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Blood Supply of Human Gingiva Following Periodontal Surgery

VIEWS: 52 PAGES: 12

									Blood Supplyof Human                                                   artery to study the vascular architecture of the cat
                                                                       mandible and demonstrated that the blood supply to
Gingiva Following                                                      the periodontal ligament emanates from three different
                                                                       sources; namely, alveolar bone, gingiva and apical
PeriodontalSurgery                                                     arteries.
                                                                          Techniques to study gingival capillary architecture
A FluoresceinAngiographic Study                                        and function have been reviewed by Clemmesenl3 and
                                                                       Gehrke et al.14Recently, a fluorescencevital micros-
                                                                       copy method was used for repeated in vivo examination
                                                                       of vascular patterns in the buccal gingiva of cats and
by                                                                     d o g s . t st' a
W n n N E n o n u n N N .D . M . D . *
           M                                                              The use of fluorescein angiography to observe the
                                                                       blood circulation in healthy and inflamed gingiva in
SEsesrreN CreNclo.o.o.s.t
             G.                                                        man was described by Mormann and Lutz.rT The
                                                                       method allowed successful evaluation of functional
TnE vnscurnn supplv of gingival tissues during and                     conditions in the gingival capillary bed. Sodium fluo-
subsequent to periodontal surgery is critical to the                   rescein was selected to study the circulation in view of
healing of the tissue. Most studies of the blood supply                its widespread use in medicine.'8 The 5th edition of
of gingiva have been done in animals or on human                       Goodman and Gilman's textle statesthat its diagnostic
cadavers,and have shonn that the blood supply to the                   usefulnesslies in its fluorescent properties and that
free and attached gingiva is derived mainly from the                   untoward effects are minimal. When they do occur,
supraperiostealvesselst'1n'hile the periodontal liga-                  they are limited to nausea and vomiting. Our experi-
ment is supplied bv vesselsperforating the alveolar                    ence with this agent resulted in only one patient
bone proper.3 Kindlova{'i described anastomoses       be-              experiencingmild nausea.
tween vesselsof the gingiva and periodontal ligament,                     The purpose of the present study was to use fluores-
though the capillaries $.ere arranged differently in each              cein angiography in humans in order to observe altera-
of these two netuorks. In the normal periodontium of                   tions in gingival circulation following various modifica-
different laboraton' animals. connectionsbetween gin-                  tions of mucogingival flap design.
gival and periodontal ligament vessels were seldom                        The rationale for this approach was to confirm, in
observed.6                                                             humans, previous animal findings concerning pathways
   The independence of the gingival and periodontal                    of gingival circulation as well as to provide additional
ligament blood supplies also has been demonstrated                     information relative to current concepts of periodontal
functionally. Occlusion of vessels in the periodontal                  flap design.
ligament does not effect the blood supply of the
                                                                                     MerEnrers eNo MrrHons
gingivai and occlusion of arterioles supplying the gin-
giva does not appear to alrer rhe blood supply of the                    Injection Technique
periodontal ligament.8 However. in the latter study,                      All patients received an intravenous injection of 2
the initial revascularization of the gingiva was derived               ml of 20Vo sodium fluorescein at 24 hours after the
from vesselsof the periodontal ligament, thus demon-                   surgical procedure. Employing a rapid injection ante-
strating a potential for extensive collateral circulation              cubital venipuncture technique an adequate fluorescein
to the gingiva from the periodontal ligament. Garfun-                  concentration occurred during the first passage of the
kel and Sciakye have made a similar observation in                     dye through the gingival vasculature. After 15 to 20
describing the vasculature of the gingiva and periodon-                seconds, the Na-fluorescein entered the gingival capil-
tal ligament. Kennedyroalso showed that when specific                  lary system. An initial photographic sequence of 15
needs arise a compensatory blood supply can be pro-                    exposures showed that the intracapillary phase of the
vided easily.                                                          fluorescein labeling occurred 15 seconds after the
   The distribution pattern of the vessels in human                    beginning of the injection. The fluorescein was then
jaws was studied by Hayashi'r using carmine gelatin.                   allowed to permeate through the vessel walls and to
He found a richer blood supply in the upper jaw, with                  diffuse evenly into the gingival tissue. Additional pho-
more vascularizationon the lingual periosteal aspects                  tographs were taken 1, 3, 5 and 10 minutes after
of both upper and lower jaws than the buccal. though                   injection, to document postangiographic plasma fluid
the anterior teeth were an exception to this rule.                     diffusion.
Cohenl2injected the samedye into the common carotid
                                                                       P hoto grap hic Technique
   * Department of Cariology and Periodontology,
                                                   Dental Institute.     The principles of fluorescein angiography of the
University of Zurich, Zurich, Switzerland.
   1 Department of Periodontology, School of Dentistry, State Uni-     gingiva have been described previously.lT' 20-23 this
                                                                                                                      In
versity of New York at Buffalo, 3435 Main St., Buffalo, NY.            study a new photographic system was used (Fig. 1).
682 Mdrmann, Ciancio                                                                                                                                                            ,ni;.til?I",',i?
The system consistedof a Zeiss operating microscope             electronictimer unit. Optimal harmonizing of the Zeiss
with a newly constructed integral coaxial electron              emulsion (485 nm) and absorption (520 nm) filters
strobe light (720 W sec), an integral halogen pilot             provided fluoresceinangiographsof high contrast. Ko-
light (100 W) and a monitoring Zeiss power and                  dak Ektachrome High Speed film was used and proc-
                                                                e s s e da t 8 0 0 A S A .
                                                                   Eight subjectswith an age range of 20 to 50 (4 male
                                                                and 4 female) were included in this study. AII surgical
                                                                proceduresdescribedwere performed under local infil-




                                                                                                  in t e r n
                                                                                                  bevel
                                                                                                  incision
                                                                                                  ( S u b i e c tB )




                                                                  horizontal
                                                                  incision
                                                                               t
                                                                  ( S u b i e cA )                                                         -main      periodontal vessels
                                                                                                                                                intraalveolar vessels
                                                                                                                                                Yessels lying above
                                                                                                                                                periodontium
FIcunE 1. Z : Zeiss operating microscope, Oy and 02             F t c u n r l , S t l t t ' l t t r r t r r , . r r , . t r r l 1 1,{r q l r i ( / l t l b l r t , ' t l s u p p l v u n d
                                                                                                                                          ,
separateoptical systems, M, and M2 motor driven cameras, F      e X p e r i t t t t ' t t t u(l 1 i \ \ r ' ( i l r , r l , h \r j l l 0 a : / , l l i u ' r i r l \ 1 ( ) t l r t t t t t t i t t gi t t l l t t '
: Jbcusing knob, H:      height dial, HP:   head positioner,    fac'ial uttutltr'rl gtrr{rri/ . rl'rl(jrrig It, ltrtl71 rrr Suhjcct .\ rtrirl
'VtlB -
        removable individual wax bite, LR : lip retractor, CS   t l i s s e t t i t t r tr r , / I / i , g t r t g t l t t - l . r i ! , d t t n l d l r l r l ( 1 J / ( / f l l ( ) J tl t t t i s i t t r t i t t
                                                                                                                                                                                          r
: chin supporl, ST : standardizing device.                       S u b i c c tB .




FrcunE 3. Subject A. Angiograph 24 hours afier fult thickness horizontal incision running in attached gingiva of the lower
anterior region indicated by thick vertical black arrows. Long white arrows show central anemia, short arrows show zones of
partial blood supply by collateral circulation, clear zones: normal blood supply.
Volume 48
Number 11                                                                                Blood Supply of Human Gingiva            683

tration anesthesia(Xylocaine with 1:80,000 epineph-                   aspect of the mandibular right central incisor and the
rine). Silk sutures (5.0) were placed wherever a flap                 facial papilla between the mandibular left central and
was raised. All flaps were covered with a periodontal                 lateral incisors (Fig. 5). The purpose of this procedure
dressing which was removed at the time of photogra-                   was to determine the effect of dissecting the anasto.
phv.                                                                  mosis between the gingival and the periodontal vessels
   ln subject A a hoizontal incision extending to bone                a t t h e g i n g i v a lm a r g i n .
was made at the mucogingival junction in the area of                      In subject C the incisions for a full thickness flap
the mandibular incisors. The purpose of this procedure                were made extending to bone in the mandibular right
was to determine the effect.of dissecting the supraper-               anterior region but the flap was not raised. Between
iosteal gingival vesselsat the mucogingival junction on               the mandibular left incisors the same incisions were
gingival blood circulation coronal to the incision as                 made and a labial full thickness replaced flap was
shown in the schematicdrawing (Fig. 2).                               raised (Fig. 7). The purpose of this experimental
   In subject B an internal bevel incision extending to               procedure was to evaluate the effect on circulation of
bone was made as shown in Fig. 2. This surgical                       raising a flap.
Drocedure was carried out at two sites: The facial                        In subject D two labial full thickness replaced flaps




FrcunE 4. Subject A. Clinicol aspect 18 hours after ltori:ontal   incision   Tltree areas of superfcial necrosis coronal to horizontal
incision (arrows).




                                        9:




               Ftcurt 5 . Subject B. Clinical view immediately after internally beveled incisions (IBI), BL -- blood.
684 M6rmann, Ciancio                                                                                                  ..i;i,iill"."1ii
were raised. Between the mandibular right incisors the               (Fig. 13). Both flaps had approximately the same
vertical incisions extended to the mucogingival junc-                length but the base of the right flap (NF) was narrower
tion. Between the mandibular left incisors the vertical              than that of the left (BF) in terms of the relationship
incisions were twice as long, extending beyond the                   of flap base to length. This design allowed an evalua-
mucogingival junction (Fig. 10). The purpose of this                 tion of the role of the width of the base/flap length.
design was to determine the effect of the length of the                 In subject F a laterally positioned flap was placed
incision and the ratio of length to width on gingival                over an area of recession on the labial aspect of the
flap blood supply in replaced full thickness flaps.                  maxillary left cuspid (Fig. 16). The coronal half of the
   ln subject .E two labial laterally positioned flap                flap was partial thickness and the apical half was full
procedureswere performed to cover areasof recession                  thickness. The flap was designed so that its base was
over the mandibular right and left lateral incisors.                 less than 1/z of its length. Flap mobilizalion was easy
Both flaps were prepared with an experimental flap                   becauseof its length. The purpose of this design was
design so that they were partial thickness in their                  to determine the effect on blood supply of overextend-
coronal half and full thickness in their apical position             ing the length of a flap.




                        Frcunn 6. Subjec'tB. Angiograph 24 hours after internally bevelled incisions (IBI).




 FrcunE 7. Subject C. Clinical view 24 hours afier surgery; vertical incisions as for a full thicknessflap (I) and actual raised full
 thickness flap (FF).
Volume 48
Number 1 1                                                                           Blood Supply of Human Gingiva 685




Frcunr 8. Subject C. Angiograph 21 hours after surgery showing disturbance of capillary blood supply (arrows) at incision sites
(I) and in the area of thc raised .full thicknessflap (FF).




FIcune 9. Subiect C, angiograph 96 hours a-fter surgerv shox'ing still more areas of repair at raised and retracted full thickness
flap (FF , arrows).

   In subject G the same flap as thar described for                                          Resurrs
subjects E and F was positioned over an area of
recession on the buccal of the maxillarl right first               Subject A
premolar (Fig. 19). This flap differed from that for                 The horizontal incision in subject A was evaluated
subject E in that its base lay in a zone of attached               24 hours after it was made (Fig.3). At this time a
gingiva which had been widened by a free graft of                  disturbance in gingival blood supply was present coro-
palatal mucosa 3 months ago. Therefore this flap had               nal to the incision. This suggeststhat the blood flow to
less mobility than the others described.Consequently,              the gingiva was mainly in an apical to coronal direction.
in being laterally positioned the flap was bent with               When the blood vesselswere dissected horizontally, a
traction force needed to fix it to the recipient site.             collateral circulation..wasnot initially established in the
Tension was exerted by the sutures as they held the                gingival areas coronal to the horizontal incision as
flap in place. With this design the combined effect of             shown in the 24-hour angiograph (Fig. 3). Clinically
tension and flexion on the flap's blood circulation                the horizontal incision resulted in local superficial
could be evaluated.                                                gingival necrosis in the same region of angiographic
686 Mdrmann, Ciancio                                                                                              ,ui;"'ii?l',"i?i
circulation disturbance 48 hours after it was made                 circulation was reduced by about 50Vo at the site
(Fig.
    a).                                                            where the full thickness flap was both raised and
                                                                   retracted. At 96 hours both wounds appearedclinically
Subject B                                                          similar. However, the vascular pattern of the area
  The internal bevel incisions in subject B are angio-             along the incision lines of the raised flap was still
graphically shown 24 hours later (Fig. 6). At 24 hours             poorer than that of the "nonelevated flap" (Fig. 9).
no changes were seen in gingival circulation. This
suggeststhat the blood supply to the gingival tissues              Subject D
was adequate even when the blood vesselsfrom the                      In subject D the flap with the longer vertical incisions
papillary and periostealarea were severed.                         showed a poorer revascularizationat 24, 48 and 96
                                                                   hours (Figs. 10, 11,12).The poorer revascularization
Subject C
                                                                   of the longer flap (LF) resulted in a triangular, cleft-
  The incisions and flap in subject C are shown angio-             like tissue loss at its marginal edges of approximately 2
graphically (Fig. 8) at 24 hours after surgery. Both               mm as indicated by the vertical dotted lines in Figs.
areas showed a disturbance in circulation (Fig. 8):                10. 11 and 72. As can be seen from the photographs,
however, examination of the angiographs shou,s that                 the short flap (SF) showed less circulation disturbance




 FrcunE 10. Subject D, angiograph 24 hours after surgery . Short full thickness replaced JIap (SF). Long full thickness replaced
flap (LF). Distances A, B, C, D from cemento-enamel junction to respective flap margins. Arrows indicate clinical flap outline
and area ofsubsequent necrosis.




    Frcunr 1L. Subject D, angiograph96 hours artersurgery.Increasedtissueloss at long llap (LF) as indicatedby C' and D'
                                                                                       Blood Supply of Human Gingiva 687




   Frcunl 12. Subject D, angiograph 96 hours after surgery. Increased tissuelossat long
                                                                                        flap (LF) as ind.icatedby C,, and D,,.

                                    9 l




                                                                           : i    "l




FtcurE 73. Subject E, clinical aspect immediatelv
                                                  follou'ing surgery', narrow based partial split thickness /ap   (NF) and broad
based partial split thickness fap (BF).




and a better healing of the gingival margin than the               Subject F
long flap (LF).
                                                                     In subject F minimal tension and flexion was neces-
Subject E                                                          sary to position and fix the overlong flap laterally.
                                                                   Nevertheless,a small ischemicmark (N) was produced
   In subject E at 24 hours (Figs. 13. 14) the flap on
                                                                   by the suture (Fig. 17). Also, the vascular pattern in
the right with the narrow base (NF) showed a reduced
                                                                   the flap was good at 24 hours (Fig. 17) and 7 days
circulation of approximately 507o. The flap with the
                                                                   (Fig. 18), new circulation in the donor site (DS).
wide base (BF) showed less disturbance. At 7 days
(Fig. 15), the vascular pattern in both flaps was the              Subject G
same. After 7 days (Fig. 15) a cleft-like tissue loss                In subject G the flap was bent into position and
(TL) was discernible at the gingival margin of the                 tension was exerted by the suture to hold the flap in
narrow based flap. Healing of the gingival margin at               place. At 24 hours no vascularizalion was present in
the wide based flap showed an acceptable gingival                  the flap (Fig. 19). At 5 days the flap had sloughed
margin with minimal clefting.                                      away from the root surface (Fig. 20).
                                                                                                                   J. Periodontol.
                                                                                                                  November, 1977
688 Mbrmann, Ciancto

                                                                               :;   l   :




                                                                             circulationonly in narrow based flaP (NF), clinical
Frcunr 14. subjectE, angiograph24 hours after surgery.Fifry perc.ent
o"riiii of llap iidicated by"ariows. Eighty prrrint circulation in broad basedflap (FB)'




                                                                        (TL) at the narro"r./ap      (NF) than at the broad flap
 Frcutt 75. Subiect E, angiograph 7 days after surgery' More tissue/oss
 (BF). New vascularization in the donor site (DS)'



                                                                     blood circulation with experimental full thickness inci-
          ",                               on
                                    procedures
   rheeffect ""rr",,?ii,i""i'i?i'.rt.",                              sions in humans, vascular disturbanceswere observed'
                                                                     They resulted in superficial necrosis in those areas
 the gingival capillary blood circulation was evaluated
                                                                     coronal to the incisions.23 These findings indicate that
 by means of fluorescein angiography' The circulation
                                                                     main   gingival vessels may have been severed in these
 .hung.t observed suggested that flaps receive their                           -Ryan,"'
                                                                     region-s.           in another human study, reported
 major blood supply from their apical aspects' The full
                                                                     th"at the blood supply of skin is not homogenous' Our
 thiikness incision in clinically healthy gingiva revealed
 that, functionally, the blood supply was mainly directed            angiographic observations suggestthat the same is true
 caudocranially from the vestibule to the gingival mar-              for human gingiva.
 gin. This is consistent with the morphological findings                In this ttuOy, the internal bevelled incision (subject
                                                                     B) severedthe anastomosis    between gingival and peri-
 i-n animals by Kindlovaa'5 and the histologic findings in
  mongrel dogs of Novaes et al.2a                                    odontal vasculature and between gingival and interden-
                                                                      tal vasculature.Angiographically, the separations  from
   In a fluorescein angiographic study on the gingival
Volume 48
N u m b e r1 1                                                                     Blood Supply of Human Gingiva         689
either vasculaturesshowed no effect on circulation of            base, the better is its circulation pattern. This was also
the free and alveolar gingiva. This finding verifies the         stated by Patterson30who described a series of experi-
results of circulation measurements in man. which                ments in the flank of the pig in which pedicle flaps
have shown that gingival and periodontal vesselsare              were raised. He found that randomly placed pedicle
independent of each other.26-28                                  grafts had a constant 34Vo redtction in survival length
   The flaps raised in patient D suggestthat the greater         when compared with control flaps designedto include
the ratio of flap length to base, the greater is the             a major artery. Kon et a1.,31      using a carbon black
amount of vascular disturbance. These findings corrob-           perfusion technique in dogs, found histologically that
orate previous animal studies of pedicle flaps on the            the main vessels had been maintained within broad
backs of rabbits,2ewhich indicated that the intrinsic            full thickness flaps during raising and retracting the
circulation of the flap is maintained up to the point            flap. In subject C, raising and retracting a full thickness
where the ratio of the length to width of the simple             flap affected an approximate 50Va disturbance of the
parallel pedicle flap is 2:1. Regarding the design of the        superficial capillary circulation.
flap, these findings suggestthat the broader the flap               In subjects E to G these principles were tested in




FIcunr 16. Subject F, clinical aspect immediately following surgery Overextension in length of experimental
                                                                                                            flap design. Easy
mobilization of flap and minimal tension placed on flap by suturing.




FrcunE 17. Subject F, angiograph 24 hours after surgery. Good
                                                              flap circulation. Small necrosis area (N) caused.by sutures.
Tissue loss at flap end (TL). Donor sire (DS).
                                                                                                               J. Periodontol.
                                                                                                              November, 1977
690 Mdrmann, Cianao




Frcunr 18.subjectF, angiograph daysafier surgery.some tissue
                                7                                loss^at end (TL). Good circulation in maintained part of
                                                                       flap
                                                   of
     end.Slightiyadvancidie- and neo vascularization  donor site (DS)'
llap




                      Frcunp 19. Subject G, angiograph 24 hours after surgery. No circulation in Jlap area'



 lateral sliding flap procedures. These operations were            caused by the previous operation may have played a
 similar to those described by a number of other inves-            role also in that mobility was decreased' Ryan2s re-
 tigators32-3e  and were modified slightly to test the             ported that skin graft sites can develop areas of dimin-
 effects of various modalities on their circulation. The           ished resistanceto further surgery.
 results in these subjects suggestthat sliding flaps should           A full thickness or partial thickness preparation may
 be sufficiently extended into the alveolar mucosa to              be used in lateral sliding flaps.35'36 the donor site a
                                                                                                         In
 provide adequate mobilization. Myer et al.a0found, in             loss of bone (0.5 mm) and recession (1'5 mm) is
 the dog, that pedicle grafts under tension which dem-             reported with full thickness flaps.33'al Therefore, at
  onstrated complete vascular filling retained their vital-        thl donor site a partial thickness flap is preferable
  ity for 3 or 4 days after surgery. However, Glickmann'           because it offers the advantage of more rapid healing
  stated that excess tension and bending impair the                 and reduces the risk of postsurgical recession, particu-
  circulation when the flap is moved. Regarding the                larly if the bone is thin or a dehiscence or fenestration
  failure of the flap in subject G, tension was certainly           is suspected. However, if the gingiva is thin, partial
                                                                    thickness may not be sufficient for flap survival'33'38A
  involved, and persisting changes in the vasculature
                                                                                        Blood Supply of Human Gingiva 691




                                                                            awayfrom the root surface.
             Ftcunr 20. Subject angiograph davsaftersurger\'.Theflap sloughed
                              G,         5


study on pig skin showed that thick pedicle flaps                -l . Partial thickness flap preparations to cover avas-
separatedfrom their wound beds had a 55.7Vcsun'ival           cular areas should not be too thin so that more blood
rate whereas thin flaps separated from their wound            vessels are included in them.
bed had a 26.5% survival rate.a2 This study also                 ,5. The apical portion of periodontal flaps should be
showed that the survival of thin flaps is dependent on        full thickness q'hen possible.
the vascular quality of the recipient site. These findings
                                                                                             Acxsou Lrocurxrs
are in agreement with histologic impressions reported
                                                                The authors rrish to acknogledge the support of the Zeiss
by Staffileno et al.a3 and may explain the excellent
                                                              Company, Zurich. Sr.ritzc-rland. technical advice of Dr.
                                                                                             thc'
healing they reported for split thickness flaps reposi-       Walter H. Lang. Director. \tc-dical Optical Department,
tioned to their original position. Compared to these          Zeiss Company. Oberkochen. rrVest   Gc'rman1 and the clini-
                                                                                                          .
sites, a thin flap cannot provide nutrition for the           cal assistance Dr. Andre Bachmann.
                                                                           of
grafted tissue if its own blood supply is inadequate.                                              RrrrnEscrs
Therefore, partial thickness flaps or parts of flaps
                                                                 1. Folke, L. 8., and Stallard. R. E.: Pc-riodontal                            microcir-
which are designed to cover an avascular area should          culation as revealed by plastic microspheres. J Periodont Res
not be prepared too thin. The success the very long
                                          of                  2: 53.1.967     .
partial thickness flap in this study in subject F can be         2. Keller, G. H., and Cohen.D. \4'.: lndia ink perfusions
explained by its full thickness preparation in its apical     of the vascularplexus of oral tissues Oral Surg 8: 539. 1955.
                                                                                                                      .
part which may have preserved a major gingival vessel            3 . C a s t e l l i ,W . C . , a n d D e m p s t e r .W . T . : T h e p e r i o d o n t a l
                                                              vasculatureand its responseto experimental pressure."/,4rt
inside the flap and by the relative thickness of the          Dent Assoc 70: 890, 1965.
partial thicknessdissection.                                     4. Kindlova, M.: The blood suppll of the marginal perio-
                                                              dontium in macacusRhesus. Arch Oral Biol lO:869. 1965.
                     CoNcrusroNs                                 5. Kindlova, M.: Gefdssversorgung Marginalparodon-       des
   This study demonstrates changes in the gingival            tium bei Zdrhnen eines bleibenden Typus. Stoma (Heidelb)
                                                              19:84.1.966.
vascular supply of humans following various periodon-            6 . C a r r a n z a ,F . A . , J r . . I t o i z . M . E . . C a b r i n i , R . L . , a n d
tal surgical procedures. A special system was used to         Dotto, C. A.: A study of periodontal vascularization in
photograph circulatory changesfollowing an i.v. injec-        different laboratory animals.J Periodont Res lz 120, 1966.
tion of sodium fluorescein to visualize blood supply.            7. Goldman, H. M.: Gingival vascular supply in induced
                                                              occlusal traumatism. Oral Surg 9t 936, 1956 .
   The results of this study suggest that the following
                                                                 8. Kennedy, J.: Experimental ischemia in monkeys. II.
concepts are important in the design of periodontal           Vascular response. Dent Res 48: 888, 1969.
                                                                                           J
flaps.                                                           9. Garfunkel, A., and Sciaky, l.: Vascularization of the
   1. Flaps should be broad enough at             base to     periodontal tissues in the adult laboratory rat. J Dent Res
include major gingival vessels.                               50: 880. 1971.
   2. A flap's length to width ratio should not exceed2:1 .      10. Kennedy, J.: Effects of inflammation of collateral
                                                              circulation of the gingiva . J Periodont Res 9: I47 , 1974 .
   3. Minimal tension should be produced by suturing             11. Hayashi, S.: Untersuchungenriber die arterielle Blut-
techniques and the tissue should be managed gently            versorgung des Periodontiums. Drscft Mschr Zahnheilkd 5O:
during the surgical procedure.                                r45. 1932.
692    Mdrmann,             Cisncio
                                                                                                                                                                        .'i;i'iii3i.'iil|
   12. Cohen. L.: Methods of investigating the vascular                                          28. Korber, K. H.: Periodontal pulsation' J Periodontol
                                                                                              4lt 382, 1970.
architectureof the mandible.J Dent Res 38:920,1959'
   13. Clemmesen, Th.: The early circulation in split skin                                       29. Ohmori, S., and Kurata, K.: Experimental studieson
prafts . Acta Chir Scand l27l 1 ' 1964 .                                                      the blood supply to various types of skingrafts in rabbits
=
   14. G.h.ke, V., Lange, D., and Altenhof, H': Histo-                                        using isotope Plz'.Plast Reconstr Surg 25: 547 ' 1960 '
                                                                                                 36. Patie.soo. T.: The survival of skin flaps in the pig' Br
chemische Untersuchung zur Gefdssarcfiirelronit-der. men-
schlichenGingiva. Dtsch zahniirztl226:586. 1971'                                              J Plast Surg 2lz 113, 1968.
   15. Hock,l.: Gingival vasculaturearound erupting teeth'                                       3 1 . K o i , S . , N o v a e s ,A . B . , R u b e n , M . P ' , a n d G o l d m a n ,
J Clin Periodontol 2z 44,7975.                                                                H. M.: Visualization of the healing periodontal wound' IV'
   16. Wayland, H., and Hock, J.: Application of fluorescein                                  Mucogingival surgery: Full thickness flap' J Periodontol 4Oz
vital microscopy to the vasculature around eruption teeth'                                    441.t969.
Microvasc R:es7z 201 ,1974.                                                                      3 2 . A l b a n o , E ' A ' , C a f f e s s e ,R . G ' , a n d C a r r a n z a ,F '
    17. Mormann, W.' and Lutz, F.: Fluoreszenz,angiographie                                   A., Jr.: A biometric analysis of laterally displaced pedicle
der Gineiva. Acta Parodontol Schweiz Monatssc'hr Zahn-                                        flaps. Rev Asoc Odont Argent 57z 35tl ' 1969
heilkd 842798.1974.                                                                              33. Bhaskar, S. N., Cutright. D. E., Beasley, J' D''
    18. Wessing, A.: Fluoreszenzangiographie                                  der Retina'     Perez, B., and Hunsuck, E. E.: Healing under four types ot
Stuttgart, Georg           Thieme Verlag, 1968.                                               mucogingival flaps. Programs and abstracts. 'l Am Dent
    191 Goodman, L' S', and Gilman, A': The Pharmacolog-                                      A s s o c 4 8 t h G e n e r a lM e e t i n g , 1 9 7 0 ' p ' 1 0 0 '
ical Basis of Therapeutics,ed 5, p 394. New York' Macmil-                                         34. Ebert. J. R.. and Ratcliff' P' A.: An analysisof the
land PublishersCo . , Inc. , 1975 .                                                           vascular supply of pedicle grafts. Periodontal Abst 192 57 '
    20. Mormann, W., Bernimoulin. J.-P.. and Schmid' M'                                        7971.
O.: Fluorescein angiography of free gingival autografts' "/                                       35. Grupe, H. E.: Modified technique for the sliding flap
Clin Periodontol 2z 177 . L975 '                                                               operation.J Periodontol 37 1 491, 1966'
    21. Mormann, W.. and Bernimoulin. J'-P': Possibilitds                                         36. Grupe, H' E., and Warren' R': Repair of gingival
offertes par I'angiographie fluoresc6iniquc' en parodontolo-                                   defects by a sliding flap operation. I Periodontol 27t 92'
e i e . A c t u a l O d o n t o s t o m a t o ( P a r i s )1 0 9 : 1 0 5 ' l 9 7 r '
                                              l                                                I 956.
    2 2 . M o r m a n n . W . . S c h m i d .M . O . . a n d B e r n i m o u l i n ' J ' -         3 7 . S u l l i v a n ,H . C . . D i n n e r . D . ' a n d C a r m a n ' D ' : C l i n i c a l
 P.: Fluoreszenzangiographische                     Untersuchung dc'r Blutzirk-                evaluation of the laterally positioned flap' I'A'D'R Abstr
 ulation       im MukoiaSpaltlappen bei der Vestibulumplastik                                  N o . 4 6 6 ,p 1 6 9 , 1 9 7 1 .
 nach Edlan und M6jchar. Dtsch ;ahniir:tl Z 3Ol.171' 1975'                                         3 8 . T i i o t . R . J . . a n d S u l l i v a n ,H ' C ' : E v a l u a t i o n o f t h e
     2 3 . M o r m a n n . W . . a n d M e i e r . C h - : D i e F i i r d e r u n gd e r      survival of partial thicknessand full thicknessflaps' I'A'D'R
 Revaskularisation von Gingivadefektsunden durch eine                                          A b s t r N o 4 7 0 .P 1 1 0 , f 9 7 1 .
 H a f t s a l b e .1 9 7 7 . i n P r e P .                                                        39. Wilderman, M.' and Wentz. F': Repair of a dentogin-
     2 4 . N o v a e s .A . B . . K o n . S ' . R u b e n . M . P " a n d G o l d m a n '      gival defect with a pedicle flap. l Periodontol 362 218, 1965 '
 H. M.: Visualization of microvascularization the healing                   of                     40. Myers, B.,-Combs' B., and Cohen. G': Wound ten-
 periodontal wound. V. Periosteum retention technique ot                                       sion and wound sloughs.Am J Surg 272 303, 1961'
 mucogingivalsurgery.J Periodontol 4l: 685 ' I 970 '                                               4 1 . G l i c k m a n . J . : C l i n i c a l P e r i o d o n t o l o g y .e d 4 , p 7 5 3 '
     ZSI n"yan. T. J.: Pathophysiologyof skin capillaries'1nr '/                               Philadelphiaand London. Saunders.1972'
 Dermatol 1.4t708. 19'7 .              5                                                           42. ilodius, L.. and Smahel. J.: Thin and thick pedicle
     26. Hofmann , M.'. Zut Oszillographiedes Gingivapulses                               '     flap. Acta Chir plast l4z 30 ' 1972.
 Dtsch zahndrztlZ l9t'765, 1964.                                                                   43. Satffileno, H., Levy. S', and Gargiulo. A': Histologic
     27. Korber, K. H.: Untersuchungen zur Phvsiologiedes                                       study of cellular mobilization and repair following a perios-
 parodontalen Gefdssystems.
                                                -Dtsah
                                                             adlr:nar.tl Z l8z 1092'            teal ietention operation via split thickness mucogingival flap
  1963.                                                                                         surgery.J Periodontol 372 117 .1966.




                                                                        Announcement
                        :                              :                              .
              THE SIR WILFRED              FISH RESEARCH             PRIZE                       fifteen minutes duration, followed by a 10-minute discussion period'
                                                                                                 during the Society's International Meeting to be held at the Europa
          'Sir Wilfred Fish Research Prize' was instituted in 1970 by The
     The                                                                                         Hotel, London, England on 3rd and 4th of April, 1978' The final
   British Society of Periodontology with the object of promottng                                selection will be made on the content and presentation of the work'
   periodontal research by young workers. The prize of fl00 will be                                  The closing date for receipt of manuscripts (three copies) which
   awarded annually where appropriate.                                                           must be submitted to the Honorary Secretary, is 31st January 1978'
     The research work should have an application to periodontology
                                                                                                 Honorary SecretarY:
   and must be unpublished. Individuals may compete either on their
                                                                                                 H. D. GLENWRIGHT
   own behalf or on behalf of a research group. Eligibility is limited to
                                                                                                 The Dental School,
   those under the age of 40.
                                                                                                 St. Chad's QueenswaY,
     A short list will be drawn up from the manuscripts submitted to the
                                                                                                 Birmingham, 84 6NN,
   Panel of Judses. Entrants who reach the short list will be expected to
   present theiiwork, at their own expense, in the form of a paper of                            England.

								
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