Periodontal Plastic Surgery

Question 1

what are the techniques for the autogenous gingival graft

Answer 1

• free gingival graft
• connective tissue graft
• semi-lunar coronally positioned flap
• laterally positioned flap

Question 2

what are the types of free gingival grafts

Answer 2

• miller’s free gingival graft with use of citric acid
• holbrooks free gingival graft technique with stretching suture design

Question 3

what is the clinical technique for free gingival graft- immobilization

Answer 3

• 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 4

what are the advantages and disadvantages of a connective tissue graft

Answer 4

• advantages: high predictability of root coverage, good color blend, smaller palatal wound site, double blood supply at graft site
• disadvantages: technical finesse to do procedure at recipient and donor site

Question 5

what is the technique of the connective tissue graft

Answer 5

• horizontal incisions at CEJs
• vertical incisions at line angles of adjacent teeth - optional
• partial thickness flap/split thickness graft bed

Question 6

describe the donor tissue of the connective tissue graft

Answer 6

• parallel or trap door incisions
• 2mm 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 7

where is the thickest palatal tissue

Answer 7

opposite the bicuspids

Question 8

what is the name of the semi lunar coronally repsotioned flap

Answer 8

tranow procedure

Question 9

what are the advantages of the tarnow procedure

Answer 9

• superior esthetics and color blend
• flap graft maintains blood supply
• no tension on flap

Question 10

what are the disadvantages of the tarnow procedure

Answer 10

• requires 3-5mm of keratinized gingiva apical to area of recession
• heals by secondary intention
• needs underlying bone

Question 11

what are the advantages and disadvantages of the lateral sliding flap

Answer 11

• advantages: superior esthetics and color blend, flap graft maintains blood supply, no tension on flap
• disadvantages: requires adequate adjacent keratinized tissue, loss of 1-2mm of attachment at donor

Question 12

what is another name for the lateral sliding flap

Answer 12

pedicle graft

Question 13

what is localized alveolar ridge deficiency

Answer 13

resorption of ridge following extraction or loss of teeth

Question 14

similar problems from localized alveolar ridge deficiency result from:

Answer 14

• developmental defects
• advanced periodontal disease
• excessive ridge resorption

Question 14

what is used in an edentulous ridge augmentation

Answer 14

• gingival onlay graft
• connective tissue graft

Question 15

what are the indications for edentulous ridge augmentation

Answer 15

• pre prosthetics
• poor esthetics

Question 16

what is a class I localized alveolar ridge defect

Answer 16

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

Question 17

what is a class II localized alveolar ridge defect

Answer 17

coronal apical defect with ridge exhibiting loss of vertical height

Question 18

what is a class III localized alveolar ridge defect

Answer 18

combination defect (commonly seen in anterior sextants)

Question 19

describe the onlay graft in the localized alveolar ridge deficiency

Answer 19

• classification system
• full thickness graft
• de-epithelialize recipient site
• stabilize graft
• slow healing

Question 20

what are the advantages and disadvantages of the connective tissue graft

Answer 20

• advantages: similar to root coverage procedures, improved blood supply, improved color match, minimal discomfort
• disadvantages: limited thickness; multiple procedures

Question 21

what is tooth uncovery often for

Answer 21

orthodontics

Question 22

what is considered in tooth uncovery

Answer 22

• try to maintain keratinized tissue
• apically position tissue to retain KG
• may also require osseous surgery to expose the crown