perio plastic sx parts 3 and 4

Question 1

freeze dried skin as graft

Answer 1

has been used in past but could grow hair

Question 2

how could you tell graft material from native tissue 6 mo post op?

Answer 2

only histologically

Question 3

techniques of autogenous gingival grafts

Answer 3

– Free Gingival Graft
* Miller’s Free Gingival Graft with use of citric acid
* Holbrook’s Free Gingival Graft technique with “stretching” suture design
– Connective Tissue Graft
– Semi-lunar Coronally Positioned Flap
– Laterally Positioned Flap

Question 4

miller technique

Answer 4

free gingival graft with citric acid etch of root surface prior to graft/flap to disinfect surface and also not kill cells of flap/graft

Question 5

immobilization of free gingival graft

Answer 5

– 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.)

Question 6

more CT in the graft tisse leads to?

Answer 6

more shrinkage

Question 7

holbrok procedure

Answer 7

use of sutures to streatch graft and prevent shrinkage

Question 8

Coronally Positioned
Free Gingival Graft

Answer 8

placement of graft apical to a narrow band of KT, then allow 12wk healing before coronally repositioning the tissue

Question 9

alloderm

Answer 9

freeze dried collagen matrix graft material (hypoallergenic)

Question 10

advantages of CT graft
– root coverage?
– color?
– wound site?
– blood supply?

Answer 10

– High predictability of root coverage
– Good color blend
– Smaller palatal wound site
– Double blood supply at graft site

Question 11

disadvantage of CT graft

Answer 11

– Technical finesse to do procedure at recipient and donor site

Question 12

technique of CT graft

Answer 12

–Horizontal incisions at CEJs
–Vertical incisions at line angles of
adjacent teeth (optional)
–Partial thickness flap/split thickness
graft bed

Question 13

donor tissue of CT graft
– incisions?
– mm thickness of graft?
– Place over?
– Suture connective tissue to?
– Recipient flap positioning?

Answer 13

– Parallel or “trap door” incisions
– 2 mm thickness of graft
– Place over denuded root surfaces
– Suture connective tissue to underlying
tissue with resorbable suture (optional)
– Recipient flap is coronally positioned over the connective tissue graft and sutured.

Question 14

where is the thickest palatal tissue for a CT graft

Answer 14

Thickest palatal tissue is
opposite the bicuspids

Question 15

blood supply of CT graft

Answer 15

flap and periosteum

Question 16

Semi-Lunar Coronally Repositioned Flap: Tarnow Procedure
advantages
–looks?
–blood supply?
–tension?

Answer 16

–Superior esthetics and color blend
–“Flap” graft maintains blood supply
–No tension on flap

Question 17

Semi-Lunar Coronally Repositioned Flap: Tarnow Procedure
 Disadvantages
-Requires ? mm of keratinized gingiva
apical to area of recession
-Heals by?
-Needs?

Answer 17

-Requires 3-5 mm of keratinized gingiva apical to area of recession
-Heals by secondary intention
-Needs underlying bone

Question 18

Lateral Sliding Flap (Pedicle graft) Advantages
– looks?
– blood supply?
– tension?

Answer 18

– Superior esthetics and color blend
– “Flap” (Pedicle) graft maintains blood supply
– No tension on flap

Question 19

lateral sliding flap disadvantages
– Requires adequate?
– Loss of ? mm of attachment at donor

Answer 19

– Requires adequate adjacent keratinized tissue
– Loss of 1-2 mm of attachment at donor

Question 20

lateral slding graft technique

Answer 20

Question 21

Localized Alveolar Ridge Deficiency
* Resorption of?
* Similar problems result from?

Answer 21

• Resorption of ridge following extraction or loss of teeth
• Similar problems result from
  – Developmental defects
  – Advanced periodontal disease
  – Excessive ridge resorption

Question 22

Edentulous ridge augmentation grafts

Answer 22

– Gingival onlay graft
– Connective tissue graft

Question 23

indications for edentualous ridge augmentation

Answer 23

– Pre-prosthetics
– Poor esthetics

Question 24

localized alv ridge defect classes

Answer 24

1-3

Question 25

class 1ridge defect

Answer 25

facial-lingual defect with ridge collapse
to the lingual (usually) or facial (rarely)

Question 26

class 2 defect

Answer 26

coronal-apical defect with ridge exhibiting loss of vertical heigh

Question 27

class 3 defect

Answer 27

combination defect (commonly seen in anterior sextants)

Question 28

Onlay graft (Siebert, 1983)
– Classification?
– thickness of graft?
– Do what at recipient site?
– Stabilization?
– healing?

Answer 28

– Classification system
– Full thickness graft
– De-epithelialize recipient site
– Stabilize graft
– Slow healing

Question 29

what is removed at recipient sites for ridge defect grafts

Answer 29

epithelium

Question 30

Localized Alveolar Ridge
Deficiency
* Connective Tissue Graft
– Advantages
* Similar to?
* blood supply?
* color?
* discomfort?

Answer 30

• Similar to root coverage procedures
• Improved blood supply
• Improved color match
• Minimal discomfort

Question 31

Localized Alveolar Ridge
Deficiency
* Connective Tissue Graft
disadvantages

Answer 31

Limited thickness; multiple procedures

Question 32

Tooth Uncovery
* Often for?
* Try to maintain?
* why apically position tissue?
* May also require?

Answer 32

• Often for orthodontics
• Try to maintain keratinized tissue
• Apically position tissue to retain KG
• May also require osseous surgery to expose the crow