periodontal grafting? Flashcards
mucogingival conditions
1) gingival phenotype
- GT + KTW
2) periodontal phenotype
- GT + KTW + BT
2) recession
3) keratinized gingiva
4) decreased vestibular depth
5) aberrant frenum / muscle pull
6) gingival excess
7) abnormal color
epidemiology of gingival recession
1) teeth that erupt in prominence
2) gingiva on prominent teeth is prone to receding
3) inadequate attached gingiva predisposes teeth to recession upon wounding
4) in absence of wounding, recession may not occur despite a predispotion
predisposing factors
1) inadequate attached gingiva
2) prominent root
3) osseous dehiscence
4) thin gingiva
the root of a tooth
1) cannot make new gingiva
2) only bone can make new gingiva
dehiscence
1) cleft of absence of alveolar cortical plate resulting in denuded root surface
precipitating factors
1) improper brushing
2) laceration
3) inflammation
4) iatrogenic factors
gingival thickness
1) probe visible
- thin
- <1 mm
2) not visible >1 mm
P.D. miller classification
1) class I
- no loss of interprox attachment, recession short of MGJ
- chance of total coverage
2) class II
- no loss of interprox attachment
- recession beyond MGJ
- chance of total coverage
3) class III
-loss of interprox attachment but less than buccal loss
4) class IV
- loss of interprox exceeds buccal
- low predictability for root coverage
recession classification
1) RT1
- no loss of interprox attachment
2) RT2
- loss of interprox attachment <= buccal attachment
3) ST3
- loss of interprox attachment > buccal attachment
KTW
1) keratinized tissue width
2) gingival margin to mucogingival junction
is cej detectable
1) y or n
2) a or b
step
1) + or -
2) abfraction
attached gingiva
2) gingiva from bottom of pocket to the MGJ measured with thin probe
- KG - sulcus depth
2) free of inflammation
- probe would go into the CT
3) best time to measure is during the reevaluation
free of inflammation
1) need 2 mm KG
2) 1 mm AG
cementing a crown with subgingival margin and free of inflammation
1) need 5 mm KG
2) 3 mm AG
longitudinal mucogingival studies
1) cannot evaluate the adequacy of AG based on width alone
2) control inflammation first
3) if inflammation persists, or recession advances, then surgery maybe
possible indications for increasing AG width
1) when <= 1 mm AG
2) progressive recessive
2) persisting inflammation with good home care
3) subgingival margins to be placed
4) esthetic concern
5) orthodontics
* prophylactic grafting
indications for mucogingival surgery
1) increase attached gingiva
2) root coverage
free grafts
1) gingival graft, CT graft
- epithelialized (gold standard for increasing gingival width)
-CT graft (gold standard for root coverage)
pedicle grafts
1) graft remains attached at donor site
- for root coverage
epithelialized free grafts
1) prepare donor site
2) split thickness
- leave some periosteum on the bone
3) full is safer
- reflect periosteum and CT together
4) graft shape
- straight line on top, curve on bottom
- you can use a template
- cut palate and AVOID greater palatine artery
5) put collagen hemostatic agent over donor site
