Exam 2 Mucogingival Flashcards
Mucogingival surgery is now referred to as _______________, since mucogingical surgery has moved beyond the traditional treatment of problems associated with the amount of gingiva and recession type defects to include correction of ________________ form and _________ esthetics.
- “Periodontal plastic surgery”
- alveolar ridge form
- soft tissue
What is the definition of mucogingival surgery ?
Surgical procedures performed to correct or eliminate anatomic development, or traumatic deformities of the gingiva or alveolar mucosa.
What is the mucogingival surgery (Pre-1965), The “PUSHBACK PROCEDURE”?
-Used to eliminate periodontal pockets and establish a wider band of keratinized and attached gingiva
The pushback procedure causes what 5 things?
1) Exposure of denuded bone during healing
2) RESORPTION of crestal bone
3) “Stormy” post-surgery healing phase
4) Poor esthetic results
5) Poor long-term results if infra bony lesions (vertical bone defects) are not adequately treated
Bower (1963) study stated how much gingiva is enough?
Amount of attached gingiva varies from 1mm to 9mm
*Lang & Loe (1972) study stated how much gingiva is enough?
2mm keratinized (1mm attached) is required fro health
Myosato (1977) study stated how much gingiva is enough?
1mm of attached gingiva can be healthy
Maynard & Wilson (1979) study stated how much gingiva is enough?
5mm keratinized & 3mm attached for prosthetic abutments
Dorfman & Kenny (1980) study stated how much gingiva is enough?
1mm of attached is adequate if there is not inflammation
Hangorsky & Bissada (1980)
No relationship between amount of attached gingiva & periodontal health
Wennstorm (1996) study stated how much gingiva is enough?
At LEAST 2mm attached-keratinized mucosa is necessary for maintaining health
What is the etiology of gingival recession?
1) Chewing tobacco use
2) malposed teeth
3) factital injury
4) eruption patterns
5) frenulum attachment
6) parafuctional habits
7) chromic inflammation
8) toothbrushing technique
9) thin-biotype (thin bone/thin gingiva)
10) Iatrogenic (including orthodontics)
11) Discrepancy in facial-lingual width of tooth vs. that of the alveolus
Tooth position relative to facial or lingual cortical bone may result in __________ or ______________
- Bony fenestrations
- dehiscence
When we graft recession what 2 questions can you ask?
1) How much recession
2) Is there enough keratinized gingiva
Biotype for thin gingiva (lack of tissue thickness) when combined with ________ or ___________ is likely to result in gingival recession
- bony dehiscene
- fenestration
Attached gingiva = Width of keratinized tissue - _____
PD (probing depth)
Use a probe to determine point where _______ of tissue beings
mobility
Keratinized tissue is not always ________
attached
Why increase the thickness of kermatizied attached gingival tissue?
1) Crown margins
2) Esthetics
3) Prevent further recession from happening
4) Orthodontics
___ % of teeth with less than ___ mm keratinized attached tissue will show further recession over time
- 90%
- 2mm
Increasing width of keratinized and attached gingiva ?
1) Prosthetic concerns
2) Orthodontic concerns
3) Prevent progressive recession
What are the reasons for treatment of gingival recession defects for root coverage?
1) esthetic concerns
2) dentinal sensitivity
3) prevention of root caries
What are the treatment options for increasing the width of attached gingiva ?
1) Apically positioned flap (APF)
2) Free autogenous gingival graft (FGG)
3) Subepithelial connective tissue graft (CTG)
What is a Apically positioned flap (APF) ?
- Full thickenss flap
- Surgical flap that you slide down and suture into place you move it down.
- You don’t cut it
What is a Free autogenous gingival graft? (FGG)
- Soft tissue graft
- Square of surface epithelium
- Bleeding on one side no bleeding on the other
What are the treatment option for obtaining root coverage?
1) CTG
2) Semi-lunar incision + coronal positioning (Tarnow procedure)
3) Lateral pedicle flap (LPF)
What are the factors to consider in determinng where to position the apically positioned flap (APF)? (5)
1) Initial width and thickness of the gingiva
2) Thickness of the marginal alveolar bone
3) Amount of pocket reduction required
4) Length of the root trunk (AVG = 3 mm)
5) Clinical crown length required for restorative or prosthetic treament and esthetics
What are the indications for the FGG graft?
1) INCREASE width of attached gingiva
2) Remove abnormal frenulum attachment
3) Deepen oral vestibule
4) Ridge augmentation procedures
5) Cover exposed roots
- The FGG is rarely used for this purpose
What are the advantages of the FGG ?
1) Not technically demanding
2) May be accomplished with partial or full-thickness flap reflections
3) Wide variety of clinical applications
What are the disadvantages of the FGG?
1) Poor ability to provide blood supply to graft for root coverage
2) Esthetic results are compromised due to scarring during healing resulting in poor color match
3) Surgery required at 2 intraoral sites
4) Donor sire may present problems w/ bleeding, pain, and slow healing
Why do a APF?
- When preoperative condition indicates a minimal zone of exisiting keratinized attached tissue.
- If you have to remove marginal tissue if you are going to run out at the end of the procedure you should re-position
What are the indications for CTG ? (5)
1) acquire a width of attached gingiva
2) deepen the oral vestibule
3) remove frenulum and muscle attachment
4) acquire esthetic attached gingiva ( color match)
5) cover exposed root surface
What are the advantages of CTG? (5)
1) High predictability
2) Graft receives abundant blood supply
3) Palatal wound (donor site) can be surgically closed, thereby facilitating rapid healing with little to no discomfort or bleeding
4) Good color match
5) Applicable for recession on multiple teeth
What are the disadvantages for CTG?
1) technically demanding
2) Gingivoplasty may be necessary after healing to obtain better tissue contours and decrease thickness
What is the GOLD STANDARD for grafting tissue?
Connective Tissue Graft (CTG)
CT induces _________ of whatever you put over it
keratinization
What are the indications for the Semi-lunar incision with Coronal Positioning (Tarnow procedure)
1) MAX anterior teeth with no more than 2 mm of recession and 3-5 mm of remaining keratinized gingiva
2) A complimentary procedure for small areas of gingival recession remaining after other procedures were used for root coverage (e.g., FGG, CTG, GTR)
What are the ADVANTAGES of the Semi-lunar incision with coronal positioning (Tarnow procedure) ? (7)
1) No tension on coronal positioned flap
2) No narrowing of the oral vestibule
3) Good esthetics due to color match
4) Papillary height is preserved
5) Simple surgical procedure
6) Minimal post-operative discomfort
7) Applicable to minimal gingival recession across multiple teeth
What are the DISADVANTAGES to the Semi-lunar incision with coronal positioning (Tarnow procedure) ?
1) Not applicable in cases of moderate to advanced gingival recession, i.e., Greater than 2 mm
2) Requires 3-5 mm of thick keratinized tissue
3) Healing is by secondary intention and therefore some contraction may occur
4) May require a second procedure, depends on occurrence of tissue contraction
5) Where osseous dehiscence or fenestration exists apical to the gingival recession area, a FGG or CTG should be performed after coronal positioning of the semi-lunar flap
What is the LPF procedure?
- Lateral pedicle flap
- Removing gingiva from the adjacent tooth
