36 - Mucogingival 2 - Hunter - DONE

Question 1

Is flap thickness a relevant predictor for root coverage when doing coronally positioned flaps?

Answer 1

Yes, Baldi found that there is a direct relationship between flap thickness and recession reduction

When flap thickness was > 0.8 mm, 100% root coverage is achieved

Dr. Mills says a flap that is thin has decreased blood supply

Question 2

Is there a critical threshold for thickness for coronally advanced flaps?

Answer 2

Systematic reviews say there is no critical threshold for success but that thicker flaps have more layers of keratinized epithelium, ECM, and collagen for physical protection and increased vascularity for wound healing.

Question 3

What factors affect the predictability of CAF technique?

Answer 3

Huang found that a gingival thickness of 1.2 mm or greater was the greatest predictor for 100% root coverage

Maxillary teeth have more success that mandibular

Complete coverage occurs in younger patients

Question 4

What is the relationship between the post-surgical gingival margin and root coverage in a coronally advanced flap?

Answer 4

Pini-Prato said The more coronal the gingival margin after suturing, the greater the probability of achieving complete root coverage

Question 5

Do NCCLs and interdental tissues affect root coverage?

Answer 5

Yes, Pini-Prato said loss of interdental tissue (inter-proximal CAL loss) and the presence of NCCLs 1 mm or greater decrease ability to achieve complete root coverage

Question 6

Does adding CTG to a CAF procedure help?

Answer 6

YEs, Cairo found that adding a CT graft to a CAF showed benefitical effects on width of keritanized tissued and percentage of complete root coverage

Question 7

Is the CAF procedure stable long term?

Answer 7

Pini Prato found that In about 50% of patients the CAF procedure is stable long term. Instability is attributed to KT band less than 2 mm and absence of interdental tissue

Question 8

What is better CAF or semilunar coronally repositioned flao?

Answer 8

Santana found that for Miller class 1 defects, CAF is superior because semilunar flaps leave a notable white scar and did not have as much change in receesion and CAL .

Question 9

How do you decide if you are going to do a CAF alone or are you going to do a CAF plus CTH?

Answer 9

Cairo said that CAF + CT graft is most beneficial in a thin periodontal biotype. CAF alone may have same or better outcome in patients with a thick biotype.

Question 10

In treating multiple gingival recessions would you prefer a CAF or a CTG?

Answer 10

Pini-Prato found at 6 months there is no difference, bbut that in the long eterm sites treated with CTG + CAF continued to improve while CAF alone did not (aka creeping attachment)

Question 11

What’s better a xenogenic collagen matrix or a CTG when used as an adjunct to a CAF?

Answer 11

According to Tonetti, Using a xenogenic graft allows for shorter surgical time and waier revovergy, but using a CRG had imporived root coverage, KT width, and decreased sensitivity

Question 12

Which would you choose a tunnel with a CTG or a CAF with emdogain?

Answer 12

Zuhr said taht the Tunnel was better than CAF in regards to predictibilaity of root coverage and keratinized tissue height but this is only in the case where tissue thickness was less than 1.4 mm. If it was greater, there was no difference in clinical outcomes

Question 13

5 years later which has better results a CAF with biologics or a CTG?

Answer 13

McGuire found that in Miller class 2 defects results are stable and effect for both treatment modalities, but that CTG plus CAF had greater recession defect reductions and incrased KT

Question 14

Is there a difference in results of patients treated with mucogingival procedures whether they received maintenance at a perio office versus a general dentists office?

Answer 14

McGuire found that patients maintained in a perio office had greater root coverage over a long period. Possible factors are longer periods between maintenace in GD office and more frequent review of atraumatic brushing techniques

Question 15

If you had the choice between solvent-dehydrated (Puros dermis) or freeze-dried alloderm which would you choose?

Answer 15

Wang found that no significant difference exists between the two materials

Question 16

What is between alloderm or CTG?

Answer 16

Harris found that CTG has more predictable and stable LONG TERM root coverage results

Moslemi found no difference between the two after 5years but found that root coverage was not maintainable in both groups if horizontal toothbrushing was used

Question 17

What is better alloderm with a tunnel or alloderm with a CAF?

Answer 17

Papageorgakopoulos found that A CAF with alloderm gives much more predictable coverage than alloderm with a tunnel.

Question 18

In smokers does the addition of emdogain improve clinical outcomes when using alloderm?

Answer 18

Alves found that the addition of emdogain seemed to have better clinical outcomes, but both techniques result in successful root coverage

Question 19

Can alloderm be used to treat soft tissue ridge deformities?

Answer 19

Yes, alloderm may be a suitable material for treatment of soft tissue ridge deformities

Question 20

Who else did a a study about papilla fill and interproximal root distance/alveolar crest location besides Tarnow and what did they find?

Answer 20

Hae-Sung found that an IDP was present 89.7% of time when the distance from alveolar crest to contact point was 4 mm and only 58.5% when the distance was 5 mm

Papilla presence also decreased when interradicular distance increased. Found papillar was present 77% of time when roots were 1 mm apart

Overall less favorable reports than Tarnows paper

Question 21

In deep recession defects is GTR better than a mucogingival procedure?

Answer 21

Zucchelli found that They are both effective treatment modalities. CTG + CAF had better clinical results with higher % of root coverage than GTR w/ nonresorbable membrane. GTR with a resorbable membrane had better results than nonresorbable

Question 22

What is better CAF + xenogenic collagen matrix or CAF alone in Miller 1 and Miller 2?

Answer 22

Jepsen found that there is no significant difference between the two when recession was less than 3 mm. Adding the xenograft improved gingival thickness and KT width

Question 23

In the long term is there a difference between using a xenogenic collagen matrix with a CAF versus using a CAF w/ autogenous graft?

Answer 23

McGuire found that xenogenic graft is a maintainable alternative but autogenous graft was better in mean root coverage and has more CRC.

Question 24

Is a porcine collagen matrix (mucograft) beneficial in augmenting KT width around existing dental implants?

Answer 24

Yes Schallhorn found that mucograft increases soft tissue thickness and KT width around implants with mucogingival problems

Question 25

What are some factors that will affect the success of your CAF only?

Answer 25

Flap thickness: Thickness 0.8 – 1.2 mm
Presence of NCCL 1 mm or greater
Post surgical location of CAF
Tension of the flap – want low tension – passive flap 
Loss of interdental tissue