Kazanjian Flap an alternative flap design for special cases

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Posted on By Howard Gluckman In Bone Grafting

This patient required a ridge split technique to place 2 implants in the 7 and the 8 areas. However the patient had been wearing his denture non stop day and night and as a result had a clads 3 denture stomatitis. this means a very swollen and red and deep papillary swelling in the oxalate associated with the denture and most often secondarily infected by Candida albicans. An incision in the area of the crest may lead to tearing of the flap due tot he immature tissue in this area and hence poor sound healing and wound dehiscence. Suturing is difficult and it is almost impossible to oppose the flaps properly. This case shows the use of the Kazanjian flap as an alternative flap design to live the crestal part of the flap intact and allow us to suture only in healthy tissue in the buccal vestibule.




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26 Comments


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healing after 10 days and 3 weeks


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Howie do you have the CBCT of this cae preop


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Good to hear this..I had solved this type of a problem last year.


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Smart, Howie.
Thank you for sharing. When we always do the same, we forget the alternative.
Beautiful surgery all the way from treatment plan to the healing.
Cheers
Snjezana


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Howie; How do you maintain the periosteum on the labial bone with this approach? I would think keeping the periosteum intact on labial in a split ridge is important. But you seemed to have done some GBR in addition so that should not be an issue. Masterpiece, and good thinking my friend as usual. regards Mo


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Mo I never really have left the periost in tact. I prefer to open completely then veneer graft not he outside as well as on the inside to try and get as much as possible in all directions.


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Thanks Sjnez. I appreciate your kind words


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Howie, amazing case and management. Congratulations and thanks for sharing.


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Thank you my friend.


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Hi Howard , fantastic case, thanks for sharing.I had never heard of this flap design. There seem to be many advantages to this type of flap from what I can see. . Am I right in saying that there is no chance of any soft tissue dehiscence at the crest of the ridge which is completely covered by the flap? What are the possible disadvantages of this type of flap and why is it not used more often? I hope you are well and I still intend to come to one ( or more ) of your courses at your academy in the future. Kind regards Peter Zeltmann


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HI Peter. Great questions thats for sure. It is a very old flap and one that was used a lot in the past and used more by our Maxillo facial colleagues. The benefit of the flap is definitely less risk of wound dehiscence when one does vertical flaps especially. It was originally designed as a vestibuloplasty technique but was since changed to bone grafting as well but also many years ago although I see someone wrote an article recently claiming the technique as his own. The problem with the technique is that it is a little more uncomfortable and involves much more swelling and bruising. It is also more difficult and you do get scarring in the line of the incision so perhaps not a first choice but definitely an option for many different types of techniques. Again just another technique to have in our armamentarium to make sure we get the best result.


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Thanks Howard !


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Great case!
Are concerned at all about the vascularity to the bone that you split?
Thank you
Margarita


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That is a good question I assume related to the fact that I stripped the purist from the split. There is currently no literature that I know of that supports or prefers one way or the other in a scientific way i.e. no randomized control. MY personal expiereice is that it makes no difference and i realized this after splitting the bone off by mistake and screwing it back. It basically acts like a bone block. the fact that this case has a very thick dimension as aopposed to the cases were a 2-3mm ridge is split which will very quickly resorb, I feel I have a very good chance of great blood supply and good success. That coupled with the veneer graft on the buccal is also a way of protecting that bone and reducing that resorption rate.


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Thank you!
Margarita


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Howie; Great post, when do you choose one flap over the other? regards Mo


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Mo the only reason I used this flap is because of the denture stomatitis in the palate an the occlusal portion which would have been difficult to suture. I also use this for lower jaw cases for vertical augmentations


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Great idea! I use the Kazanjian in order to have more attached gingiva, and to deep the vestible...but this idea is USEFULL!
Thanks for the present!
Regards
Jorge


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Thanks Jorge


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Lovely case Howard. Would you ever considered doing a remote sulcular incision, and then tunneling subperiostally, grafting and then coming back later to place implants. This would eliminate the issue of tissue apposition and suturing in the "infected" area.


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HI Yarron. Not in this case. I would do a tunnel only if I wanted to do both vertical and horizontal but it depends on what you are planning. If you are thinking of the Ernesto Lee technique of just placing synthetic bone below the perio then Im not a fan of the technique at all. If you are talking about autogenous bone blocks from the Khoury technique then It is overkill in this case.


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Hi thanks. What was the temp?


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acrylic denture


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KLS Martin
BTI