mucogingival surgery Flashcards
periodontal surgery part of
BSP S3 guidelines
step 3
types of periodontal surgery
4
access therapy
resective therapy
regnerative therapy (GTR and GBR)
mucogingival therapy
access therapy
gain more access to the root surface in persisting pockets
resective therapy
To remove infected soft tissue of the gingivae and infected bone
Only used in:
* Furcation resective tx (tunnel preparation; root resection/separation – make more cleansable)
* Ginvectomy – only in hyperplasia
* Crown lengthing – before prosthetic tx
3 instances where resective therapy used
- Furcation resective tx (tunnel preparation; root resection/separation – make more cleansable)
- Ginvectomy – only in hyperplasia
- Crown lengthing – before prosthetic tx
regenerative therapy uses
2
Infrabony defects convert from vertical to horizontal
Augmentation of the edentulous ridge – imp for implant placement, gain space from sinus/nerves
mucogingival therapy uses
4
- Gingival augmentation
- Root coverage
- Gingival preservation at ectopic tooth eruption
- Preservation of ridge collapse associated with tooth extraction
perio plastic surgery
mucogingival therapy uses
4
- Gingival augmentation
- Root coverage
- Gingival preservation at ectopic tooth eruption
- Preservation of ridge collapse associated with tooth extraction
perio plastic surgery
when to introduce perio surgical tx
Not first line tx
Need excellent OH
Some at S3 - OFD
Or once disease is settled - OFD and regenerative, reconstructive (no inflammation but there is recession)
regenerative periodontal therapy aims
3
- An increase in periodontal attachment of severe compromised teeth
- A decrease in deep pockets to a more maintainable range
- Reduction of the vertical and horizontal component of furcation defects
obtain a shallow, maintainable pocket by reconstruction of the destroyed attachment apparatus and thereby also limit recession of the gingiva margin
regenerative periodontal therapy
goal
obtain a shallow, maintainable pocket by reconstruction of the destroyed attachment apparatus and thereby also limit recession of the gingiva margin
horizontal bone loss
Suprabony (supracrestal) pocket – base of the pocket is located coronally to the alveolar crest
vertical (angular) bone loss
Infrabony, subcrestal pocket, defect
* when the apical end of the pocket is located below the bone crest.
2 types of vertical bone loss
Infrabony defect – when the subcrestal component involves the root surface of only one tooth
Crater - Affects 2 adj teeth
classification of infrabony defect
1 wall infrabony defect
2 wall infrabony defect
3 wall infrabony defect
infrabony defect management
3
- Closed/open root surface debridement – healing by repair
- Pocket elimination with Osseous resection – rarely used nowadays
- Regenerative techniques
aetiology of recession
with perio
Inflammatory process – periodontal disease
* Active inflammation leads to bone lost but gingivae inflamed/enlarged so pt don’t have recession issue in active disease
* Want to halt active disease to prevent more bone loss
Need to explain to pt that successful HPT will cause recession
* Inevitable after successful HPT
recession
mechical/physical factors
9
- Vigorous tooth brushing or brushing with a hard bristle toothbrush - patents with good oral hygiene.
- Traumatic incisal relationship can cause striping of the gingival tissues.
- Trauma from foreign bodies such as lower lip piercings
- Prominent teeth out of alignment of the arch, especially if there is thin gingival biotype overlying the dehiscence
- Aberrant fraenal attachments due to an apical pull on the gingival tissues
- High fraenal attachments (close to the gingival margin) making oral hygiene difficult therefore leading to a localised periodontal problem and subsequent recession.
- Iatrogenic damage caused by Restorative treatment which involves placement of subgingival margins of restorations can directly impinge on the supracrestal attachement
- Orthodontic treatment not respecting amount of the width of the dental alveolus
recession type 1
gingival recession with no loss of inter-proximal attachment. Interproximal CEK is clinically not dectable at both mesial and distal aspects of tooth
able to cover up fully
recession type 2
gingival recession associated with loss of interproximal attachment. The amount of interproximal attachment loss (measured from the interproximal CEJ to the depth of the interproximal pocket) is less than or equal to the buccal attachment loss (measured from the buccal CEJ to the apical end of the buccal pocket)
able to cover up, but not fully
recession type 3
gingival recession associated with loss of interproximal attachment. The amount of interproximal attachment loss (measured from the interproximal CEJ to the depth of the interproximal pocket) is less than or equal to the buccal attachment loss (measured from the buccal CEJ to the apical end of the buccal pocket)
not able to cover up/tx - HORIZONTAL BONE LOSS
types of grafts for periodontal surgery
1)Free soft tissue graft (gingival and connective)
2)Pedicle gingival graft
Rotational flaps
* Laterally positioned flap
* Double papilla flap
Advanced flap
* Coronally advanced flap - most popular
* Semilunar coronally repositioned flap procedure
Want attached split thickness thick flap graft with pedicle
questions to ask when deciding on which graft needed for perio
Is recession progressing
Is the tooth tx planned for ortho care or prosthetic tx
Is there root sensitivity
Is there difficulty cleaning the root surface by the pt
* Lower inicisor recession is uncleansable - if left without any tx, can lead to issue
Is there an aesthetic concern
* Aesthetic - hard to make look good if not enough bone in first place, Know the biotype is very thin and know there will be little bone so tranforming biotype before
free connective tissue graft
pro
Used to change biotype from thin to thick
Thin biotype more prone to recession
* So if didn’t change will likely just have more recession
Always pedicle flap - type depends on situation
Want attached split thickness thick flap graft with pedicle
