48. Mucogingival therapy and plastic periodontal surgery - methods for gingival augmentation.

Question 1

Mucogingival therapy and plastic periodontal surgery

Answer 1

• Correct defects=>
• In morphology, position, and amount of soft tissue and underlying bone support
• Enhance periodontal structure and function=>
• Improve aesthetics and oral health

Question 2

Common reasons for gingival recession

Answer 2

• Mechanical forces=>toothbrushing trauma
• Localized plaque-induced inflammatory lesions
• Generalized destruction=>periodontal disease

Question 3

Procedures included in mucogingival therapy

Answer 3

• Gingival augmentation
• Root coverage
• Crown lengthening
• Correction of mucosal defects at implants
• Gingival preservation at ectopic tooth eruption
• Removal of abnormal frenulum

Question 4

Goal of gingival augmentation

Answer 4

• Create and widen attached gingiva around teeth and implants=>
• Provides more keratinized gingiva and vestibular depth=>
• Improves aesthetics and reduces inflammation around restored teeth

-Helps individuals with less than optimal oral hygiene

Question 5

Pedicle graft technique used in gingival augmentation

Answer 5

• Primarily used for root coverage procedures=>
• Repositioning gingival tissue from adjacent area to cover exposed root surface=>
• Restore gingival contour and improve root coverage

Question 6

Free grafts, and how they used in gingival augmentation

Answer 6

• Placing donor graft tissue apical to recession gingival margin w/out attempting to cover exposed root surface
• Free gingival autografts or free connective tissue autografts
• Recipient site requires firm connective tissue bed, w/ incisions placed at mucogingival junction=>avoid periosteum
• Incisions extended twice desired width of attached gingiva to account for graft contraction
• Donor site typically palate=>
• Graft epithelium and thin layer of connective tissue, 1-1.5 mm thick

• Movement of the graft should be minimized to ensure proper healing

Question 7

How donor site protected during free graft procedures

Answer 7

• w/ sterile dressing
• Hemostatic agent
• Surgical splint=>
• Healing and prevent complications

Question 8

AlloDerm, and how it’s used in gingival augmentation

Answer 8

• Acellular dermal matrix=>
• Alternative donor tissue in gingival augmentation procedures
• Used w/ alternate papilla tunnel and papilla retention pouch
• Healing=>fibrous organization between graft and recipient bed within two days=>
• Revascularization after 2-3 days and complete healing after 10-16 weeks

-APT=> (incision made in papilla adjacent to the tooth with recession, then tunneled to the next papilla)
-PRP=> (all papillae are tunneled)

Question 9

Key steps in the healing process for grafts

Answer 9

• Fibrous organization between graft and recipient bed within two days
• Revascularization beginning after 2-3 days
• Complete healing achieved after 10-16 weeks