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Perio 2 > perio plastic surgery > Flashcards

perio plastic surgery Flashcards

1
Q

def of mucogingival conditions

A

deviations from norm anatomic relation btwn gingival margin and MGJ

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2
Q

common mucogingival conditions

A
  • recession
  • loss of keratinized tissue
  • probing depths beyond MGJ
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3
Q

anatomy that can imapct how mucogingival defects are treated

A
  • tooth position
  • frenum position
  • vestibular depth
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4
Q

can ridge anatomy impact mucogingival conditions?

A

yes

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5
Q

classes of mucogingival deformities

A
  • localized tooth factors that mod or predispose to plaque induced dx
  • mucoging conditions around teeth
  • mucoging condtions of edentulous ridges
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6
Q

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:

A

– 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

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7
Q

esthetic enhancement of MG sx

when is this applicable:
gingiva?
alveolar ridge?

A

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

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8
Q

Recession definition

A
  • Apical shift of the gingival margin, associated with attachment loss
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9
Q

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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10
Q

Potential consequences of gingival recession

A

Exposed root surface making it potentially more susceptible
to
– Root caries
– Non-carious cervical lesions (NCCL’s)
– Dentinal sensitivity
– Poor esthetics

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11
Q

what is always asked with recession

A

sensitivity/esthetic issues?

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12
Q

predisposing factors to localized recession:
– Inadequate?
– Malposed?
– habit?
– inflam?
– Iatrogenic?
– Factitious?

A

– Inadequate attached gingiva: a dimension not a measurement (width and thickness)
– Malposed teeth
– TB habit
– Chronic inflammation
– Iatrogenic
– Factitious

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13
Q
A

inadequate attatched gingiva

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14
Q

**localized **gingival recession etiology-predisposing factors:
- Frenulum?
– Eruption?
– tobacco?
– Substances?
– Ortho?

A
  • Frenulum attachment
    – Eruption pattern
    – Smokeless tobacco
    – Substance abuse (cocaine)
    – Orthodontics (?)
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15
Q
A

frenae attatchment

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16
Q

Localized Gingival Recession
* Treatment Objectives:
* root/KT

A

–Root coverage
–Increase the width and thickness of
keratinized tissue

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17
Q

indications for root coverage

A
  • Esthetic concern
  • Dentinal sensitivity
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18
Q

indications for increased width of KT

  • Control of?
  • Prevent?
A
  • Control of plaque/inflammation
  • Prevent further recession
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19
Q

by decade

Patients over the age of 40 and with recession :

A
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20
Q

gingival recession with 3mm vs 4mm recession

A
  • 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
21
Q

millers class 1 recession
–Marginal recession?
–No loss of?
–% root coverage possible

A

–Marginal recession not extending to
the mucogingival junction
–No loss of interdental bone or soft
tissue
–100% root coverage possible

22
Q

miller class 2
–Marginal recession extends?
-loss of interdental bone or soft
tissue?
–% root coverage possible

A

–Marginal recession extends to or
beyond the mucogingival junction
–No loss of interdental bone or soft
tissue
–100% root coverage possible

23
Q

miller class 3
– Marginal tissue extends?
– Loss of interdental bone and/or soft tissue?
– root coverage?

A

– 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%)

24
Q

miller class 4
–Marginal tissue extends?
–Loss of interdental tissue extends?
–Root coverage?

A

–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

25
Q

biotype to phenotype

A
  • Biotype:(Genetics) group of organs having same specific genotype
  • Phenotype: Appearance of an organ based on multifactorial combination of genetic traits and environmental factors (its expression includes the biotype)
  • Phenotype may be modified (environmental factors and clinical intervention, think soft tissue grafting)
26
Q

Periodontal Phenotype
* Determined by

A

– Gingival phenotype (gingival thickness, keratinized tissue width)
– Bone morphotype (thickness of buccal bone plate)

27
Q

thin pheno implication

A

– Thin Phenotype increases risk for gingival recession

28
Q

gingivo thicknesses

A

– Gingival thickness
* <1mm=thin (see probe through tissue)
* >1mm=thick (cannot see probe)

29
Q

Miller Classification shortfalls
* Clinically may be difficult to identify?
* Does not identify how much soft or hard tissue loss is needed to?

A
  • Clinically may be difficult to identify location of apical extent of recession as it relates to the mucogingival junction
    (MGJ) so hard to determine difference between Class I (recession does not extend to MGJ) or Class II (recession
    extends to or beyond MGJ)
  • Does not identify how much soft or hard tissue loss is needed to determine if Class III or Class IV
30
Q

recession type classes

A

RT 1 to 3, also called cairo

31
Q

RT1

A

Facial or lingual recession with no interproximal attachment loss

simmilar to miller 1 and 2

32
Q

RT 2

A

Interproximal attachment loss is less
than or equal to the buccal attachment loss (recession)

similar to miller 3

33
Q

RT3

A

Interproximal attachment loss is greater than the buccal attachment loss

miller 4

34
Q

push back procedure

A

not used very often due to unesthetic result.
refelct and move tissue apically resulting in granulation tissue with a zero probing depth

35
Q

Autogenous Gingival Graft
* Advantages

A

– Root coverage on single or multiple teeth?
– Abundant donor tissue available

36
Q

Autogenous Gingival Graft * Disadvantages

A

– Color
– Type of attachment?
– Second surgical site

37
Q

“Free” Gingival Graft
* Graft Thickness

A

–Primary contraction
–Secondary contraction

38
Q

“Free” Gingival Graft

variation in technique: placement on bone results

A

– Placement on bone results in less mobility, less shrinkage, better hemostasis, retarded healing

39
Q

“Free” Gingival Graft
* Clinical Technique: Recipient Site

A

–Anesthesia
–Incision (length and angle)
–Connective tissue bed preparation
–Fenestration (Optional)
–Hemostasis

40
Q

“Free” Gingival Graft
* Clinical Technique: Donor Site
–Measure?
–Remove graft from? with?

A

–Measure required graft size and mark
if needed
–Remove graft from palate or other
area of attached tissue with scalpel or
graft knife

41
Q

“Free” Gingival Graft
* Clinical Technique: Immobilization
– Place graft in?
– Place first suture in?
– Place graft onto? and?

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.)

42
Q

“Free” Gingival Graft
* Graft Thickness

A

–Primary contraction
–Secondary contraction

43
Q

“Free” Gingival Graft Variation in Technique
– Placement of graft on bone results in?

A

– Placement on bone results in less mobility, less shrinkage, better hemostasis, but slower healing time

44
Q

“Free” Gingival Graft
* Wound Healing
– Plasmatic circulation?
– Revascularization?
– Organic Union?
– Epithelialization?
– Keratinization?

A

– Plasmatic circulation (2-4 days)
– Revascularization (2-8 days)
– Organic Union (4-10 days)
– Epithelialization (10-14 days)
– Keratinization (21-180 days)

45
Q

order of healing in gingival free graft

A

– Plasmatic circulation (2-4 days)
– Revascularization (2-8 days)
– Organic Union (4-10 days)
– Epithelialization (10-14 days)
– Keratinization (21-180 days)

46
Q

how does free gingival graft recieve blood supply

A

periosteum and wound

47
Q

Free gingival graft appearence post op

A

can look like it is failing but give it time

48
Q

how do you calculate CAL?

A

PD-KT

Perio 2 (13 decks)

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