Mucogingival Surgery Flashcards
what are patient factors to consider for mucogingival surgery?
- Good OH, (<20% Plaque, <10% Bleeding)
- Quality of maintenance (Step 4)
- Pt ability to tolerate surgery
- Cost
- Aesthetics - potential post-op recession
Tooth considerations for mucogingival surgery?
Consider prognosis:
- access to non-responding sites
- shape of defect (1, 2, 3 wall’d defect)
- pros/endo considerations
- tooth position/anatomy
Medical/systemic considerations for mucogingival surgery?
- smoking (healing)
- unstable angina, uncontrolled hypertension, MI/Stroke
- poor diabetes
- immunosuppression
- anticoagulants (Vit K Antagonist, DOAC, Anti Platelet)
what are the general surgical approaches for mucogingival surgery?
- conservative approach (preserving tissue i.e access surgery)
- resective approach (removing tissue i.e resective surgery)
- Reconstructive approach (i.e regenerative surgery)
what are the indications of mucogingival surgery?
- periodontitis lesions
- mucogingival deformities
- short clinical crowns
- removal of freenum
what are types of mucogingival surgery procedures?
- free gingival graft
- pedicle graft
- connective tissue graft
what is a free gingival graft?
what is a pedicle sliding graft?
what is a connective tissue graft?
What are the type of bony defects/loss you can get?
1 Walled
2 Walled
3 Walled
what are some types of biomaterials?
- barrier membrane (collagen)
- DBBM (deproteinised bovine bone matrix)
- EMD (enamel matrix derivative)
Types of surgical healing outcomes
what is gingival recession, and indications for tx?
- apical migration of gingival margin from the CEJ
Indications for tx:
- poor aesthetics, difficult plaque control & sesitivity
aetiology of localised and generalised recession?
localised recession:
- excessive brushing (abrasion/poor technique)
- traumatic incisors
- habits: fingernail, tongue stud
Generalised:
- ongoing periodontal disease
What is the classification for gingival recession and the types?
Cairo Classification
RT1
RT2
RT3
Treatment for gingival recession?
- record magnitude of recession on regular basis
- eliminate any causative factors (habits/piercings)
- OHI (gentle brushing)
- topical fluoride if sensitive
- gingival veneers (aesthetics)
- mucogingival surgery
what is the aim of soft tissue grafting?
to create more keratinised tissue/achieving root coverage
if interproximal bone lost, full root coverage is not possible
if extensive recession & interproximal bone loss, if surgery is not viable, what is another option?
Gingival veneer
aim of crown lengthening surgery?
to apically re-reposition the entire periodontal attachment including alveolar bone
indications when to crown lengthen?
- increase clinical crown height for restorations
- expose enough clinical crown for ferrule to be achieved
- expose subgingival restoration/margins/secondary caries
when to refer pt for surgery?
- only after thorough non-surgical tx
- highly motivated/engaged pt with good OH and risk factor control
- non-smoker & no contraindicated MH
- good prognosis of teeth
