Periodontal Plastic Surgery

Question 1

Define periodontal plastic surgery and mucogingival therapy

Answer 1

Periodontal plastic surgery is defined as a surgical procedures performed to correct or eliminate anatomic, developmental ,or traumatic deformities of the gingiva or alveolar mucosa .

Mucogingival therapy is a broader term that includes non surgical procedures by means of orthodontic or restorative therapy.

Periodontal plastic surgery includes only the surgical procedures of mucogingival therapy.

Question 2

Why widening of attached gingival is important?

Answer 2

A wide attached gingiva is more protective against the accumulation of plaque

Question 3

Widening attached gingiva accomplish the following objectives:

Answer 3

1. Enhance the plaque removal around the gingival margin .
2. Improve esthetics.
3. Reduced inflammation around restored tooth.
4. Gingival margin binds better around teeth & implants with attached gingiva.

Question 4

What are Techniques to increased attached gingiva?

Answer 4

. Gingival Augmentation apical to recession:

1- Free gingival autograft.

2- Free connective tissue Autograft.

3- Apically displaced flap

B. Gingival Augmentation coronal to recession (root coverage):

Question 5

What are Gingival augmentation coronal to the recession (root :coverage)?

Answer 5

1. Free gingival autograft.
2. Free connective tissue Autograft
3. Pedicle autograft.
   a. laterally (horizontally ) positioned flap.
   b. coronally positioned flap.
4. Subepithelial connective tissue graft
5. Guided tissue regeneration.
6. Pouch &tunnel technique

Question 6

Write miller classification of gingival recession

Answer 6

Miller Classification of Gingival Recession Class I

– Marginal tissue recession which does not extend to the mucogingival junction

– No periodontal bone loss in the interdental area

– 100% root coverage

(good to excellent prognosis)

Class II

– Marginal tissue recession which extends to or beyond the mucogingival junction

– No periodontal loss in the interdental area

– 100% root coverage

(good to excellent prognosis) Class III

– Marginal tissue recession which extends to or beyond the mucogingival junction

– Bone or soft tissue loss in the interdental area or malpositioning of the teeth, preventing 100% root coverage

– Partial root coverage

Class IV

– Marginal tissue recession which extends to or beyond the mucogingival junction

– Severe bone or soft tissue loss in the interdental area and/or malpositioning of teeth

– No root coverage (Very poor prognosis)

Question 7

What are indications and contra indications of laterally displaced flap?

Answer 7

Indication :

1. For coverage the isolated denuded root.
2. When there is sufficient width of interdental papilla in the adjacent tooth .
3. Sufficient vestibular depth.

Contraindications:

1. Presence of deep interproximal pocket.
2. Excessive root prominence.
3. Deep or extensive root abrasion or erosion.

4- Significant loss of interproximal bone height.

Question 8

Talk about procedure of laterally displaced flap

Answer 8

Step 1:Prepare the recipient site make an incision , resecting gingival margin around the exposed roots. The root surface will be thoroughly scaled & planed.

Step 2: Prepare the flap the periodontium of the donor site should have a satisfactory width of attached gingiva .Full thickness or partial thickness flap may be used ,with a #15 blade a vertical incision from the gingival margin to outline the flap adjacent to the recipient site & extend the incision to the oral mucosa to the level of the base of the recipient site

The flap should sufficiently wider than the recipient site to cover the root . The interdental papilla at the distal end of the flap , or a major portion of it should be included . Make a vertical incision along the gingival margin & interdental papilla ,& separate a flap consisting of epithelium & a thin layer of C T leaving the periostium on the bone. releasing incision some time needed to avoid tension on the base of the flap (short oblique incision in to the alveolar mucosa at the distal corner of the flap pointing in the direction of the recipient site).

Step 3: Transfer the flap. Slide the flap laterally on to the adjacent root .Fix the flap on to the adjacent gingiva & alveolar mucosa with interrupted suture. A suspensory suture may be made around the involved tooth to prevent the flap from slipping apically .

Step 4:protect the flap & donor site .cover the surgical site with a periodontal pack, remove the pack & suture after 1week.