Periodontal Surgery

Question 1

Indications for periodontal surgery

Answer 1

Improved access for RSI +/- guided tissue regeneration

Excision of gingival hyperplasia

Correction of recession

Access sub-gingival caries/increase tissue for restoration e.g. crown

Question 2

Appropriate case selection criteria

Answer 2

Optimised OH (ideally PS <20%)

NSM first

Motivated

No MH contraindications e.g. immunocompromised, radiotherapy

Non-smoker

Reasonable prognosis of dentition

Question 3

Flap surgery (open flap debridement)

Answer 3

Direct vision of root surfaces for instrumentation +/- immediate pocket reduction by excision of pocket lining or apical repositioning of flap

Question 4

Guided tissue regeneration

Answer 4

Regenerates lost peridontium in localised vertical/infrabony defects by surgical access, placement of stable biomaterial into defect, coverage with membrane, primary closure. Uses barrier membranes e.g. Biogide (porcine collagen).

Common biomaterials: Emdogain, Bio-Oss.

Question 5

Gingival hyperplasia causes

Answer 5

CCBs - amlodipine, nifedipine

Phenytoin (anti-epileptic)

Ciclosporin (immunosuppressant)

Often in combination with poor OH

Question 6

Gingivectomy

Answer 6

Excision of excess keratinised tissue, exposed raw connective tissue bed, application of Coe-Pak temporary dressing

Question 7

Aetiology of gingival recession

Answer 7

Trauma - brushing. occlusion, piercings

Inflammatory - periodontal disease

Orthodontics - thin/absent labial alveolus

Question 8

Miller’s classification of gingival recession

Answer 8

Class I - recession defect not extending beyond mucogingival junction and no interdental ST/bone loss

Class II - extending beyond mucogingival junction and his loss of interdental soft tissue and bone

Class III - beyond mucogingival margin with loss of interdental sift tissue and bone

Class IV - defect extending beyond mucogingival junction with loss of interdental soft tissue and bone APICAL to the recession

Question 9

Cairo 2012 classification of gingival recession

Answer 9

RT1 - no interproximal tissue loss

RT2 - interproximal tissue loss (from CEJ to base of pocket) not as significant as mid-buccal

RT3 - interproximal tissue loss (from CEJ to base of pocket) worse than mid-buccal (no root coverage)

Question 10

Surgery for gingival recession

Answer 10

Free gingival graft

Connective tissue graft

Question 11

Solution for extensive recession (interproximal bone loss)

Answer 11

Surgery not indicated as root coverage not achievable.

Gingival veneer +/- composite augmentation

Question 12

Indications for crown lengthening surgery

Answer 12

Access sub gingival caries

Increase surface area for restoration

Improve aesthetics (uneven gingival contour or ‘gummy smile’)