mucogingival surgery

Question 1

What makes a pt a good candidate for mucogingival surgery

Answer 1

Good OH (<20% plaque, <10% marginal bleeding)
Ability to tolerate procedure
Good maintenance care available
Likely compliance post-surgery
Cost acceptable

Question 2

What prosthodontic and endodontic considerations should be made during planning of mucogingival surgery?

Answer 2

Tooth position and anatomy - tilting
proximity to adjacent roots
Presence of enamel pearls or ridges and root grooves

Question 3

What are red flags in MH for mucogingival surgery?

Answer 3

Smoking
Unstable angina, uncontrolled hypertension, MI/stoke within 6 months

Question 4

What are the general periodontal surgical approaches an what are examples of each?

Answer 4

Conservative approach (preserving tissue ie - access surgery)
Resective approach (removing tissue ie - resective surgery)
Reconstructive approach (ie - regenerative surgery)

Question 5

What is the aim of regenerative surgery?

Answer 5

To promote the regeneration of the periodontal tissues that have been lost

Question 6

What are the indications of mucogingival surgery?

Answer 6

Periodontitis lesions requiring reconstructive or regenerative tx
Mucogingival deformities/poor aesthetics eg - recession defects or reconstruction of papillae
Short clinical crowns where additional crown height is needed prior to restorative work
Removal of frenum that is causing recession
Creation of a more favourable soft tissue bed pre-implant surgery

Question 7

What are the most common mucogingival surgery procedures?

Answer 7

Free gingival graft
Pedicle graft
Connective tissue graft
Guided bone regeneration (GBR)

Question 8

What is a full thickness flap?

Answer 8

Raising the entire soft tissue including the periosteum

Question 9

What is a split thickness flap?

Answer 9

Leaving behind some connective tissue, the periosteum, and raising the epithelium with some connective tissue

Question 10

Describe the flap for a free gingival graft

Answer 10

Raising a split thickness flap - leaving some connective tissue behind so BVs can enter the site for healing by secondary intention

Question 11

What is a pedicle sliding graft?

Answer 11

When the gingival margin around the exposed root is excised and a split thickness flap is raised
The flap is rotated laterally to cover the defect
Donor site heals by secondary intention

Question 12

What are the different types of infra bony defects?

Answer 12

1 walled
2 walled
3 walled

Question 13

Which type of infrabony defect heals best and why?

Answer 13

3 walled - osteoblasts are coming from 3 sides

Question 14

Name 3 biomaterials used in bone grafting

Answer 14

Barrier membrane (collagen)
DBBM (deproteinised bovine bone matrix)
EMD (enamel matrix derivative/amelogenins)

Question 15

What are the 2 surgical healing outcomes?

Answer 15

Healing by formation of long junctional epithelium - pt needs good OH after
Healing by new connective tissue attachments (in grafting procedures)

Question 16

Describe the aetiology of local gingival recession

Answer 16

Excessive toothbrushing, incorrect technique or use of an abrasive brush
Traumatic incisor relationship
Habits - rubbing gingivae with fingernail/pencil/lip stud
Anatomical - frenal pull or teeth out of alignment

Question 17

Describe the aetiology of generalised gingival recession

Answer 17

Ongoing periodontal disease or following resolution of inflammation after successful tx

Question 18

What is known to cause localised or generalised recession?

Answer 18

Complication of ortho tx

Question 19

What is gingival recession type 1 (RT1)?

Answer 19

No interproximal tissue loss, full root coverage may be achievable

Question 20

What is gingival recession type 2 (RT2)?

Answer 20

Interproximal tissue loss (from CEJ to base of pocked) not as significant as mid buccal, partial root coverage may be expected

Question 21

What is gingival recession type 3 (RT3)?

Answer 21

Gingival recession associated with loss of interproximal attachment, interproximal tissue loss (from CEJ to base of pocket) worse than mid buccal, no root coverage expected

Question 22

How is gingival recession treated?

Answer 22

Record magnitude of recession - clinically or study models
Eliminate aetiological factors
OHI - single tufted brushes
Topical desensitising agents - fluoride varnish and toothpaste
Gingival veneer
Mucogingival surgery

Question 23

What is the aim of ginigval recession surgery?

Answer 23

Soft tissue grafting to create more keratinised tissue or achieving root coverage

Question 24

What is the aim of crown lengthening?

Answer 24

To apically re-position the entire periodontal attachment including the alveolar bone

Question 25

What are the indications of crown lengthening surgery?

Answer 25

Increase the clinical crown height to give adequate retention for restorations
Expose enough clinical crown to allow a restorative ferrule to be achieved
Expose subgingival restorations margins/secondary caries/fracture
Correction of uneven gingival contour compromising aesthetics including excessive gingival display

Question 26

When should onward referral for mucogingival surgery be considerd?

Answer 26

Only after thorough non-surgical tx
If pt is highly motivated and engaged with plaque and risk factor control
Non-smoker
No contraindicated MH
Reasonable prognosis of tooth/teeth

Question 27

What is the exception for referral for mucogingival surgery?

Answer 27

If gingival overgrowth