mucogingival surgery

Question 1

periodontal surgery part of

BSP S3 guidelines

Answer 1

step 3

Question 2

types of periodontal surgery

4

Answer 2

access therapy
resective therapy
regnerative therapy (GTR and GBR)
mucogingival therapy

Question 3

access therapy

Answer 3

gain more access to the root surface in persisting pockets

Question 4

resective therapy

Answer 4

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

Question 5

3 instances where resective therapy used

Answer 5

• Furcation resective tx (tunnel preparation; root resection/separation – make more cleansable)
• Ginvectomy – only in hyperplasia
• Crown lengthing – before prosthetic tx

Question 6

regenerative therapy uses

2

Answer 6

Infrabony defects convert from vertical to horizontal

Augmentation of the edentulous ridge – imp for implant placement, gain space from sinus/nerves

Question 7

mucogingival therapy uses

4

Answer 7

• Gingival augmentation
• Root coverage
• Gingival preservation at ectopic tooth eruption
• Preservation of ridge collapse associated with tooth extraction

perio plastic surgery

Question 7

mucogingival therapy uses

4

Answer 7

• Gingival augmentation
• Root coverage
• Gingival preservation at ectopic tooth eruption
• Preservation of ridge collapse associated with tooth extraction

perio plastic surgery

Question 8

when to introduce perio surgical tx

Answer 8

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)

Question 9

regenerative periodontal therapy aims

3

Answer 9

• 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

Question 10

regenerative periodontal therapy
goal

Answer 10

obtain a shallow, maintainable pocket by reconstruction of the destroyed attachment apparatus and thereby also limit recession of the gingiva margin

Question 11

horizontal bone loss

Answer 11

Suprabony (supracrestal) pocket – base of the pocket is located coronally to the alveolar crest

Question 12

vertical (angular) bone loss

Answer 12

Infrabony, subcrestal pocket, defect
* when the apical end of the pocket is located below the bone crest.

Question 13

2 types of vertical bone loss

Answer 13

Infrabony defect – when the subcrestal component involves the root surface of only one tooth

Crater - Affects 2 adj teeth

Question 14

classification of infrabony defect

Answer 14

1 wall infrabony defect
2 wall infrabony defect
3 wall infrabony defect

Question 15

infrabony defect management

3

Answer 15

• Closed/open root surface debridement – healing by repair
• Pocket elimination with Osseous resection – rarely used nowadays
• Regenerative techniques

Question 16

triad of tissue engineering

Answer 16

scaffold
cells
signalling molecules

Question 17

strategies for periodontal regeneration

4

Answer 17

• Space maintenance and clot protection
• Selective cell repopulation
• Provision of progenitor cells
• Use of biological mediators – signaling molecules

Regenerative Techniques may employ one or more of the above strategies

Question 18

biological mediators in regenerative techniques

Answer 18

• Platelet-derived growth factor
• Insulin growth factor
• Transforming growth factor b
• Bone morphogenetic proteins
• Prostaglandin
• Fibronectin
• Enamel matrix proteins

Question 19

GTR

Answer 19

guided tissue regeneration

Question 20

GBR

Answer 20

guided bone regeneration

Question 21

bone grafts
objectives

Answer 21

Space maintenance and clot protection

Osteoconduction
* Scaffold

Osteoinduction
* Promoting osteoblast activity

Osteogenesis
* Osteoblasts present in the graft

Question 22

all perio surgery

Answer 22

debride first

Question 23

autograft

Answer 23

from same individual

Question 24

allograft

Answer 24

same species

Question 25

allopast

Answer 25

synthetic

Question 26

xenograft

Answer 26

different species

Question 27

recession

Answer 27

Gingival recession is the displacement of the gingival soft tissue margin apical to the cement-enamel junction which results in exposure of the root surface

Question 28

aetiology of recession with perio

Answer 28

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

Question 29

recession mechical/physical factors | 9

Answer 29

* 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

Question 30

recession type 1

Answer 30

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

Question 31

recession type 2

Answer 31

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

Question 32

recession type 3

Answer 32

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

Question 33

recession symptoms | 5

Answer 33

* dentine hypersensitivity * cervical caries * cervical abrasion and erosion * poor aesthetics * loss of vitality tooth loss

Question 34

why are teeth with recession more susceptible to caries and erosion

Answer 34

greater surface area of teeth exposed. * When surface of root exposed only 3micrmillimters of cementum- gone within days * Both cementum and dentine softer than enamel not designed to withstand oral cavity

Question 35

recession tx

Answer 35

1. Monitoring * a. Correct brushing techqnieu to prevent future abrasion * b. Educate pt on dietary intake and any medical issues refer 2. Use of desensitizing agents, varnishes and dentine bonding agents to decrease oversensitivness * a. close canals from environment * b. Fluoride helps - FA stronger than HA - more resistant to acid attack and helps prevent hypersentivity 3. Composite restoration * a. Risk of iatrogenic damage - overhang, cause more problems and development of further recession; limited cases that it will aid 4. Prosthetic crown with pink porcelain in the region of the recession * a. Some are just hiding problem rather than solving the issue * b. plaque retentive factor 5. Removable pink gingival veneers 6. Orthodontics 7. Surgery

Question 36

types of grafts for periodontal surgery

Answer 36

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

Question 37

questions to ask when deciding on which graft needed for perio

Answer 37

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

Question 38

free gingival graft pro cons (2)

Answer 38

Increase keratinized tissue around the teeth, implant or crown Disadvantages: 1)Not perfect aesthetics (colour not match esp in high smile line) 2)Graft has no blood supplies through the vessels during first week – high chance fail/necorisis Don’t go further than 1st molar = palatal - arteries

Question 39

free connective tissue graft pro

Answer 39

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