10 - Mucogingival Defects and Esthetic Surgery

Question 1

10. 5 - What procedure (pre-1965) was used to eliminate periodontal pockets and establish a wider band of keratinized and attached gingiva?
    - What are the issues with this procedure?

Answer 1

Pushback Procedure

“Stormy” post-surgery healing phase, poor esthetic results, and poor long-term results if infrabony lesions (vertical) are not adequately treated.

Question 2

10.7 According to a 1996 study by Wennstrom, how much attach-keratinized mucosa is necessary to maintain health?

Answer 2

At least 2 mm of attached keratinized mucosa

Question 3

10. 9 Etiology of Gingival Recession - Know these
    - Use of what substance?
    - Malposed ___
    - Factitial ___
    - ___ patterns
    - ___ Attachment
    - ___-functional habits

Answer 3

1. Chewing tobacco
2. Teeth
3. Injury
4. Eruption
5. Frenulum attachment
6. Para-functional

Question 4

10. 9 Etiology of Gingival Recession - Know these
    - Chronic ___
    - ___ technique
    - ___ (Thin/Thick) biotype
    - Discrepancy in facial-lingual width of tooth vs that of the ___
    - Iatrogenic (including orthodontics)

Answer 4

1. Inflammation
2. Toothbrushing
3. Thin biotype (when combined with bony dehiscence or fenestration)
4. Alveolus (can result in bony fenestration or dehiscence)

Question 5

10.20 What are the three reasons that you would want to undergo gingival recession defect treatment to increase the width of keratinized and attached gingiva?

Answer 5

1. Prosthetic concerns
2. Orthodontic concerns
3. Prevent progressive recession

Question 6

10.20 What are the three reasons that you would want to undergo gingival recession defect treatment to increase root coverage?

Answer 6

1. Esthetic concerns
2. Dentinal sensitivity
3. Prevention of root caries

Question 7

10.21 What are three treatment options for increasing the width of attached gingiva?

Answer 7

1. APF (apically positioned flap)
2. FGG (Free autogenous gingival graft)
3. CTG (Subepithelial connective tissue graft)

Question 8

10.22 What are three treatment options for increasing root coverage?

Answer 8

1. CTG (Subepithelial connective tissue graft)
2. Tarnow procedure (pinpoint or semi-lunar incision + coronal positioning)
3. LPF (Lateral pedicle flap)

Question 9

10. 23 Apically positioned flap Indications
    - Initial ___ and ___ of gingiva
    - Thickness of the marginal ___ ___
    - Amount of __ reduction required
    - Length of the ___ (avg is 3 mm)
    - Clinical crown length required for ___ treatment and esthetics

Answer 9

1. Width and thickness
2. Alveolar bone
3. Pocket
4. Root trunk
5. Prosthetic

Question 10

10. 25 FGG - Free autogenous gingival graft

- Would you perform a FGG to increase root coverage or increase the width of attached gingiva?

Answer 10

Increase width of attached gingiva

FGG is rarely used to cover exposed roots

Question 11

10.25 What are three advantages to doing a free autogenous gingival graft?

Answer 11

1. Not technically demanding
2. May be accomplished with partial or full-thickness flap reflections
3. Wide variety of clinical applications

Question 12

10. 27 Free autogenous gingival graft - Disadvantages
    - Poor ability to provide ___ ___ to graft for root coverage
    - ___ results are compromised due to scarring during healing resulting in poor color match
    - Surgery required at ___ intraoral sites
    - ___ (Donor/recipient) site may present problems with bleeding, pain, and slow healing

Answer 12

1. Blood supply
2. Esthetic
3. Two
4. Donor

Question 13

10. 34 Subepithelial connective tissue graft (CTG)

- Would you perform a CTG to increase root coverage or increase the width of attached gingiva?

Answer 13

Both! Both to increase root coverage and increase the width of attached gingiva

Question 14

10. 35 What are advantages of a subepithelial connective tissue graft (CTG)
    - __ (high/low) predictability
    - Graft receives __ (low/high) blood supply
    - Palatal wound can be surgically closed, facilitating __ (slow/rapid) healing with __ (little/high) discomfort/bleeding
    - Good or bad color matching?
    - Applicable for __ on multiple teeth

Answer 14

1. High
2. High
3. Rapid; little
4. Good color
5. Recession

Question 15

10. 36 CTG - Disadvantages
    - Easy or difficult procedure?
    - What procedure may be necessary to perform after healing to obtain better tissue contours and to decrease thickness?

Answer 15

1. Difficult - technically demanding

2. Gingivoplasty

Question 16

10. 41 Tarnow procedure (semi-lunar with coronal positioning) - Indications
    - __ (Max/Mand) ant teeth with no more than __ mm of recession and __ mm of remaining keratinized gingiva

Answer 16

1. Max
2. 2 mm
3. 3-5 mm

Question 17

10. 42 Tarnow procedure
    - Good or bad esthetics?
    - Simple or complex
    - Oral vestibule narrowed?
    - Post-operative discomfort?
    - Papillary height conserved or disrupted?
    - Applicable for moderate or advanced gingival recession?

Answer 17

1. Good esthetics
2. Simple procedure
3. Not narrowed
4. Minimal discomfort
5. Papillary height conserved
6. Not applicable to moderate or advanced. Only minimal (2 mm)

Question 18

10. 47 Lateral pedicle flap (lpf)

- Would you perform a LPF to increase root coverage or increase the width of attached gingiva?

Answer 18

Increase root coverage

Dr. Malak only does LPF in conjunction with a CTG.