Mucogingival Procedures Parts 5 and 6 Flashcards
ROLE OF
KERATINIZED
GINGIVA
(2)
- HIGHLY DEBATED OVER MANY YEARS
- POSSIBLE TO MAINTAIN PERIODONTAL HEALTH IN THE
ABSENCE OF KERATINIZED GINGIVA
- ALL SURFACES WITH LESS THAN – MM OF KERATINIZED
GINGIVA EXHIBIT CLINICAL INFLAMMATION EVEN IN THE
ABSENCE OF PLAQUE.
2.0
WHEN A NARROW BAND OF KERATINIZED GINGIVA IS
PRESENT, SITES WITH A — PHENOTYPE HAVE A
GREATER TENDENCY TO PROGRESS
THINNER
Periodontal
Phenotype
(3)
Thin scalloped
Thick scalloped
Thick flat
Gingival/soft
tissue recession
(7)
Facial or lingual
surfaces
Interproximal (
papillary)
Severity of recession
Gingival thickness
Gingival width
Presence of
NCCL/cervical caries
Patient esthetic
concern
Hypersensitivity
Gingival
excess
(4)
Pseudo-
pocket
Inconsistent
gingival
margin
Excessive
Gingival
display
Gingival
enlargement
GINGIVAL RECESSION
* GINGIVAL RECESSION BY DEFINITION IS …
* THIS CONDITION AFFECTS A LARGE POPULATION IRRESPECTIVE OF ORAL HYGIENE.
* ESTIMATED PREVALENCE:
* –% OF YOUNG ADULTS
* –% MIDDLE AGED-ELDERLY ADULTS SUFFER FROM GINGIVAL RECESSIONS WITH AN AVERAGE
PREVALENCE OF –%
APICAL MIGRATION OF THE GINGIVAL MARGIN WITH
CONCOMITANT EXPOSURE OF THE ROOT SURFACE.
54.5
100
78.6
MOST COMMON MUCOGINGIVAL
DEFECTS IN DAILY PRACTICE
(2)
- GINGIVAL RECESSIONS
- INADEQUATE ZONE OF KERATINIZED GINGIVA
Predisposing Factors:
(5)
- Periodontal Phenotype and attached Gingiva
- The impact of tooth brushing
- The impact of cervical restorative margins
- The impact of orthodontics
- Other conditions
DIAGNOSTIC
CONSIDERATIONS
(2)
- RECESSION DEPTH AND GINGIVAL
THICKNESS. - MODERN RECESSION
CLASSIFICATION ( CAIRO ET AL 2011)
- RECESSION TYPE (RT) 1-
GINGIVAL
RECESSION WITH NO LOSS OF
INTERPROXIMAL ATTACHMENT.
INTERPROXIMAL CEJ WAS NOT
DETECTED EITHER ON THE MESIAL OR
DISTAL ASPECT OF THE TOOTH
Recession Type (RT) 2-
Gingival recession
associated with loss of interproximal attachment.
The amount of interproximal attachment loss
was less or equal to the buccal attachment loss
Recession Type (RT) 3-
Gingival recession with the loss of interproximal
attachment. Interproximal attachment loss is greater than the buccal attachment
loss.
CAIRO CLASSIFICATION FOR GINGIVAL RECESSION
* TREATMENT ORIENTED
* RT 1 ( MILLER CLASS I AND II) :
* CAIRO RT 2 ( OVERLAPPING MILLER CLASS III):
* CAIRO RT 3 (OVERLAPPING MILLER CLASS IV)
100% ROOT COVERAGE CAN BE
PREDICTED
MIXED RESULTS
FULL ROOT
COVERAGE IS NOT ACHIEVABLE
COMPARISON ON TREATED AND UN TREATED SITES
* 18-35 YEAR FOLLOW-UP
* 47 PATIENTS WITH 64 SITES
* –% OF THE 64 TREATED SITES SHOWED RECESSION REDUCTION, WHILE –% OF THE 64
UNTREATED SITES EXPERIENCED INCREASED RECESSION
* AMOUNT OF INCREASES IN RECESSION WAS LIMITED
* THIN GINGIVAL BIOTYPES ( PHENOTYPES) AUGMENTED BY GRAFTING REMAINED STABLE OVER TIME
COMPARED TO UNTREATED AREAS WITH THIN BIOTYPES ( PHENOTYPES)
* UNTREATED AREAS ALSO SHOWED A TENDENCY TO DEVELOP —
83
48
NEW RECESSION
MODALITIES
OF
TREATMENT
(5)
Free Autogenous Soft tissue graft
Connective tissue Auto or allograft with Tunneling or
vestibular approach
Coronally positioned flap
Semilunar flap
Guided Tissue Regeneration
A SYSTEMATIC REVIEW LABELED — GRAFTS AS THE “GOLD-STANDARD” SURGICAL
PROCEDURE IN THE TREATMENT OF RECESSION DEFECTS
CONNECTIVE TISSUE
A SYSTEMATIC REVIEW LABELED CONNECTIVE TISSUE GRAFTS AS THE “GOLD-STANDARD” SURGICAL
PROCEDURE IN THE TREATMENT OF RECESSION DEFECTS. **
* AAP REGENERATION WORKSHOP- — HAVE THE BEST LONG-TERM RESULTS. ∞
* CHALLENGES ASSOCIATED WITH GRAFT HARVEST, ESPECIALLY WITH —.
* A MORE RECENT STUDY FOUND NO DIFFERENCE IN ROOT COVERAGE AND INCREASE IN WIDTH AND
THICKNESS OF KERATINIZED TISSUE WHETHER A – THICK CTG WAS USED
CTGS
THICKNESS
1MM OR 2MM
Tunnelling technique
(3)
- HAS GAINED POPULARITY
- FLAP ELEVATION THAT DOES NOT DISSECT THE PAPILLA OR REQUIRE VERTICAL RELEASING
INCISIONS - A RECENT MEAT-ANALYSIS AND SYSTEMATIC REVIEW FOUND THE TUNNEL TECHNIQUE TO BE
AN EFFECTIVE PROCEDURE IN TREATING LOCALIZED AND MULTIPLE RECESSION DEFECTS.
Acellular Dermal Matrix Allograft (
ADMA)
(2)
- CELL-FREE DERMAL MATRIX COMPRISED OF A
STRUCTURALLY INTEGRATED BASEMENT MEMBRANE
COMPLEX AND EXTRACELLULAR MATRIX. ∞ - ADMA’S HAVE SUCCESSFULLY BEEN APPLIED AS A
SUBSTITUTE FOR CTGS’ IN VARIOUS PERIODONTAL
PROCEDURES INCLUDING ROOT COVERAGE CELL-FREE
FREE GINGIVAL GRAFTS
* ONE OF THE MOST COMMON APPROACHES FOR —
* IN A LONG-TERM RETROSPECTIVE STUDY( 10-25 YEARS), GINGIVAL
AUGMENTATION PROCEDURES UTILIZING FREE GINGIVAL GRAFTS PROVIDE AN
INCREASED AMOUNT OF — ALONG WITH A REDUCTION OF
— OVER A LONG PERIOD OF TIME.
GINGIVAL AUGMENTATION.*
KERATINIZED GINGIVA
RECESSION
“FREE” GINGIVAL GRAFT
* WOUND HEALING
(5)
- PLASMATIC CIRCULATION (2-4 DAYS)
- REVASCULARIZATION (2-8 DAYS)
- ORGANIC UNION (4-10 DAYS)
- EPITHELIALIZATION (10-14 DAYS)
- KERATINIZATION (21-28 DAYS)
skipped
PHENOTYPE
CONVERSION
(2)
- HEALING PROGRESSION OF THE FREE
GINGIVAL GRAFT - THIS CLINICAL CHRONICLE
DEMONSTRATES THE DAY-TO-DAY
HEALING OF A FREE GINGIVAL GRAFT,
AND CORRELATES THE VISUAL
PRESENTATION WITH THE HISTOLOGY OF
THE HEALING WOUND
FACTORS AFFECTING TREATMENT
(5)
- EXTENT OF THE RECESSION
- ROOT PROMINENCE
- QUANTITY OF KERATINIZED GINGIVA
- TOOTH LOCATION
- CONCOMITANT PRESENCE OF NON-CARIOUS CERVICAL LESIONS
ANATOMICAL CHALLENGES
(4)
- VASCULAR SUPPLY
- MUSCLE PULL
- SHALLOW VESTIBULE
- LOCATION AND EXTENT OF THE RECESSION
Most treated –
(2)
were second and third
Least treated teeth were
(2)
Maxillary canines
Maxillary first premolars
and mandibular incisiors
maxillary right laterals and
second pre-molars
