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Perio II > Mucogingival Surgery Part 1 and 2 > Flashcards

Mucogingival Surgery Part 1 and 2 Flashcards

1
Q

what is mucogingival surgery

A

plastic surgery that concerns relations between mucogingival tissues and attached gingiva, alveolar mucosa, frenulum, muscle attachment and vestibule

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2
Q

what are mucogingival conditions

A

deviations from the normal anatomic relationship between the gingival margin and MGJ

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3
Q

what are the clinical features of mucogingival conditions

A
  • 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
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4
Q

how much keratinized tissue is considered normal

A

1-9mm

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5
Q

what cases would you need to provide a more esthetically acceptable gingival form and contour

A
  • localized gingival recession
  • localized alveolar ridge deficiency
  • excessive gingival display
  • gingival enlargement or asymmetrry
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6
Q

what is the definition of recession

A
  • apical shift of the gingival margin, associated with attachment loss
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7
Q

what are the etiologies of recession

A
  • toothbrush abrasion
  • frenal attachment
  • intrasulcular restorative margin placement
  • orthodontics- dependent upon direction and bucco-lingual soft tissue thickness
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8
Q

exposed root surfaces makes it potentially more susceptible to:

A
  • root caries
  • non carious cervical lesions
  • dentinal sensitivity
  • poor esthetics
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9
Q

what are the predisposing factors for localized gingival recession

A
  • inadequate attached gingiva
  • malposed teeth
  • TB habit
  • chronic inflammation
  • iatrogenic
  • factitious
  • frenulum attachment
  • eruption pattern
  • smokeless tobacco
  • substance abuse- cocaine
  • orthodontics
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10
Q

inadequate attached gingiva is:

A

a dimension not a measurement - width and thickness

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11
Q

what are the treatment objectives for localized gingival recession

A
  • root coverage
  • increase the width and thickness of keratinized tissue
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12
Q

what are the indications for root coverage

A
  • esthetic concern
  • dentinal sensitivity
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13
Q

what are the indications for the width of keratinized tissue

A
  • control of plaque/inflammation
  • prevent further recession
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14
Q

patients in their 40s with recession, ____ have an area of 3mm of recession

A

18%

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15
Q

patients in their 50s with recession, ____ have an area of 3mm of recession

A

30%

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16
Q

patients in their 60s with recession, ____ have an area of 3mm of recession

A

40%

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17
Q

patients in their 70s with recession, ____ have an area of 3mm of recession

A

46%

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18
Q

patients in their 80s with recession, ____ have an area of 3mm of recession

A

60%

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19
Q

3mm of recession sites had ____ of sites increase in recession

A

67%

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20
Q

4mm of recession sites had ____of sites increase in recession

A

98%

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21
Q

what is class I recession

A
  • marginal recession not extending to the MGJ
  • no loss of interdental bone or soft tissue
  • 100% root coverage possible
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22
Q

what is a class II recession

A
  • marginal recession extends to or beyond the MGJ
  • no loss of interdental bone or soft tissue
  • 100% root coverage possible
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23
Q

what is class III recession

A
  • 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%
24
Q

what is class IV recession

A
  • margincal tissue extends to or beyond the MGJ
  • loss of interdental tissue extends to the apical extent of recession
  • root coverage cannot be anticipated
25
Q

what is biotype (genetics)

A
  • group of organs having same specific genotype
26
Q

what is a phenotype

A

appearance of an organ based on multifactorial combination of genetic traits and environmental factors - its expression includes the biotype

27
Q

is the phenotype or biotype able to be modified

A

phenotype

28
Q

the periodontal phenotype is determined by:

A
  • gingival phenotype
  • bone morphotype
  • thin phenotype
  • gingival thickness
29
Q

what is the gingival phenotype

A

gingival thickness, keratinized tissue width

30
Q

what is the bone morphotype

A

thickness of buccal bone plate

31
Q

what phenotype increases risk for gingival recession

A

thin

32
Q

what is considered thin gingival thickness

A

less than 1mm
- can see probe through tissue

33
Q

what is considered gingival thickness

A

greater than 1mm
- cannot see probe through gingiva

34
Q

what are the miller classification shortfalls

A
  • 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
35
Q

gingival recession classification evaluates what 2 things

A

attachment loss at buccal and interproximal sites

36
Q

what is recession type 1

A

recession with no loss of interproximal attachment. interproximal CEJ not detectable at both mesial and distal aspects

37
Q

what is recession type 2

A

recession associated with loss of interproximal attachment. however, interproximal attachment loss is less than or equal to depth of buccal attachment loss

38
Q

where is interproximal attachment loss measured from

A

interproximal CEJ to the depth of the interproximal sulcus/pocket

39
Q

what is buccal attachment loss measured from

A

buccal CEJ to apical extent of buccal sulcus/pocket

40
Q

what are the techniques for the autogenous gingival graft

A
  • free gingival graft
  • connective tissue graft
  • semi lunar coronally positioned flap
  • laterally positioned flap
41
Q

what are the types of free gingival grafts

A
  • millers free gingival graft with use of citric acid
  • holbrook’s free gingival graft technique with stretching suture design
42
Q

what are the advantages of the autogenous gingival graft

A
  • root coverage on single or multiple teeth
  • abundant donor tissue available
43
Q

what are the disadvantages of autogenous gingival graft

A
  • color
  • type of attachment
  • second surgical site
44
Q

what are the types of graft thickness in the free gingival graft

A
  • primary contraction
  • secondary contraction
45
Q

placement of the free gingival graft on bone results in:

A

less mobility, less shrinkage, better hemostasis, and retarded healing

46
Q

what is the clinical technique/recipient site for the free gingival graft

A
  • anesthesia
  • incision (length and angle)
  • connective tissue bed preparation
  • fenestration (optional)
  • hemostasis
47
Q

what is the clinical technique for the donor site with the free gingival graft

A
  • measure required graft size and mark if needed
  • remove graft from palate or other area of attached tissue with scalpel or graft knife
48
Q

what is the clinical technique for immobilization for the free gingival graft

A
  • 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
49
Q

what do we want to see in wound healing in the free gingival graft

A
  • plasmatic circulation
  • revascularization
  • organic union
  • epithelialization
  • keratinization
50
Q

how long does plasmatic circulation take after a free gingival graft

A

2-4 days

51
Q

how long does revascularization take after a free gingival graft

A

2-8 days

52
Q

how long does organic union take after a free gingival graft

A

4-10 days

53
Q

how long does epithelialization take after a free gingival graft

A

10-14 days

54
Q

how long does keratinization take after a free gingival graft

A

21-180 days

55
Q
A

Perio II (13 decks)

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