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Week 85 > Mucogingival Surgery > Flashcards

Mucogingival Surgery Flashcards

1
Q

Define Mucogingival Surgery

A
  • Surgical procedure
    • correct/enhance the thickness/amount or position of mucogingival tissue
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2
Q

Periodontal Plastic Surgery

A
  • reshape the tissue around the teeth or implants
  • prevent or correct anatomical, developmental, traumatic, or plaque-induced defects of the gingiva, alveolar mucosa, or bone
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3
Q

What is gingiva?

A
  • Keratinized tissue
  • composed of:
    • dense, collagen rich CT
  • covered by keratinized epithelium
  • extends from:
    • free gingiva margin→mucogingival line
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4
Q

What are the regions of the gingiva?

A
  • Free gingiva
    • depth of the sulcus
  • Attached gingiva
    • Width of gingiva minus PD
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5
Q

What are some mucogingival deformities that affect the periodontium?

A
  • Gingival Phenotype
  • Gingival/soft tissue recession
  • Lack of gingiva
  • Decreased vestibular depth
  • Aberrant frenum/muscle position
  • gingival excess
  • abnormal color
  • condition of the exposed root surface
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6
Q

Periodontal/Gingival Phenotype

A
  • Thin Scalloped
    • slender, triangular crown
    • subtle cervical convexity
    • inter proximal contacts close to incisal edge
    • narrow KT
    • clear thin gingiva
    • thin alveolar bone
  • Thick flat
    • square-shaped crown
    • pronounced cervical convexity
    • large interproximal contact located more apically
    • broad zone of KT
    • thick fibrotic gingiva
    • thick alveolar bone
  • Thick scalloped
    • thick fibrotic gingiva
    • slender teeth w/narrow zone of KT
    • pronounced gingival scalloping
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7
Q

Define Gingival Recession

A
  • apical shift of gingival margin
    • based on CEJ
  • associated with
    • attachment loss
    • exposure of root surface
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8
Q

Gingival Recession Classification

A

Interdental CAL=reference

  • Recession Type 1 (RT1)
    • no loss of interproximal attachment
    • cant detect interproximal CEJ (M or D)
  • Recession Type 2 (RT2)
    • loss of interproximal attachment
      • ≤ buccal attachment loss
  • Recession Type 3 (RT3)
    • loss of interproximal attachment
      • > buccal attachment loss
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9
Q

Diagnostic Considerations of Gingival Recession:

A

reduce potential for complete root coverage

  • Depth of recession
    • Greater the depth
  • Gingival Thickness:
    • < 1 mm
  • Interdental CAL
    • Loss of interdental CAL
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10
Q

Etiology of Gingival Recession

A
  • Faulty toothbrushing technique
  • Tooth malposition
  • tooth and bone relation
  • orthodontic movements
  • trauma from occlusion
  • frenum attachment
  • mechanical trauma
  • local irritants
  • improper restorative procedure
  • psychosomatic factors
  • periodontal surgery and disease
  • teeth adjacent to extractions
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11
Q

How much attached gingiva is necessary to maintain gingival health?

A
  • page 5
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12
Q

What are the peri-implant soft tissue deficiencies?

A
  • Soft tissue deficiencies
    • before implant placement
      • tooth loss
      • perio disease
      • systemic diseases
    • after implant placement
      • lack of buccal bone
      • papilla height
      • keratinized tissue
      • migration of teeth and life-long skeletal changes
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13
Q

Gingival Augmentation: Indications

A
  • tooth movement → alveolar bone dehiscence
  • Stop progressive marginal tissue recession
  • improve plaque control and patient comfort
    • teeth and implant
  • intracrevicular restoration margins
    • in conjunction w/prosthodontist
  • major or minor connectors or removable partials infringe on marginal mucosa
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14
Q

Root Coverage: Indications

A
  • reduce tooth sensitivity
  • improve esthetics
  • manage
    • Root Caries removal defects
    • cervical abrasion defects
    • mucogingival defects
      • dont respond to different toothbrushing technique or plaque control
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15
Q

What are the different type of flaps for Pedicle Graph?

A
  • Rotational Graphs: (Better outcomes)
    • Laterally sliding flap
    • double papilla repositioned flap
  • Advanced flaps
    • semi-lunar coronally positioned flap
    • coronally positioned flap
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16
Q

Laterally sliding flap: Steps

A
  1. SRP
  2. Remove inflamed gingiva
  3. Vertical Releasing incision
    1. at least 1 tooth away
  4. Full-partial thickness flap resected
    1. full- mesial to target site
    2. partial- distal/away
  5. Reposition flap over target site & suture in place
17
Q

Laterally Sliding Flap: Advantages vs disadvantages/limitations

A
  • Advantages:
    • 1 surgical site
    • good vascularity
    • good color match
  • Limitations:
    • Donor Site:
      • amount of attached gingiva
      • Dehiscence or fenestrations
      • possible recession
    • 1 tooth
18
Q

Laterally Sliding Flap: Contraindications

A
  • Receiving Site:
    • Deep interproximal pockets
    • excessive root prominences
  • Receiving & Donor Site:
    • Significant loss of interproximal bone height
  • Recession in 2 or more neighboring teeth
19
Q

Laterally Moved, Coronally Advanced flap (LMCAP): Anatomical requirements

A
  • Width of KT lateral to defect
    • 6mm greater than the width recession at CEJ
      • (6mm +x)
  • Height of KT
    • 3mm greater than Buccal Probing depth of adjacent donor tooth
      • 3mm + Buccal PD (donor)
    • if < 3mm
      • unable to preserve collar of attached gingiva protecting donor tooth
      • alternative=LMCAF (w/marginal incision) + FGG placed over donor site
20
Q

Laterally Moved, Coronally Advanced flap (LMCAP): Indications vs Contraindications:

A
  • Indications:
    • isolated recession defects on:
      • mandibular incisors
      • mesial roots of 1st molars
  • Contraindications:
    • Insufficient dimensions of adjacent KT
      • Width= 6mm + x (x=width of recession at CEJ)
      • Height= 3mm + PD
    • High esthetic expectations
21
Q

Semilunar Coronally Advanced Flap: Steps

A
  • Steps:
    • FTF
    • tissue moved more coronally
    • held in place by gauze
      • suture is optional
22
Q

Semilunar Coronally Advanced Flap: Advantages vs limitations

A
  • Advantages:
    • does not shorten vestibule
    • good color match
    • single or multiple teeth
    • doesn’t need sutures
    • M/D papilla stay the same
  • Limitations:
    • can’t treat deep recession
      • only shallow localized recession
    • requires at least 3-4mm of keratinized attached gingiva apical to defect
    • requires freee gingival graft for dehiscence or root fenestration
23
Q

Double papilla (repositioned) Flap

A
24
Q

Coronally Advanced Flap: Steps

A
  • Initial Horizontal Incision
  • 2 vertical releasing flaps
  • FTF to MGJ, then partial thickness
  • coronally position then sutured
25
Q

Coronally advanced flap: Advantages:

A
  • treat multiple areas
    • single or multiple tooth
      • multiple=use biologics
  • don’t involve adjacent teeth
  • good color match
26
Q

Coronally Advanced Flap: Contraindications:

A
  • Extremely thin gingiva
  • insufficient attached gingiva
  • shallow vestibular depth
27
Q

Types of Soft Tissue Grafts?

A
  • Free Gingival Graph (FGG)
    • epithelialized
  • Connective Tissue Graph (CTG)
    • non-epithelialize
28
Q

Technique/Steps for Free Gingival Graph(FGG)

A
  • if root coverage is needed→SRP root
  • Prepare recipient tissue bed
    • Partial Thickness Flap
      • leave periosteum
    • Apico-coronal dimension is 2x desired width
  • Obtain keratinized graph from donor site (Palate or edentulous ridge)
    • thickness=1-1.5 mm
  • Transfer graph
  • immobilize graph/suture
29
Q

Free Gingival Graph: Indications vs contraindications

A
  • Indications
    • increase
      • width of attached gingiva
      • vestibular depth
    • root coverage
  • Contraindications:
    • esthetics
      • poor color match
      • different surface contours
30
Q

Free Gingival Graph: Healing

A
  • Initial Phase→Plasmic Circulation
    • 0-3 days
  • Revascularization phase
    • 2-11 days
  • Tissue Maturation Phase
    • 11-42 days
31
Q

Appearance of a healing Graft:

A
  • Surgery:
    • pale white
      • graft vessels are empty
  • 1st week post-op
    • ischemic gray
      • sloughing epithelium
    • reddish pink
      • vascularization of graft
  • 16 weeks post op
    • coral pink
      • epithelial maturation
32
Q

Connective Tissue Graft (CTG): Technique/steps

A
  • Horizontal incision at CEJ and gingival margin
  • vertical releasing flap
  • partial thickness flap
  • remove CT on palate
    • suture over recession
  • cover autograph w/flap
33
Q

CTG: Advantages:

A
  • Esthetics
    • good color and texture match
  • predictable
    • best outcomes for restoring gingival height
  • 1 step procedure
  • minimal palatal trauma
  • multiple teeth
  • increased graph vascularity
34
Q

CTG: Tunnel Technique

A
35
Q

Combination Grafts

A
  • 1-stage procedures
    • CTG + pedicle flap
    • Biodegradable barrier + pedicle flap
  • 2-stage procedure
    • coronally positioned previously placed FGG
    • non-resorbable barrier + pedicle flap

Week 85 (8 decks)

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