MucoGing Defects/Perio Surgery! (E2,L3) Flashcards
________: surgical procedures performed to correct or eliminate anatomic, developmental, or traumatic deformities of the gingiva or alveolar mucosa.
Mucogingival Surgery (Periodontal Plastic Surgery)
Why isn’t the “pushback” surgery method no longer used?
It resulted in more recession and bone loss. It is also not aesthetic.
How much keratinized and attached gingiva is enough? ___ mm keratinized and ___ mm attached for prosthetic abutments
5mm ker….3mm attach (talking about distance from GM to MGJ)
How much keratinized and attached gingiva is enough? At least __ mm attached-keratinized mucosa is necessary for maintaining health
2mm (talking about distance from GM to MGJ)
The Etiology of Gingival Recession: Tooth position relative to facial or lingual cortical bone may result in bony ________ or ________.
fenestration or dehiscence
The Etiology of Gingival Recession: ______ for thin gingiva (lack of tissue thickness) when combined with a bony dehiscence or fenestration is likely to result in gingival recession.
BIOTYPE
Etiology of Recession: Orthodontic arch expansion and/or movement of tooth through facial ________.
cortical bone
Diagnosis of Recession Problems: What is the formula for finding the amount of ATTACHED GINGIVA?
Width of Keratinized Tissue - Probing Depth = Attached Gingiva (freakin straight forward, eh!?)
How can I clinically determine the MGJ? Be Aware: keratinized tissue is not always _______!
Slide the Probe on the tissue until the tissue don’t move no more…..not always attached!
Drop some knowledge: ___% of teeth with LESS THAN 2mm of Keratinized attached tissue will have FURTHER recession.
90 freggin %
Treating gingival defects for increasing width of keratinized and attached gingiva is more of a ______ where as treating for root coverage is more of a ______.
need….Want
BOOM. What are the 3 Treatment Options for increasing the width of Attached Gingiva?
- Apically Positioned Flap (APF)-full thickness flap. 2.Free autogenous Gingival Graft (FGG) 3.subepithelial Connective Tissue Graft (CTG)
BOOM. What are the 3 Treatment Options for obtaining Root Coverage???
- sub epithelial Connective Tissue Graft (CTG) 2.Semi-lunar incision + coronal positioning (Tarnow procedure) 3.Lateral Pedicle Flap (LPF)
Factors to consider in determining where to position the Apically Positioned Flap (APF): Initial _____ and ______ of the gingiva.
width and thickness
Factors to consider in determining where to position the Apically Positioned Flap (APF): Thickness of the marginal ______ bone
alveolar
Factors to consider in determining where to position the Apically Positioned Flap (APF): mount of _______ reduction required
Factors to consider in determining where to position the Apically Positioned Flap (APF): Length of the root trunk (average is ___ mm)
3mm
Factors to consider in determining where to position the Apically Positioned Flap (APF): _______ crown length required for restorative or prosthetic treatment and esthetics
Clinical
The Free Autogenous Gingival Graft (FGG), indications: Increase width of ______ gingiva
attached
The Free Autogenous Gingival Graft (FGG), indications: Remove abnormal _______ attachment
FRENULUM
The Free Autogenous Gingival Graft (FGG), indications: to _______ the oral vestibule
DEEPEN
The Free Autogenous Gingival Graft (FGG), indications: Ridge ___________ procedures
augmentation
The Free Autogenous Gingival Graft (FGG), indications: Cover exposed _____, but FGG is RARELY used for this indication!!!
ROOTS
Advantages to the FGG: Not ________ demanding
technically
Advantages to the FGG: May be accomplished with ______ or full-thickness flap reflections
partial
Advantages to the FGG: Wide _____ of clinical applications.
VARIETY
DISadvantages to the FGG: Poor ability to provide _______ to graft for root coverage
blood supply
DISadvantages to the FGG: Esthetic results are compromised due to _______ during healing resulting in poor ______ match
Scarring…COLOR
DISadvantages to the FGG: Surgery required at ____ intraoral sites
TWO
DISadvantages to the FGG: _____ site may present problems with bleeding, pain, and slow healing
DONOR
Speaking of the donor site in a FGG, how fast does the epithelium heal? (mm/day)
0.5mm/day…holy stratified squamous epithelium batman!
Indications for the sub epithelial Connective Tissue Graft (CTG): Acquire a _____ of attached gingiva
width
Indications for the sub epithelial Connective Tissue Graft (CTG): to _______ the oral vestibule
Deepen
Indications for the sub epithelial Connective Tissue Graft (CTG): Remove ______ and muscle attachment
FRENULUM
Indications for the sub epithelial Connective Tissue Graft (CTG): Acquire _______ attached gingiva (_____ match)
esthetic!!!! color!!!!
Indications for the sub epithelial Connective Tissue Graft (CTG): Cover exposed ____ surface
root
ADVANTAGES of sub epithelial Connective Tissue Graft (CTG): _____ predictability
HIGH
ADVANTAGES of sub epithelial Connective Tissue Graft (CTG): Graft receives abundant ______ supply
BLOOD
ADVANTAGES of sub epithelial Connective Tissue Graft (CTG): ______ wound (donor site) can be surgically closed, thereby facilitating rapid healing with little to no discomfort or bleeding
PALATAL
ADVANTAGES of sub epithelial Connective Tissue Graft (CTG): Good _____ match
color
ADVANTAGES of sub epithelial Connective Tissue Graft (CTG): Applicable for _______ on multiple teeth
Recession
DISadvantages of the ole sub epithelial Connective Tissue Graft (CTG): ________ demanding
TECHNICALLY
DISadvantages of the ole sub epithelial Connective Tissue Graft (CTG): _________ may be necessary after healing
to obtain better tissue contours and to decrease thickness
GingivoPlasty
Indications for the Semi-lunar incision With Coronal Positioning (Tarnow Procedure): _______ anterior teeth with no more than ___ mm of recession and ____ mm of remaining keratinized gingiva.
Maxillary…2….3-5
Indications for the Semi-lunar incision With Coronal Positioning (Tarnow Procedure): A ________ procedure for small areas of gingival recession remaining after other procedures were used for root coverage (e.g.,
FGG, CTG, GTR)
COMPLEMENTARY
Semi-lunar incision With Coronal Positioning (Tarnow Procedure) Advantages: No _______ on coronal positioned flap
tension
Semi-lunar incision With Coronal Positioning (Tarnow Procedure) Advantages: No ________ of the oral vestibule
narrowing
Semi-lunar incision With Coronal Positioning (Tarnow Procedure) Advantages: Good ________ due to color match
esthetics
Semi-lunar incision With Coronal Positioning (Tarnow Procedure) Advantages: Papillary _______ is preserved
height
Semi-lunar incision With Coronal Positioning (Tarnow Procedure) Advantages: ______ surgical procedure
simple
Semi-lunar incision With Coronal Positioning (Tarnow Procedure) Advantages: Minimal post-operative _________
discomfort
Semi-lunar incision With Coronal Positioning (Tarnow Procedure) Advantages: Applicable to minimal gingival recession across _______ teeth
multiple
Semi-lunar incision With Coronal Positioning (Tarnow Procedure) Disadvantages: Not applicable in cases of moderate to advanced gingival recession, i.e., greater than ___ mm
2mm
Semi-lunar incision With Coronal Positioning (Tarnow Procedure) Disadvantages: Requires ___-___ mm of thick keratinized tissue
3-5mm
Semi-lunar incision With Coronal Positioning (Tarnow Procedure) Disadvantages: Healing is by _______ intention and therefore some contraction may occur
SECONDARY
Semi-lunar incision With Coronal Positioning (Tarnow Procedure) Disadvantages: May require a ______ procedure, depending on occurrence of tissue contraction
second :(
Semi-lunar incision With Coronal Positioning (Tarnow Procedure) Disadvantages: Where osseous dehiscence or fenestration exists apical to the gingival recession area, a FGG or CTG should be performed _____ coronal positioning of the semi-lunar flap.
AFTER
What is a disadvantage to the “slick” Lateral Pedicle Graft (LPF)?
the donor site can show recession
What is the name of the Acellular graft material from a cadaver?
AlloDerm
