mucogingival/periodontal plastic surgery

Question 1

periodontal surgery - patient factors to consider

Answer 1

oral hygiene
- >20% plaque, >10% bleeding
ability of patient to tolerate procedure
likely patient compliance in maintenance post surgery
cost and patient acceptance
aesthetics of site and potential for post op recession

Question 2

periodontal surgery - tooth factors

Answer 2

consider prognosis
access to non-responding sites
shape of defect
Prosthodontic/endodontic considerations
tooth position/anatomy
- tilting
- overeruption
- enamel pearls
- ridges/root grooves

Question 3

periodontal surgery - systemic/medical considerations

Answer 3

smoking
unstable angina, previous MI or stroke in last 6 months
poorly controlled diabetes
immunosuppressed
anticoagulants

Question 4

periodontal surgery - operator factors

Answer 4

skill and experience
should be provided by dentists with additional specific training or by specialists in referral centres
access to tier 2 (dentist with special interest) or tier 3 (specialist) care
may vary by region

Question 5

general surgical approaches

Answer 5

conservative approach
- preserving tissue
- access surgery
resective approach
- removing tissue
- resective surgery
reconstructive approach
- regenerative surgery

Question 6

regenerative surgery - aims

Answer 6

aims to promote the regeneration of the periodontal tissues that have been lost

Question 7

surgical techniques in regenerative surgery

Answer 7

regeneration of the PDL using membranes and grafts and the application of biologic agents

Question 8

mucogingival surgery - indications

Answer 8

periodontitis lesions requiring reconstructive or regenerative treatment
mucogingival deformaties and poor aesthetics
- e.g. recession defects
short clinical crowns
- where an increase in clinical crown height is required before completing a restoration
creation of a more favourable soft tissue bed pre implant surgery
- e.g.socket preservation for future implants

Question 9

give examples of common mucogingival surgery procedures

Answer 9

free gingival graft
pedicle graft
connective tissue graft

Question 10

localised gingival recession aetiology

Answer 10

excessive toothbrushing or incorrect technique
traumatic incisor relationship
habits
anatomical
complication of orthodontic treatment

Question 11

generalised gingival recession aetiology

Answer 11

complication of orthodontic treatment
ongoing periodontal disease
or following resolution of inflammation after successful treatment

Question 12

What classification is used to describe types of gingival recession?

Answer 12

Cairo 2012 classification

Question 13

recession type 1

Answer 13

no inter proximal tissue loss
full root coverage may be achievable

Question 14

recession type 2

Answer 14

inter proximal tissue loss not as significant as mid-buccal
- partial root coverage may be expected

Question 15

recession type 3

Answer 15

gingival recession associated with loss of inter proximal attachment
interproximal tissue worse than mid-buccal
- no root coverage expected

Question 16

gingival recession treatment options

Answer 16

record magnitude of recession on regular basis to asses progression or stability
eliminate etiological factors
- habits/piercings
OHI
- single tufted toothbrushes
topical desensitising agents
- fluoride varnish and toothpaste
gingival veneer to cover exposure roots/embrasure spaces
crowns
mucogingival surgery