Mucogingival Surgery Part 1 and 2 Flashcards
what is mucogingival surgery
plastic surgery that concerns relations between mucogingival tissues and attached gingiva, alveolar mucosa, frenulum, muscle attachment and vestibule
what are mucogingival conditions
deviations from the normal anatomic relationship between the gingival margin and MGJ
what are the clinical features of mucogingival conditions
- recession, absence or reduction of keratinized tissue, and probing depths extending beyond the MGJ
- anatomical variations conditions include tooth position, frenulum insertions and vestibular depth
- variations in ridge anatomy may be associated with mucogingival conditions
how much keratinized tissue is considered normal
1-9mm
what cases would you need to provide a more esthetically acceptable gingival form and contour
- localized gingival recession
- localized alveolar ridge deficiency
- excessive gingival display
- gingival enlargement or asymmetrry
what is the definition of recession
- apical shift of the gingival margin, associated with attachment loss
what are the etiologies of recession
- toothbrush abrasion
- frenal attachment
- intrasulcular restorative margin placement
- orthodontics- dependent upon direction and bucco-lingual soft tissue thickness
exposed root surfaces makes it potentially more susceptible to:
- root caries
- non carious cervical lesions
- dentinal sensitivity
- poor esthetics
what are the predisposing factors for localized gingival recession
- inadequate attached gingiva
- malposed teeth
- TB habit
- chronic inflammation
- iatrogenic
- factitious
- frenulum attachment
- eruption pattern
- smokeless tobacco
- substance abuse- cocaine
- orthodontics
inadequate attached gingiva is:
a dimension not a measurement - width and thickness
what are the treatment objectives for localized gingival recession
- root coverage
- increase the width and thickness of keratinized tissue
what are the indications for root coverage
- esthetic concern
- dentinal sensitivity
what are the indications for the width of keratinized tissue
- control of plaque/inflammation
- prevent further recession
patients in their 40s with recession, ____ have an area of 3mm of recession
18%
patients in their 50s with recession, ____ have an area of 3mm of recession
30%
patients in their 60s with recession, ____ have an area of 3mm of recession
40%
patients in their 70s with recession, ____ have an area of 3mm of recession
46%
patients in their 80s with recession, ____ have an area of 3mm of recession
60%
3mm of recession sites had ____ of sites increase in recession
67%
4mm of recession sites had ____of sites increase in recession
98%
what is class I recession
- marginal recession not extending to the MGJ
- no loss of interdental bone or soft tissue
- 100% root coverage possible
what is a class II recession
- marginal recession extends to or beyond the MGJ
- no loss of interdental bone or soft tissue
- 100% root coverage possible
what is class III recession
- marginal tissue extends to or beyond the MGJ
- loss of interdental bone and/or soft tissue is apical to the CEJ, but coronal to most apical extent of recession
- partial but not total root coverage is possible 50-70%
what is class IV recession
- margincal tissue extends to or beyond the MGJ
- loss of interdental tissue extends to the apical extent of recession
- root coverage cannot be anticipated
what is biotype (genetics)
- group of organs having same specific genotype
what is a phenotype
appearance of an organ based on multifactorial combination of genetic traits and environmental factors - its expression includes the biotype
is the phenotype or biotype able to be modified
phenotype
the periodontal phenotype is determined by:
- gingival phenotype
- bone morphotype
- thin phenotype
- gingival thickness
what is the gingival phenotype
gingival thickness, keratinized tissue width
what is the bone morphotype
thickness of buccal bone plate
what phenotype increases risk for gingival recession
thin
what is considered thin gingival thickness
less than 1mm
- can see probe through tissue
what is considered gingival thickness
greater than 1mm
- cannot see probe through gingiva
what are the miller classification shortfalls
- clinically may be difficult to identify location of apical extent of recession as it relates to the MGJ so hard to determine difference between class I or class II
- does not identify how much soft or hard tissue loss is needed to determine if class III or class IV
gingival recession classification evaluates what 2 things
attachment loss at buccal and interproximal sites
what is recession type 1
recession with no loss of interproximal attachment. interproximal CEJ not detectable at both mesial and distal aspects
what is recession type 2
recession associated with loss of interproximal attachment. however, interproximal attachment loss is less than or equal to depth of buccal attachment loss
where is interproximal attachment loss measured from
interproximal CEJ to the depth of the interproximal sulcus/pocket
what is buccal attachment loss measured from
buccal CEJ to apical extent of buccal sulcus/pocket
what are the techniques for the autogenous gingival graft
- free gingival graft
- connective tissue graft
- semi lunar coronally positioned flap
- laterally positioned flap
what are the types of free gingival grafts
- millers free gingival graft with use of citric acid
- holbrook’s free gingival graft technique with stretching suture design
what are the advantages of the autogenous gingival graft
- root coverage on single or multiple teeth
- abundant donor tissue available
what are the disadvantages of autogenous gingival graft
- color
- type of attachment
- second surgical site
what are the types of graft thickness in the free gingival graft
- primary contraction
- secondary contraction
placement of the free gingival graft on bone results in:
less mobility, less shrinkage, better hemostasis, and retarded healing
what is the clinical technique/recipient site for the free gingival graft
- anesthesia
- incision (length and angle)
- connective tissue bed preparation
- fenestration (optional)
- hemostasis
what is the clinical technique for the donor site with the free gingival graft
- measure required graft size and mark if needed
- remove graft from palate or other area of attached tissue with scalpel or graft knife
what is the clinical technique for immobilization for the free gingival graft
- place graft in saline soaked sponge
- place first suture in graft (out of the mouth)
- place graft onto recipient site and suture to immobilize the graft- suture at coronal aspect
what do we want to see in wound healing in the free gingival graft
- plasmatic circulation
- revascularization
- organic union
- epithelialization
- keratinization
how long does plasmatic circulation take after a free gingival graft
2-4 days
how long does revascularization take after a free gingival graft
2-8 days
how long does organic union take after a free gingival graft
4-10 days
how long does epithelialization take after a free gingival graft
10-14 days
how long does keratinization take after a free gingival graft
21-180 days
