3.20 Rafael_Perio Plastic Surgery Flashcards
Describe the Sullivan & Atkins ‘68 classification of recessions
Sullivan & Atkins ‘68
* Deep wide = most difficult to treat
* Shallow wide
* Deep narrow = can do tunneling
* Shallow narrow = can do tunneling
The margins of the bed should be away from the borders of the recession (at least 2-3 mm)
What are the Miller classifications of recession? What about the Cairo ‘11 recession?
Miller ‘85
Class I: Recession does not extend to the MGJ.
No bone or soft tissue loss in the interdental area.
Class II: Recession extends to or beyond the MGJ. No bone or soft tissue loss in the interdental area.
Class III: Recession extends** to or beyond the MGJ, and bone or soft tissue loss in the interdental area (or there is malpositioning**)
Class IV: Recession extends to or beyond the MGJ. Severe bone or soft tissue loss in the interdental area (or severe malpositioning)
Cairo ‘11
RT1: Miller class I and II. Gingival recession
with no loss of interproximal attachment
RT2: Miller class III. Interproximal attachment loss less than or equal to the labial/buccal site
RT3: Miller class IV. Higher interproximal attachment loss
than the labial/buccal site
Describe the Pini-Prato ‘10 classification of recessions.
Does occlusion cause NCCL’s (noncarious cervical lesions)?
Pini-Prato ‘10
Class A- : CEJ detected, no step
Class A+ : CEJ detected, with step
Class B- : CEJ not detected, no step
Class B+ : CEJ not detected, with step
Senna ‘12
“There is no scientifically sound evidence that abnormal occlusal loading causes NCCL’s.
What are the predisposing and precipitating factors for recession, according to Hall 1977?
Hall ‘77
Precipitating factors:
- Frenulum Pull (inserting in gingival margin)
- Tooth malposition/alignment (root prominence)
- Shallow vestibule
- Gingival Biotype (tissue thickness, lack of AG, bone dehiscence)
Precipitating factors:
Pathological:
- Virus infection (Herpes virus)
- Plaque / calculus
- Recurrent inflammation
- Periodontitis
Traumatic:
Mechanical / Thermal / Chemical
(Brushing technique, piercing, malocclusion, chemical erosion, self-inflicted trauma)
Iatrogenic:
Orthodontic movement
- Sub-G restorations
What studies show that age is a risk factor for recessions?
Billings ‘18
- incidence of mucogingival recessions increases with age.
- gingival recession as a primary cause for CALoss.
Gorman ‘67
positive correlation of increased PD, recession and age.
Does occlusion cause recession?
Bernimoulin ‘77
No significant correlation between tooth mobility and mucogingival recession.
How does gingival thickness correlate with recession treatments?
Baldi ‘99: If the gingival thickness of the flap was at least 0.8 mm, complete root coverage using a Coronally Advanced Flap Technique (CAF) could be achieved.
Tavelli ‘19a Assessing the long-term outcomes (12 years) of multiple gingival recessions treated with Acellular Dermal Matrix (ADM), revealed that a gingival thickness of 1.2mm at 6 month predicted gingival margin stability over time
What are the overall (average) success rates for recession treatments?
Aguido ‘16
- 83% of treated recessions showed recession reduction.
- 48% of untreated recessions exhibited an increase, as well as increase of recession depth over time.
What are the overall (average) success rates for recession treatments?
Aguido ‘16
- 83% of treated recessions showed recession reduction.
- 48% of untreated recessions exhibited an increase, as well as increase of recession depth over time.
What is the current consensus regarding minimum KT width?
Cortellini & Bissada ‘18
- If adequate oral hygiene is present, a minimum of KT is NOT required to prevent CALoss.
- Under patient’s inadequate oral hygiene, at least 2mm of KT (including 1mm of AG) is required to maintain gingival health.
Who first published the FGG technique?
Nabers ‘77
List all the Mucogingival deformities and conditions around teeth
Cortellini & Bissada ‘18 (AAP consensus)
1. Gingival/soft tissue recession
* facial or lingual surfaces
* Interproximal (papillary)
2. Lack of KT
3. Decreased vestibule depth
4. Aberrant frenum/muscle position
5. Gingival excess
* pseudo-pocket
* inconsistent gingival margin
* excessive gingival display
* gingival enlargement
6. Abnormal color
What are the 3 periodontal biotypes?
Cortellini & Bissada ‘18
Thin scalloped:
* Gingival biotype:
-Clear thin delicate gingiva
Prevalence: 42.9%
Mean: 0.80 mm
-Narrow zone of KT
Mean: 4.15 mm
* Bone morphotype:
-Thin alveolar bone
Mean: 0.343 mm
* Tooth dimension
-Slender triangular crown
-Subtle cervical convexity
-Interproximal contact close to incisal edge
Thick flat:
* Gingival biotype:
Thick fibrotic gingiva
-Narrow zone of KT
-Pronounced gingival scalloping
* -Thick alveolar bone
Mean: 0.754 mm
* Tooth dimension
-Square-shaped tooth
-Pronounced cervical convexity
-Large interproximal contact located more apically
Thick scalloped:
* Gingival biotype:
Thick fibrotic gingiva
Prevalence: 51.9%
-Broad zone of KT
Mean: 5.72 mm
* Tooth dimension
Slender teeth
Is thin phenotype associated with more recession? What happens if recessions are not treated?
Is thin gingival biotype a condition associated with gingival recession?
Yes, (Agudio, Cortellini et al. 2016) compared periodontal condition of gingival augmentation vs untreated homologous contralateral sites with thin gingival biotype with/without GR (mean F/U 23.6 years). The extent of recession was reduced to 83% of the 64 treated sites vs increased 48% in untreated sites. Thin gingival biotype augmented by grafting procedures remain more stable over time than untreated thin gingival biotype.
What occurs if an existing gingival recession is left untreated?
Untreated facial gingival recession in subjects with good oral hygiene is highly likely to result in an increase in the recession depth during long-term follow-up (Chambrone and Tatakis 2016). Individuals (with good oral hygiene), Sites lacking KG are seemingly more susceptible to further CAL loss. There was 143% chance (OR 2.43) of increase in number of patients having recession and 116% chance (OR 2.16) of increase in number of sites with recession. The presence of KT and/or greater gingival thickness decrease the likelihood of an increase in recession depth or the development of new gingival recession.
What factors influence the success of root coverage procedures?
Some factors are known to influence root coverage procedures, such as interproximal periodontal tissue high (interproximal bone height, dimension of the interdental papilla, CAL), smoking, KT thickness, position of the gingival margin in relation to CEJ, flap tension, graft stability, root planing and others.
