Exam 2 - Periodontal Esthetic Surgery Flashcards
Mucogingival surgery is now referred to as what?
Periodontal plastic surgery
Define Periodontal plastic surgery
Surgical procedures performed to correct or eliminate anatomic, developmental, or traumatic deformities of the gingiva or alveolar mucosa
The purpose of the Pushback Procedure
Used to eliminate periodontal pockets and establish a wider band of keratinized and attached gingiva
For what 5 reasons is the pushback procedure not necessarily a good procedure
- Exposure of denuded bone during healing
- Resorption of crestal bone
- “Stormy” post-surgery healing phase.
- Poor esthetic results
- Poor long-term results if infra bony lesions (vertical bone defects) are not adequately treated.
How much attached keratinized mucosa is necessary for maintaining health?
2 mm at least
Name 6 etiologies of recession
- Plaque
- Plaque/calculus
- Trauma
- Malposed tooth
- Plaque/Frenulum
- Toothbrushing
T or F, Width of Keratinized tissue - PD = Attached gingiva
True
T or F, Keratinized tissue is always attached
False, Not always!
Bony dehiscence combined with thin biotype may result in what?
Tissue fenestration and recession
Reasons for Treatment of Gingival Recession Defects:
- Increasing width of Keratinized and attached gingiva
2. For root coverage
What concerns cause us to increase the width of keratinized and attached gingiva?
- Prosthetic concerns
- Orthodontic concerns
- Prevent progressive recession
What concerns do we have causing us to treat gingival recession for root coverage?
- Esthetic concerns
- Dentinal Sensitivity
- Prevention of root caries
3 treatment options for increasing the width of attached gingiva?
- Apically positioned flap (APF)
- Full thickness flap - Free autogenous gingival graft (FGG)
- Subepithelial connective tissue graft (CTG)
3 treatment options for obtaining root coverage
- Subepithelial connective tissue graft (CTG)
- Semi-lunar incision + coronal positioning (Tarnow procedure)
- Lateral pedicle flat (LPF)
5 factors to consider in determining where to position the apically positioned flap
- Initial width and thickness of the gingiva
- Thickness of the marginal alveolar bone
- Amount of pocket reduction required
- Length of the root trunk (average is 3 mm)
- Clinical crown length required for restorative or prosthetic treatment and esthetics
5 indications of the Free Autogenous Gingival Graft (FGG)
- Increase width of attached gingiva
- Removed abnormal frenulum attachment
- Deepen oral vestibule
- Ridge augmentation procedures
- Cover exposed roots
- The FGG is rarely used for this purpose
3 advantages of the FGG procedure
- Not technically demanding
- May be accomplished with partial or full-thickness flap reflections
- Wide variety of clinical applications
4 disadvantages of the FGG procedure
- Poor ability to provide blood supply to graft for root coverage
- Esthetic results are compromised due to scarring during healing resulting in poor color match
- Surgery required at two intraoral sites
- Donor site may present problems with bleeding, pain, and slow healing
5 indications of the Subepithelial Connective Tissue Graft (CTG)
- Acquire a width of attached gingiva
- Deepen the oral vestibule
- Remove frenulum and muscle attachment
- Acquire esthetic attached gingiva (color match)
- Cover exposed root surface
5 advantages of the CTG procedure
- High predictability
- Graft receives abundant blood supply
- Palatal wound (donor site) can be surgically closed, thereby facilitating rapid healing with little to no discomfort or bleeding
- Good color match
- Applicable for recession on multiple teeth
2 Disadvantages of the CTG
- Technically demanding
2. Gingivoplasty may be necessary after healing to obtain better tissue contours and to decrease thickness
2 indications of Semi-lunar incision with coronal positioning (Tarnow procedure)
- Maxillary anterior teeth with no more than 2 mm of recession and 3-5 mm of remaining keratinized gingiva
- A complimentary procedure for small areas of gingival recession remaining after other procedures were used for root coverage
7 advantages to the Semi-lunar incision with coronal positioning (Tarnow procedure)
- No tension on coronal positioned flap
- No narrowing of the oral vestibule
- Good esthetics due to color match
- Papillary height is preserved
- Simple surgical procedure
- Minimal post-operative discomfort
- Applicable to minimal gingival recession across multiple teeth
5 Disadvantages to the turnoff procedure
- Not applicable in cases of moderate to advanced gingival recession (greater than 2mm)
- Requires 3-5 mm of thick keratinized tissue
- Healing is by secondary intention and therefore some contraction may occur
- May require a second procedure, depending on occurrence of tissue contraction
- 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
