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BDS4 Periodontology - supple > 3 - Mucogingival/perio plastic surgery > Flashcards

3 - Mucogingival/perio plastic surgery Flashcards

1
Q

What step does mucogingival and perio plastic surgery fall under?

A

Step 3

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2
Q

What factors are there to consider before undertaking mucogingival surgery?

A
  • patient
  • tooth
  • systemic and medical
  • operator
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3
Q

What are the patient factors to consider for mucogingival surgery?

A
  • OH (<20% plaque, <10% marginal bleeding)
  • quality of maintenance available and access, compliance for maintenance
  • ability of patient to tolerate surgery
  • cost and patient acceptance
  • aesthetics of site and post op recession
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4
Q

What are the tooth factors to consider for mucogingival surgery?

A
  • access
  • shape of defect
  • prosthodontic and endodontic considerations
  • tooth position anatomy (tilting, overeruption, proximity to adjacent roots, enamel pearls, root grooves)
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5
Q

What are the systemic factors to consider for mucogingival surgery?

A
  • smoking = poorer outcome (absolute contraindication on NHS)
  • unstable angina, uncontrolled hypertension, MI or stroke within last 6 months
  • poorly controlled diabetes
  • immunosuppressed patients
  • anticoagulants
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6
Q

What are the operator factors to consider for mucogingival surgery?

A
  • skill and experience
  • additional training or specialist required
  • access to tier 2 or tier 3 care
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7
Q

What is tier 2 vs tier 3 care?

A

Tier 2 = dentist with special interest
Tier 3 = specialist care

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8
Q

What are the general surgical approaches for periodontal treatment?

A
  • conservative approach
  • resective approach
  • reconstructive approach
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9
Q

What is regenerative periodontal surgery?

A
  • aims to promote regeneration of periodontal tissues that have been lost
  • includes use of membranes and grafts and application of biologic agents
  • aka mucogingival surgery, perio plastic surgery
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10
Q

What are the indications for mucogingival surgery?

A
  • periodontitis lesions requiring reconstructive or regenerative treatment including around implants
  • mucogingival deformities and poor aesthetics
  • short clinical crowns
  • removal of abnormal frenum
  • creation of more favourable soft tissue bed pre-implant placement
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11
Q

Describe the difference between a full thickness flap and a split thickness flap.

A
  • full thickness flap is cut to the periosteum and lifts the periosteum with it
  • split thickness flap leaves the periosteum in situ and leaves some connective tissue behind
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12
Q

What is a free gingival graft?

A
  • split thickness flap
  • free means blood supply is not maintained from donor site
  • placed onto recipient site (epithelium removed to leave connective tissue exposed) and sutured in place
  • usually from palate
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13
Q

What is a pedicle sliding graft?

A
  • gingival margin around defect excised
  • split thickness flap raised from adjacent tooth
  • flap is rotate laterally to cover defect
  • donor site heals by secondary intention
  • blood supply is maintained to flap
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14
Q

What is a connective tissue graft?

A
  • papillae are spared as gingival margin is excised and tissue undermined
  • graft is harvested from palate using a window (epithelium replaced to aid healing)
  • connective tissue placed into flap at margin
  • coronally advanced flap sutured in place
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15
Q

How are infrabony defects classified?

A
  • 1 walled
  • 2 walled
  • 3 walled
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16
Q

What biomaterials are used for guided bone regeneration?

A
  • barrier membrane (collagen)
  • DBBM (deproteinised bovine bone matrix)
  • EMD (enamel matrix derivative)
17
Q

What is GBR?

A

Guided bone regeneration

18
Q

What is the function of the collagen membrane in GBR?

A
  • epithelial cells advance and heal quicker than connective tissue
  • barrier membrane prevent epithelial cells from migrating apically
  • allows connective tissue to heal
19
Q

2 forms of surgical healing ourcomes

A
  • long junctional epithelium (access/ resective)
  • new connective tissue attachments (grafting procedure)
20
Q

What is a long junctional epithelium?

A
  • when epithelium cells advance apically the connective tissue does not contact the root surface
  • instead epithelium cells line the root surface
  • overall, weakers against bacteria in the mouth and therefore SPT is vital
21
Q

What is gingival recession?

A
  • describes apical migration of gingival margin from CEJ
  • does not relate to health or disease
  • descriptive term of location
22
Q

What is the aetiology of localised gingival recession?

A
  • excessive toothbrushing
  • traumatic incisor relationship (class II div 2)
  • habits (nail rubbing)
  • tongue/ lip stud
  • anatomy (eg frenal pull or teeth out of alignment)
23
Q

What is the aetiology of generalised gingival recession?

A

Periodontal disease or
following resolution of inflammation after successful tx

24
Q

What is the aetiology of localised or generalised gingival recession?

A

complication of ortho tx
usually lower incisors

25
Q

What is the old classification for gingival recession?

A

Millers 1985

26
Q

What is the new classification for gingival recession?

A

Cairo 2012
- Recession Type 1
- RT2
- RT3

27
Q

Describe RT1.

A
  • recession type 1
  • no interpromixal tissue loss
28
Q

Describe RT2.

A
  • recession type 2
  • interproximal tissue loss (CEJ-base of pocket) but not as significant as mid-buccal
29
Q

Describe RT3.

A
  • recession type 3
  • gingival recession associated with loss of interproximal attachment
  • interproximal tissue loss (CEJ-base of pocket) worse than mid-buccal
30
Q

What are the treatment options for gingival recession?

A
  • record magnitude of recession
  • elimination of aetiological factors
  • OHI
  • topical desensitising agents / FV (for roots)
  • gingival veneer
  • crowns (requires wax up)
  • mucogingival surgery
31
Q

When is a gingival veneer indicated?

A
  • extensive recession and interproximal bone loss
  • surgery would not achieve root coverage
32
Q

What is crown lengthening?

A

Aims to reposition the entire periodontal attachment including the alveolar bone

33
Q

What are the indications for crown lengthening?

A
  • to give adequate retention for restoration
  • create adequate ferrule
  • expose sub gingival restoration margins/secondary caries/fractures
  • correction of uneven gingival contour (including excessvie gingival dsiplay)
34
Q

Describe the crown lengthening procedure.

A
  • flap raised
  • 3-4mm bone removed using surgical handpiece
  • bone around root removed with hand instruments to avoid damage to root
  • (repositioning of biological width - junctional epith + connective tis)
  • coe pack placed to prevent tissue creep
35
Q

when to refer - case selection

A
  • only after thorough non-surgical tx
  • highly motivated pt eith optimal plaque and risk factor control
  • non-smoker and no contraindicated MH
  • reasonable prognosis of tooth
  • (only possible exception is gingival overgrowth)

BDS4 Periodontology - supple (10 decks)

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