Periodontal Surgery Flashcards
Describe the biological width
A 2mm width of the dento-gingival junction which is comprised of approximately 1mm epithelial attachment, and 1mm connective tissue attachment, which extends from the depth of the gingival sulcus to the crest of the alveolar bone.
What is the cavosurface margin?
The margin where the restorative material and tooth meet
List 3 effects of overhangs on the periodontium
- Significant contributing iatrogenic factor to perio disease development
- Greater plaque accumulation and gingival inflammation
- Increased bone loss
Indications and Contra-indications for margination treatment of overhanging restorations
Indications:
- Tooth anatomy can be maintained or improved
- Overhang is small or moderate in size
- Proximal contact is intact
- Overhang is accessible for instrumentation
- No fractures of the cavity margin on the tooth or resto
Contra-indications:
- Excessive overhang
- Presence of secondary caries
- Unable to instrument
- Contact area needs to be restored
- Poor adaptation cannot be corrected
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What are the two key factors to consider when looking at crown lengthening
- Level and location of bone
- Quality of keratinized tissue
List 6 indications for crown lengthening
- Short clinical crown (poor retentive form)
- Caries that violate the biological width
- Crown facture
- WEar
- Subgingival restoration margins
- Delayed passive eruption
How od you tell the difference between inflammation characteristic of violation of biological width or due to biomaterial allergy?
Biomaterial allergy won’t have pocketing and bone loss (along with inflammation)
Three strategies to avoid invasion of the biological width
- Avoid overhanging restorations
- Careful tooth preparation
- Supragingival margins
How do you determine what amount of crown lengthening is needed?
Need 3mm between alveolar crest and restorative margin to allow for:
- Epithelial attachment
- Supra-crestal fiber attachment
- Sulcus
4 techniques to achieve crown lengthening
- Tissue shrinkage (gingivoplasty)
- Gingivectomy
- Apically positioned flap (with or without osseous correction)
- Forced tooth eruption
What are apically positioned flaps used for?
- Crown Lengthening
- Pocket reduction
Why is apically positioned flap sometimes used over gingivectomy
To maintain adequate amounts of keratinised tissue
Orthodontic extrusion is usually only reserved for
Anterior teeth. However black triangle and sensitivity issue.
What is periodontal access surgery?
Surgery to improve access to allow debridement of sub
List four objectives of periodontal therapy
- Disease prevention
- Sow or arrest disease progression
- Regenerate lost periodontium
- Maintain achieved therapeutic objectives
What does the Stage and Grade of period tell us?
Stage - severity
Grade - rate of progression
Periodontal access surgery is also called:
Mucoperiosteal flap surgery
What is a modified widman flap?
When the ulcerated epithelium of the pocket is incise to leave healthy tissue against the tooth for new attachment with long junctional epithelium.
What is the difference between an Osteotomy and Osteoplasty?
Osteotomy - takes supporting bone away so height reduced. Osteoplasty takes thickness, not height so alters morphology without taking away attachment.
What surgical techniques iare used to pocket elimination
Gingivectomy and apically positioned flap.
A modified Widman flap is used when aesthetics require the gingiva to be placed in the same place or sensitivity issue.
The success of non-surgical and surgical treatment depends on (2)
- Carefully tailored supportive therapy
- Patients oral hygiene performance
What is mucogingival surgery (aka periodontal plastic surgery?)
Surgical procedure performed to prevent or correct anatomic, developmental, traumatic or disease induced defects of the gingiva, alveolar mucosa or bone.
Mucogingival surgery is mainly used to treat:
Gingival recession.
But also used for gingival augmentation, correction of mucosal defects at implants, crown lengthening and more.
What Millers Class is this:
“Marginal tissue recession not extending to the mucogingival junction; no loss of interdental bone or soft tissue”
Class I
What Millers class is this?
“Marginal tissue recession extending to or beyond the mucogingival junction; no loss of interdental bone/soft tissue”
Millers Class II
What Millers class is this?
“Marginal tissue recession extending to or beyond the mucogingival junction; loss of interdental bone/soft tissue or malpositioning of the tooth”
Class III
What Millers Class is this :
“Marginal tissue recession extending to or beyond the mucogingival junction; severe loss of interdental bone/soft tissue or severe malpositioning of the tooth
Class IV
What amount of keratinised gingiva is required in order to maintain health
2mm
7 aetiologies of marginal tissue recession (gingival recession)
- Toothbrushing, trauma
- Phenotype
- Perio
- High frenal attachment (pulling gingival margin down)
- Anatomical eg palatal groove or tooth malposition
- Iatrogenic eg ortho, perio therapy
- Occlusal Trauma
In Mucogingival surgery, what Classes get no, partial and complete root coverage.
- Class IV will not obtain any
- Class III will be partial
- Class I and II should get complete
3 indications for root coverage procedures
- Aesthetics
- Root sensitivity
- Shallow root caries lesions
What are three therapeutic goals of mucogingival surgery
- Reduction of root sensitivity
- Obtain root coverage
- Gain clinical attachment and shallow probing depth
What are three patient considerations when considering mucogingival surgery
- Plaque control and compliance
- Smoking (associated with failure)
- Diabetes (healing)
What are the four root coverage procedures most commonly done
- Pedicle soft tissue graft (flap)
- Free soft tissue graft
- Combination pedicle and free
- Combination of pedicle and GTR.
In 90% of non-surgical periodontal therapy, pockets are reduced due to:
Repair by New Attachment - long junctional epithelium
What is the issue with repair by long junctional epithelium?
It is missing the new cementum and PDL fibre cells
Repair by new attachment with Connective tissue and cementum is a good outcome of GTR, but isn’t considered regeneration because:
Bone isn’t present
Guided Tissue Regerneration will ideally bring together a functional unit which consists of:
- Cementum
- PDL
- Bone
(epithelium is blocked)
What are the biological principles of GTR
- Selective cell repopulation through epithelia exclusion
- Use of physical barriers (membranes) and/or grafts which allow clot stabiliation, wound protection, space making
5 requirements of a membrane which is to be used for GTR
- Biocompatible
- Cell occlusive
- Space making
- Tissue integration
- Clinically manageable
Example of a membrane used in GTR:
Bio-gide Perio
3 INDICATIONS FOR GTR
- Bony defects with two to three walls
- Class II furcation lesion
- Class I and Class II recession
8 Contra-indications for GTR
- Poor OH
- Medical conditions such as uncontrolled diabetes
- Smoking
- Horizontal defects (no walls)
- PD< 4mm (waste of time)
- Tooth mobility (need stability for clot)
- FUrcation lesions grade I and III
- Gingival recession class III and IV
Tx of recession:
- OHI
- Supportive perio therapy
- GTR
- Mucogingival surgery
