perio plastic surgery Flashcards
def of mucogingival conditions
deviations from norm anatomic relation btwn gingival margin and MGJ
common mucogingival conditions
- recession
- loss of keratinized tissue
- probing depths beyond MGJ
anatomy that can imapct how mucogingival defects are treated
- tooth position
- frenum position
- vestibular depth
can ridge anatomy impact mucogingival conditions?
yes
classes of mucogingival deformities
- localized tooth factors that mod or predispose to plaque induced dx
- mucoging conditions around teeth
- mucoging condtions of edentulous ridges
How much KT is enough?
– Bowers 63: normal varies from?
– Lang and Loe 72: need ? keratinized, ?
attached
– Maynard and Wilson 79: ?mm keratinized needed for restorative with ? mm attached
– Dorfman and Kennedy 80: less than ? mm is adequate if inflammation is controlled
– Freedman et al 99: 18 year study, less than ? mm is adequate if inflammation is controlled
for exam purposes:
– Bowers 63: normal varies from 1-9mm
– Lang and Loe 72: need 2 mm keratinized, 1mm attached
– Maynard and Wilson 79: 5mm keratinized needed for restorative with 3 mm attached
– Dorfman and Kennedy 80: less than 1 mm is adequate if inflammation is controlled
– Freedman et al 99: 18 year study, less than 1 mm is adequate if inflammation is controlled
for exam: 2mm or greater
esthetic enhancement of MG sx
when is this applicable:
gingiva?
alveolar ridge?
Providing a more esthetically acceptable gingival form and contour
– Localized gingival recession (today’s topic)
– Localized alveolar ridge deficiency
– Excessive gingival display
– Gingival enlargement or asymmetry
Recession definition
- Apical shift of the gingival margin, associated with attachment loss
etiologies of recession
– Toothbrush abrasion
– Frenal attachment
– Intrasulcular restorative margin placement*
– Orthodontics-dependent upon direction and bucco- lingual soft
tissue thickness
Potential consequences of gingival recession
Exposed root surface making it potentially more susceptible
to
– Root caries
– Non-carious cervical lesions (NCCL’s)
– Dentinal sensitivity
– Poor esthetics
what is always asked with recession
sensitivity/esthetic issues?
predisposing factors to localized recession:
– Inadequate?
– Malposed?
– habit?
– inflam?
– Iatrogenic?
– Factitious?
– Inadequate attached gingiva: a dimension not a measurement (width and thickness)
– Malposed teeth
– TB habit
– Chronic inflammation
– Iatrogenic
– Factitious
inadequate attatched gingiva
**localized **gingival recession etiology-predisposing factors:
- Frenulum?
– Eruption?
– tobacco?
– Substances?
– Ortho?
- Frenulum attachment
– Eruption pattern
– Smokeless tobacco
– Substance abuse (cocaine)
– Orthodontics (?)
frenae attatchment
Localized Gingival Recession
* Treatment Objectives:
* root/KT
–Root coverage
–Increase the width and thickness of
keratinized tissue
indications for root coverage
- Esthetic concern
- Dentinal sensitivity
indications for increased width of KT
- Control of?
- Prevent?
- Control of plaque/inflammation
- Prevent further recession
by decade
Patients over the age of 40 and with recession :
gingival recession with 3mm vs 4mm recession
- Patients examined and placed in age groups and followed for progression of recession for 12 years. No comment on oral hygiene level.
- 3 mm of recession sites (2 mm of recession and one mm of probing depth) had 67% of sites increase in recession.
- 4 mm of recession sites had 98% of sites increase in recession
millers class 1 recession
–Marginal recession?
–No loss of?
–% root coverage possible
–Marginal recession not extending to
the mucogingival junction
–No loss of interdental bone or soft
tissue
–100% root coverage possible
miller class 2
–Marginal recession extends?
-loss of interdental bone or soft
tissue?
–% root coverage possible
–Marginal recession extends to or
beyond the mucogingival junction
–No loss of interdental bone or soft
tissue
–100% root coverage possible
miller class 3
– Marginal tissue extends?
– Loss of interdental bone and/or soft tissue?
– root coverage?
– Marginal tissue extends to or beyond the mucogingival junction
– 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%)
miller class 4
–Marginal tissue extends?
–Loss of interdental tissue extends?
–Root coverage?
–Marginal tissue extends to or beyond
the mucogingival junction
–Loss of interdental tissue extends to
the apical extent of recession
–Root coverage cannot be anticipated
