Mucogingival Surgery/Perio Plastic Surgery Flashcards
How can you consider the prognosis of a tooth for mucogingival surgery?
- access to non-responding sites
- shape of defect involved
- prosthodontic/endodontic status
- tooth position/anatomy
What tooth anatomy may make mucogingival surgery difficult?
- tilting
- overeruption
- proximity to adjacent roots
- enamel pearls
- ridges/root grooves
What patient factors are involved in deciding if mucogingival surgery is an appropriate periodontal treatment?
- good OH paramount
- ability of pt to tolerate surgical procedure
- likeliness of pt compliance after surgery
- cost
- aesthetics of site and potential for post-op recession
What systemic/medical aspects may mean a patient isn’t suitable for mucogingival periodontal surgery?
- smoking
- unstable angina, uncontrolled hypertension, MI/stroke within 6 months
- poorly controlled diabetes
- immunosuppressed pts
- anticoagulants
What general surgical approaches to periodontal treatment exist?
- conservative approach [eg access surgery]
- resective approach [removing tissue]
- reconstructive approach
What are some indications for mucogingival surgery?
- periodontitis lesions requiring reconstructive or regenerative treatment
- mucogingival deformities
- short clinical crowns where an increase is clinical crown height is required before restorations are contructed
- removal of aberrant frena
What are the most common mucogingival surgical procedures?
- free gingival graft
- pedicle graft
- connective tissue graft
Name these surgical flaps:
- full thickness flap
- split thickness flap
What biomaterials can be used for mucogingival surgery?
- barrier membrane (collagen)
- DBBM (deproteinised bovine bone matrix)
- EMD (enamel matrix derivative/amelogenins)
What is gingival recession?
the apical migration of the gingival margin from the cemento-enamel junction
What is the aetiology of localised gingival recession?
- excessive toothbrushing
- traumatic incisor relationship
- habits = nail biting/pen chewing
- misaligned teeth
- frenal pull
What is a free gingival graft?
- raise split thickness flap
- remove epithelium around area where gingival recession is
- place graft onto exposed connective tissue and allow healing
What is the aetiology of generalised gingival recession?
ongoing periodontal disease
For a connective tissue graft, where is the tissue grafted from?
from palate
Why do 3-walled defects respond better to periodontal surgery compared to 1-wall defects?
osteoblasts come through from all 3 sides of the defect which leads to better healing
What are the healing outcomes of gingiva that can happen after periodontal surgery ?
- long junctional epithelium due to quicker migration of epithelial cells (access/resective)
- new connective tissue attachments (grafting procedures)
Why is it essential that after access/resective surgery, patients demonstrate very good OH practise?
Healing occurs via formation of long junctional epithelium, LJE is weaker if bacteria present so OHI is really important or relapse will occur fast
How is gingival recession categorised?
How can gingival recession be treated?
- record the magnitude of recession on a regular basis to assess progression/stability
- eliminate aetiological factors
- OHI
- topical desensitising agents
- gingival veneer to cover exposed roots
- crowns
- mucogingival surgery
What are some indications for crown lengthening?
- required for restorations
- to create a ferrule
- exposure of subgingival margins/caries/fractures
- correction of uneven gingival contour compromising aesthetics
