Mucogingival therapy

Question 1

What is the prevalence of dehiscence and fenestration in the maxilla and mandible

Answer 1

dehiscence 6% maxilla, 14% mandible
Fenestration 17% maxilla, 6% mandible
Mandibular canines were most affected by dehiscence’s 12.9%
Maxillary first molars are most often affected by fenestrations 37%

Question 2

What circumstances require an increased zone of KT

Answer 2

According to the World Workshop in Clinical Periodontics, the following are
indications for a gingival augmentation procedure:
1. Placement of a restoration with an intracrevicular margin
2. Impingement of major or minor connectors of removable partial dentures
3. Overdenture when there is an absence of gingiva associated with
retained teeth
Scheyer et al7 found a minimum amount of KT is not required to prevent
attachment loss when optimal plaque control is present. However, if plaque
control is suboptimal, a minimum of 2 mm of KT is essential.
Studies have found a wide band of nonmobile keratinized mucosa, an
adequate peri-implant mucosal height, and a thick tissue phenotype might
reduce the incidence of tissue inflammation and future complications.8

Question 3

What are the causes/risk factors for gingival recession?

Answer 3

• Thin periodontal phenotype: A thin phenotype develops more gingival
  recession than a thick one.
• Tooth positioned too labially.
• Underlying bony dehiscence or reduced thickness of the alveolar bone.
• Abrasive and traumatic toothbrushing habits (most important mechanical
  factor).
• Periodontal inflammation.
• Frenal and muscle attachment encroachment.
• Orthodontic movement (especially in areas with < 2 mm of gingiva).
• Invasion of supracrestal tissue attachment (previously known as biologic
  width; comprised of junctional epithelium and supracrestal connective tissue attachment).
• Absence of attached gingiva.
• Trauma from occlusion; it is controversial as to whether it affects recession
• Both lip and tongue piercings are highly correlated with the risk of gingival
  recession. The incidence of gingival recessions appeared to be 50% in
  subjects with lip piercings and 44% in subjects with a tongue piercing.
  Subjects with a lip piercing were 4.14 times more likely to develop gingival
  recession than those without a lip piercing.15

Question 4

What is the prevalence of gingival recession

Answer 4

58% at 30+ years, and increases with age

Question 5

What is the root concavity classification

Answer 5

Class A : detectable CEJ
Class B : no detectable CEJ
+ : with a step
- : Without a step

Question 6

Siebert classification

Answer 6

Class 1 - Bucco-lingual loss
Class 2 - loss of height
Class 3 - loss of both

Question 7

What are the different techniques for soft tissue augmentation

Answer 7

1. No treatment with scaling and root planing
2. Coronally positioned flap/vestibuloplasty (CPF/V)
3. CPF/V plus autogenous tissue (eg, connective tissue)
4. CPF/V plus allogenic tissue (eg, acellular dermal matrix)
5. CPF/V plus tissue-engineered live cell construct (LCC)
6. Xenografts: Extracellular matrix (ECM) or bilayer collagen

Question 8

What are the advantages of CT graft compared to FGG

Answer 8

• Palate can heal by primary intention.
• Patient has less pain. FGG is associated with a greater incidence of donor site pain compared to CT graft at the early postoperative period.
• CT graft is more esthetic (better color match).