Mucogingival Surgery

Question 1

what are patient factors to consider for mucogingival surgery?

Answer 1

• Good OH, (<20% Plaque, <10% Bleeding)
• Quality of maintenance (Step 4)
• Pt ability to tolerate surgery
• Cost
• Aesthetics - potential post-op recession

Question 2

Tooth considerations for mucogingival surgery?

Answer 2

Consider prognosis:
- access to non-responding sites
- shape of defect (1, 2, 3 wall’d defect)
- pros/endo considerations
- tooth position/anatomy

Question 3

Medical/systemic considerations for mucogingival surgery?

Answer 3

• smoking (healing)
• unstable angina, uncontrolled hypertension, MI/Stroke
• poor diabetes
• immunosuppression
• anticoagulants (Vit K Antagonist, DOAC, Anti Platelet)

Question 4

what are the general surgical approaches for mucogingival surgery?

Answer 4

• conservative approach (preserving tissue i.e access surgery)
• resective approach (removing tissue i.e resective surgery)
• Reconstructive approach (i.e regenerative surgery)

Question 5

what are the indications of mucogingival surgery?

Answer 5

• periodontitis lesions
• mucogingival deformities
• short clinical crowns
• removal of freenum

Question 6

what are types of mucogingival surgery procedures?

Answer 6

• free gingival graft
• pedicle graft
• connective tissue graft

Question 7

what is a free gingival graft?

Answer 7

Question 8

what is a pedicle sliding graft?

Answer 8

Question 9

what is a connective tissue graft?

Answer 9

Question 10

What are the type of bony defects/loss you can get?

Answer 10

1 Walled
2 Walled
3 Walled

Question 11

what are some types of biomaterials?

Answer 11

• barrier membrane (collagen)
• DBBM (deproteinised bovine bone matrix)
• EMD (enamel matrix derivative)

Question 12

Types of surgical healing outcomes

Answer 12

Question 13

what is gingival recession, and indications for tx?

Answer 13

• apical migration of gingival margin from the CEJ

Indications for tx:
- poor aesthetics, difficult plaque control & sesitivity

Question 14

aetiology of localised and generalised recession?

Answer 14

localised recession:
- excessive brushing (abrasion/poor technique)
- traumatic incisors
- habits: fingernail, tongue stud

Generalised:
- ongoing periodontal disease

Question 15

What is the classification for gingival recession and the types?

Answer 15

Cairo Classification

RT1
RT2
RT3

Question 16

Treatment for gingival recession?

Answer 16

• 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

Question 17

what is the aim of soft tissue grafting?

Answer 17

to create more keratinised tissue/achieving root coverage

if interproximal bone lost, full root coverage is not possible

Question 18

if extensive recession & interproximal bone loss, if surgery is not viable, what is another option?

Answer 18

Gingival veneer

Question 19

aim of crown lengthening surgery?

Answer 19

to apically re-reposition the entire periodontal attachment including alveolar bone

Question 20

indications when to crown lengthen?

Answer 20

• increase clinical crown height for restorations
• expose enough clinical crown for ferrule to be achieved
• expose subgingival restoration/margins/secondary caries

Question 21

when to refer pt for surgery?

Answer 21

• 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