduction of the microscope and endoscopic surgery, especially cholecystectomy and repair Arthroscopic of nees´problems .18

Microsurgery today is applied to a large spectrum of medical specialties, liver graft to bypass operations coronário.19,20 These surgeries have such a small incision, once sutured, the fabrics may be coated by a small adhesive fabric strip. These procedures are a natural evolution of microsurgical revolution that began in the early 1960s and culminated in microsurgical medicine moderna 21. A key factor in professional and public acceptance of microsurgery was a significant reduction in morbidity and pain.

In common parlance, with the term "microsurgery" means a surgical technique of the surgeon whose normal vision is enhanced by the possibilities of the microscope. However, in a broader sense, the extent of microsurgical involves a surgical principles comprising special attention to management of tissue incisions reduced dimensions and a precise contact between the tissues after the suturing of the flaps. Shanelec and Tibbetts introduced these principles in periodontics in 1992, improving the results of therapy and reducing postoperative consequences.

Source: Dentist Today, written by John Chao , DDS, JD, MAGD and Dennis Shanelec , D.D.S
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