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Classic Lit Fall 2021 > Perio Plastics II > Flashcards

Perio Plastics II Flashcards

1
Q

Who classified clinical management of non-proximal recession defects?

A

Chambrone & Avila-Ortiz 2021

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2
Q

What are the 3 Subtypes of the recession treatment classification based on?

A

Attached Gingiva and Gingival Thickness

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3
Q

What is Subtype A?

A

_>_1mm AG

_>_1mm MT

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4
Q

What is Subtype B?

A

_>_1mm AG

_<_1mm MT

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5
Q

What is Subtype C?

A

_<_1mm AG

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6
Q

What Tx options for Subtype A?

A

RT½: CAF or LPF (alternative: Bilaminar)

RT3: NOT RECOMMENDED

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7
Q

What Tx options for Subtype B

A

RT½: Bilaminar (alternative LPF)
RT3: Bilaminar may be indicated

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8
Q

What Tx options for Subtype C?

A

RT½: FGG (alternative: Tunnel/LPF)
RT3: FGG may be indicated

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9
Q

What happens to KG with time after CAF? Why?

A

It increases - repositioning of the MGJ to its genetically pre-determined position (Zucchelli)

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10
Q

Who first described CAF?

A

Bernimoulin 1975

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11
Q

How much advancement do you need for CAF? Why? Citation?

A

Pini-Prato et al. 2005 (prospective)

2mm above CEJ was associated with 100% CRC

3mm recession required 2.5mm after logistic regression

More mm of coverage can be expected when treating a larger recession

1mm apical migration of MGJ after 6mo

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12
Q

What rationale is there for CAF?

A

Root Coverage

Adequate KT apical to the root

Good OH

Maxillary anterior (more aesthetic)

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13
Q

Whats the minimum flap thickness for CAF alone? Citation What if its less? Citation

A

0.8mm (Baldi et al. 1999)

then CAF+CTG have better outcome (Cairo 2016)

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14
Q

What determines what kind of material you use?

A

Flap thickness!

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15
Q

Where should flap thickness be measured?

A

2mm below the gingival margin

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16
Q

How wide should the surgical papilla be and how far from the peak of the anatomical papilla? (Citation)

A

3mm wide

X (recession depth) +1

Zucchelli et al. 2007

(Wang says it was him)

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17
Q

What is the rationale behind split-full-split?

A

Makes use of the periosteum to cover the denuded avascular root surface

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18
Q

What is the Pro/Con of a triangular incision for CAF? When should you use it? Citation

A

Trapezoidal has more keloid formation

Triangular is more technique sensitive

When there is not 3mm interproximally for the surgical papilla width

Zucchelli et al. 2016

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19
Q

What article compared CAF vs CAF+CTG?

A

Cairo et al. 2016

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20
Q

How does CAF compare to CAF+CTG? Citation

A

32pts - RCT - 1yr FU

In GT <0.8mm CAF+CTG >> CAF alone

CAF higher esthetic score in thick gingiva

Cairo et al. 2016

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21
Q

What was the first form of tunneling? Describe it Citation

A

the Semilunar incision

Semilunar incision parallel to gingival margin - split thickness apically

no sutures

Tarnow 1986

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22
Q

Who described the lateral sliding flap/modification?

A

Grupe 1956

Grupe 1966

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23
Q

What are indications/drawbacks to the Lateral Sliding Flap? How does the modification help with the drawback?

A

Ideal for isolated gingival recessions

Better esthetic vs FGG

Recession at the donor site!

Modification allows 3mm apical to donor margin to avoid recession

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24
Q

Who first described the double papilla flap?

A

Cohen & Ross 1968

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25
Q

Who developed the Envelope flap?

A

Raetzke 1985

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26
Q

What is the Envelope flap?

A

Partial thickness around the defect

Graft placed like a tunnel with middle exposed

Middle retains epi

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27
Q

What are clinical benefits of FGG vs APF?

A

FGG increases both KTW and Thickness vs APF

28
Q

How does placing FGG on Bone vs Periosteum effect the outcome? CitationS

A

Dordick et al. 1976

FGG on bone: no mobility - less swelling

BUT 2 week “lag” in healing vs periosteum

Less shrinkage on bone (James et al. 1978)

29
Q

What is a big advantage of using autogenous tissue?

A

Creeping Attachment

30
Q

What cells do Autogenous Grafts contain? What does this provide?

A

Keratinocytes and Fibroblasts

Creeping Attachment

31
Q

What flaps maintain their blood supply specifically?

A

CAF, Double Papilla, Lateral Sliding, Envelope, Semilunar

32
Q

What does graft survival depend on for free grafts? why? Citation

A

Close adaptation to the recipient bed - facilitates revascularization (Yu et al. 2018)

33
Q

How does esposing some of a CTG effect the outcome? Citation

A

Exposed site will gain KT

Covered cites will provide more recession reduction

Dodge et al. 2018

34
Q

What phases of contraction are there for FGG? What is responsible for each? Citation

A

Primary and Secondary

Primary: due to amount of elastic fibers in graft

Secondary: cicatrization between graft and recipient bed

Sullivan & Atkins 1968

35
Q

How does graft thickness effect FGG shrinkage?

A

Thicker grafts have less secondary contraction

36
Q

How thick should an FGG be to avoid pain?? citation

A

_<_2mm (Burkhardt et al. 2015)

Residual tissue thickness of _>_2mm = less post op pain (Zucchelli et al. 2010)

37
Q

How thick do classic studies say an FGG should be? How thick do we do?

A

0.75-1.25mm (Soehren et al. 1973)

1-1.5mm

38
Q

Rationale for FGG

A

increase KT, AG, Vestibular depth, and increase tissue thickness

39
Q

how do FGG perform long term?

A

4.2mm increase in KT after 1yr
0.7mm decrease after 10-25yrs

Aguido et al. 2008

40
Q

Who developed the 2 step approach?

A

Bernimoulin et al. 1975

41
Q

When would you consider a 2 step approach instead of a CTG?

A

Shallow vestibule

non-esthetic zone

NO KT

42
Q

How much creeping attachment can we expect with CTG?

A

0.89mm but depends on:
Width of recession (narrow>wide - 3mm)
Position of graft (over denuted surface)
Bone resorption
Position of tooth
Hygene

From 3mo - 1yr

Matter & Cimasoni 1976

43
Q

What is the benefit of a De-Epithelialized CTG vs sCTG?

A

less fatty/glandular tissue

44
Q

How does sCTG compare to De-epiCTG? Citation

A

NSSD in post-op pain or root coverage outcomes (Zucchelli et al. 2010)

More GT with De-epiCTG !!! (Less graft shrinkage)

45
Q

How can you help attain hemostasis from donor site?

A

Collatape, Gelfoam, ozone therapy, Oxidized cellulose

46
Q

Who developed tunneling?

A

Zabalegui et al. 1999

47
Q

How does Tunneling compare to CAF? Citation

A

Tavelli et al. 2018

Systematic review/meta analysis

Similar outcomes

CAF > TUN when same material compared

48
Q

Who developed the VISTA approach? What is it?

A

Zadeh 2011

Tunnel with a VR in the mucosa for better access

used COMPOSITE to maintain sutures coronally

rhPDGF+B-TCP

49
Q

When treating multiple recessions, where should you suture first?

A

Periphery stabilized, the suture toward the center of the flap

50
Q

How much coronal advancement should we gt for CRC? citation

A

2mm above CEJ (Pini Prato et al. 2005)

51
Q

What type of sutures are used for fixing pedicle flaps?

A

Interrupted and Suspensory (Sling/Double Sling)

52
Q

What kind of healing takes place histologically with diffferent procedures? citation

A

Zucchelli & Mounssif 2015

for CAF, CAF+CTG, and FGG

New connective tissue

Long junctional epithelium

53
Q

Who researched healing of Lateral Pedicle flap?

A

Wilderman & Wentz 1965

54
Q

Healing of Lateral Pedicle Flap

A

Adaptation (0-4)

Proliferation (4-21)

Attachment (27-28)

Maturation

Wilderman & Wentz

55
Q

Who researched healing of CTG?

A

Guiha et al. 2001

56
Q

Healing of CTG

A

Day 7: Blood vessels from both sides of graft

Day 14: Complete vascularization of graft

Day 28: JE formed

Day 28-60: Normal vascularization/oral epithelium

57
Q

How much CTG can be exposed? itation

A

30%

Guiha et al. 2001

58
Q

Where do vessels come from to supply CT Graft?

A

Periodontal plexus

Supraperiosteal Plexus

Flap (subepithelial/crevicular plexuses)

59
Q

Who studied the healing of FGG?

A

Oliver 1968

60
Q

Healing of FGG

A

0-3: Initial (Plasmatic Circulation)

4-11: Revascularization

11-42: Maturation

61
Q

How doe primary contraction impact the graft healing?

A

Shrinkage due to the amount of elastic fibers which causes vessel collapse and delays graft vascularization

62
Q

What is the Cairo esthetic score?

A

1: Gingival Margin level
2: Marginal contour
3: Tissue Texture
4: MGJ Alignment
5: Gingival color

63
Q

What options are there for papilla reconstruction?

A

Envelope

Vertical tissue growth with Tuberosity

64
Q

Classification of gingival recession around implants (Classes)

A

Zucchelli 2019

CIass I: No recession - only color change - good implant position
Class II: Some mid-facial recession - no papilla recession (facial of crown is slightly palatal)
Class III: Papilla loss - good implant position
Class IV: Papilla loss - poor implant position

65
Q

Classification of gingival recession around implants (Subclasses)

A

Tip of papilla to Gingival Margin

Subclass A: Both papilla _\>_3mm
Subclass B: at least 1 papilla is 1-3mm
Subclass C: at least 1 papilla is \<1mm
66
Q

When can you expect creeping attachment?

A

In Narrow Deep defects

Classic Lit Fall 2021 (29 decks)

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