Mucogingival surgery Flashcards
mucogingival surgery - patient factors
OH
- <20% plaque, <10% marginal bleeding
quality of maintenance available, and access to it
likely patient compliance in terms of maintenance post surgery
cost and patent acceptance
aesthetics of the site and potential for post op recession
mugogingival surgery - tooth factors
consider prognosis
access to non-responding sites
shape of defect
pros/endo considerations
tooth position/anatomy
- tilting
- overeruption
- proximity to adjacent roots
- enamel pearls
- ridges/root grooves
mucogingival surgery - systemic/medical factors
smoking
- high risk of failure
unstable angina, uncontrolled hypertension, MI/stroke within 6 months
immunosuppression
poorly controlled diabetes
anticoagulants
antiplatelets
operator factors - mucogingival surgery
skill and experience
- should be provided by dentists with additional specific training or by specialists in referral centres
- access to tier 2 (dentist with special interest) or tier 3 (specialist) care
may vary region by region
perio surgery - general surgical approaches
conservative approach
- preserving tissue
- access surgery
respective approach
- removing tissue
- resective surgery
reconstructive approach
- regenerative surgery
aims of regenerative periodontal surgery
promote regeneration of periodontal tissues that have been lost
surgical techniques for the regeneration of the PDL
use of membranes and grafts
application pof biologic agents
indications of mucogingival surgery
periodontitis lesions requiring reconstructive or regenerative treatment
- inc around implants
mucogingival deformities (and poo aesthteics)
- e.g. recession defects
short clinical crowns where an increase in clinical crown height is required before restorations are constructed
removal of aberrant frena
creation of a more favourable soft tissue bed pre-implant surgery
most common mucogingival surgery procedures
free gingival graft
- aesthetics considerations?
connective tissue graft
- leaves wound on palate
pedicle sliiding graft
- avoid using in aesthetic zones - scarring
infra bony defects - classification
1 walled
2 walled
3 walled
requires CBCT or flap raising to view
biomaterials used in regenerative periodontal surgery
barrier membrane
- collagen
DBBM
- deproteinised bovine bone matrix
EMD
- enamel matrix derivative/amelogenins
types of grafts
autograft
- same individual
- mandible - ramus/chin
allograft
- another person
- cavederic bone
alloplast
- synthetic
xenograft
- animal products
surgical healing outcome from access or respective surgery
long functional epithelium
surgical healing outcome from grafting procedures
new connective tissue attachments
localised recession aetiology
excessive toothbrushing, incorrect technique or use of particularly abrasive dentifrice
traumatic incisor relationship
habits
- rubbing gingivae with fingernail
- tongue or lip stud
anatomical
- teeth out of alignment
generalised recession aetiology
ongoing periodontal disease
- or following resolution after successful treatmentl
localised or generalised recession aetiology
complication of ortho treatment
recession type 1
no inter proximal tissue loss
- full root coverage may be achievable
recession type 2
interproximal tissue loss (from EJ to base of pocket) not as significant as mid-buccal
- partial root coverage may be expected
recession type 3
gingival recession associated with loss of interprocimal attachment
interproximal tissue loss worse than mid-buccal
- no root coverage expected
gingival recession - treatment
record magnitude of recession
eliminate etiological factors
- remove piercings
- habits
ohi
topical desensitising agents
fluoride varnish
gingival veneer to cover exposed roots
crowns
- with great caee and appropriate diagnostic wax uo
mucogingival surgery
give examples of cases where crown lengthening surgery may be appropriate
to expose enough clinical crown to allow a restorative ferrule to be achieved
expose sub gingival restoration margins/secondary caries/fractures
correction of uneven gingival colour compromised aesthetics
- increasing excessive gingival display
