Mucogingival Surgery

Question 1

4 patient factors to consider when assessing if suitable for periodontal surgery

Answer 1

oral hygiene (<20% plaque, <10% bleeding)
quality of maintenance available and patient access to it
ability to tolerate procedure
likelihood of compliance with maintenance
cost and patient acceptance
aesthetics of site and potential for post op recession

Question 2

tooth factors when considering a patient for periodontal surgery

Answer 2

shape of defect
prognosis of tooth
tooth anatomy - enamel pearls, ridges
tooth position - access, tilting, over eruption, proximity to adjacent roots

Question 3

medical/ general considerations when thinking about periodontal surgery

Answer 3

smoking
poorly controlled diabetes
immunosuppressed
anticoagulants
unstable angina
uncontrolled hypertension
MI/ stroke within last 6 months

Question 4

what are the 3 broad surgical approaches for periodontal surgery

Answer 4

conservative (preserving tissue e.g access surgery)
resective surgery (removing tissue e.g resective surgery)
reconstructive surgery (regenerative surgery)

Question 5

3 indications for mucogingival surgery

Answer 5

short clinical crowns where an increase in clinical crown height is required before restorations are constructed
periodontitis lesions requiring reconstructive or regenerative treatment
mucogingival deformities (and poor aesthetics) e.g recession defects

Question 6

full thickness vs split thickness flap

Answer 6

full thickness - exposing bone, periosteum comes as well
split thickness - epithelium and some connective tissue raised, some connective tissue left behind

Question 7

free gingival graft

Answer 7

split thickness incision to remove epithelium and expose blood supply
new tissue, often from palate, introduced and stitched into site

Free - no blood supply with it

Question 8

pedicle graft

Answer 8

split thickness flap (still attached at base) is rotated laterally to cover defect
area left exposed from flap (donor site) heals via secondary intention

as flap still attached vascular supply remains

Question 9

connective tissue graft

Answer 9

window opened in palate and connective tissue harvested - window then closed
connective tissue then placed at surgery site

aims to thicken tissue therefore decreasing risk of recession in the long term

Question 10

name 2 examples of bio materials that may be used in periodontal surgery

Answer 10

barrier membrane (collagen)
EMD (enamel matrix derivative)
bio-oss(xenograft)

Question 11

why are barrier membranes important

Answer 11

prevent migration of epithelial cells so allows connective tissue cells time to heal

Question 12

local aetiological factors of gingival recession

Answer 12

excessive toothbrushing
abrasive dental cleaning aids
traumatic incisor relationship
habits
frenal pull
teeth out of alignment

Question 13

general aetiological factors of gingival recession

Answer 13

ongoing periodontal disease
resolution of inflammation after successful perio treatment
complication of orthodontic treatment

Question 14

what are the 3 classifications of gingival recession

Answer 14

RT1 - buccal recession only
RT2 - buccal and interproximal recession but buccal more so or equal too
RT3 - buccal and interproximal recession with greater interproximal

Question 15

prosthetic option for treatment of gingival recession

Answer 15

gingival veneer

Question 16

aim of surgical crown lengthening

Answer 16

apically reposition the entire periodontal attachment, usually including alveolar bone

Question 17

3 indications for surgical crown lengthening

Answer 17

gain adequate retention for restorations
expose enough clinical crown for ferrule
expose subgingival restoration margins, secondary caries or fractures
excessive gingival display