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Y4 - CAD > Periodontal surgery symposium P3 > Flashcards

Periodontal surgery symposium P3 Flashcards

1
Q

what is gingival recession

A
  • DISPLACEMENT OF THE MARGINAL TISSUE APICAL TO THE CEJ
  • RECESSION INVOLVES
    ➢ MARGINAL GINGIVAE
    ➢ THE UNDERLYING BONE
  • MUST BE A BONY DEHISCENCE PRESENT
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2
Q

what is oral mucose

A
  • Thin non-keratinised
    epithelium
  • Mobile
  • Not designed for
    masticatory forces
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3
Q

what is attached gingivae

A
  • Dense organised
    collagen fibres
  • Attached firmly to
    periosteum
  • Resists displacement
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4
Q

anatomy

A

Alveolar/oral mucosa
Mucogingival junction
Attached gingivae
(KM)
Free gingivae

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5
Q

aetiology of gingival recession

A
  • plaque induced inflammations
  • mechanical trauma
  • iatrogenic
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6
Q

risk factors of gingival recession

A

orthodontics
general attachments
thin biotype
anatomy
tooth position

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7
Q

PLAQUE-INDUCED
INFLAMMATORY
DISEASE

A
  • LOCALISED DISEASE
  • EXACERBATING FACTORS (FRENUM, RETENTIVE FACTORS)
  • GENERALISED PERIODONTITIS
  • POST TREATMENT OF PERIODONTAL DISEASE
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8
Q

how does orthodontics cause gingival recession

A
  • LOSS OF BUCCAL PLATE
  • BUCCAL TOOTH MOVEMENT ALWAYS CAUSES SLIGHT RECESSION AS A RESULT OF STRETCHING OF
    BUCCAL MUCOSA
  • NO CORRELATION BETWEEN AMOUNT OF
    KERATINISED GINGIVAE AND AMOUNT OF
    RECESSION OBSERVED
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9
Q

greater risks of orthdontics causing gingival recession

A

Extent of tooth movement
Strength of forces
Dimensions of soft tissues
Plaque control

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10
Q

exmaples of mechanical trauma causing gingival recession

A
  • TOOTHBRUSHING - DURATION, BRUSHING FORCE, FREQUENCY OF REPLACEMENT, BRISTLE
    HARDNESS AND TECHNIQUE
  • TRAUMATIC OVERBITE - CLASS II RELATIONSHIP
  • DENTURE TRAUMA “GUM STRIPPER”
  • REMOVABLE ORTHODONTIC APPLIANCES
  • HABITS - PEN/FINGERNAIL
  • FOREIGN BODY - LIP/TONGUE PIERCING
  • TRAUMATIC INJURY
  • IATROGENIC RESTORATION DAMAGE - BIOLOGICAL WIDTH
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11
Q

CERVICAL RESTORATIVE
MARGINS

A
  • <2MM KM SITES WITH
    SUBGINGIVAL MARGINS ARE MORE
    PRONE TO GINGIVAL RECESSION
    AND INFLAMMATION
  • GINGIVAL AUGMENTATION MAY BE
    INDICATED FOR SUCH SITES?
  • LOW LEVEL OBSERVATION
    EVIDENCE
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12
Q

IS KERATINISED MUCOSA IMPORTANT?

A

It is possible for gingival health to exist in areas with little/no attached gingivae..
But it is commonly agreed that areas with <2mm are at a higher risk of recession.

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13
Q

case selection factors

A

PATIENT MOTIVATION, MEDICAL, SMOKING STATUS, EXPECTATIONS
* GENERAL STATE OF DENTITION
* MOBILITY, POCKETING, BOP, INFLAMMATION, PLAQUE
* TOOTH POSITION AND ROOT BULBOSITY
* RECESSION CLASSIFICATION, DEPTH, WIDTH
* INTERDENTAL ATTACHMENT LOSS
* RADIOGRAPHIC BONE LEVELS
* BIOTYPE – THICK/THIN
* FRENAL ATTACHMENT
* KERATINISED MUCOSA

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14
Q

Traditional classification (Millers) for gingival recssiom

A

Class 1
Class 2
Class 3
Class 4

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15
Q

3 factors for classifying gingival recession

A

attached gingivae
mucogingival junction
alveolar mucosa

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16
Q

what are management options for gingival recession

A
  • ACCEPT/MONITOR
  • NONSURGICAL PERIODONTAL CARE
  • TAILOR ORAL HYGIENE/DESENSITISING TP
  • RESTORATIONS – LABIAL/INTERPROXIMAL
  • GINGIVAL PROSTHESES
  • ORTHODONTIC SPACE CLOSURE
  • BLACK TRIANGLES
  • ORTHODONTIC MOVEMENT INTO ALVEOLUS
  • SURGICAL MANAGEMENT
  • GINGIVAL AUGMENTATION
  • RECESSION COVERAGE
17
Q

INDICATIONS FOR
RECESSION SURGERY

A
  • FACILITATE ORAL HYGIENE (DISCOMFORT)
  • PREVENT PROGRESSION
  • AESTHETIC CONCERNS
  • DENTINE SENSITIVITY?
  • NCTSL/CARIES?
    > LACK OF EVIDENCE THAT PREVENTS TOOTH LOSS
18
Q

GOALS OF SURGICAL TREATMENT

A
  • ENHANCE PERIODONTAL REGENERATION
  • AVOIDANCE OF SCARRING (PROMOTE PRIMARY WOUND HEALING)
  • OPTIMAL TISSUE BLEND AND COLOUR
  • IMPROVE ACCESS FOR ORAL HYGIENE
  • 100% ROOT COVERAGE (!)
19
Q

general factors affecting gingival recession surgery

A
  1. Defect size - bigger=less favourable results
  2. Tissue blend and colour
    * HEALTHY THICK BROAD KERATINISED MUCOSA
    * COLOUR AND TEXTURE SHOULD BLEND WITH ADJACENT ENVIRONMENT
    * ABSENCE OF SCARRING
  3. improving access
    - prominent frenum
20
Q

patient factors affecting gingival recession surgery

A

ORAL HYGIENE
* POOR OH NEGATIVELY EFFECTS WOUND HEALING
* INCREASED RISK OF INFECTION
* REDUCED COLLAGEN FIBERS AFFECTS WOUND CLOSURE
* INCREASED INTRAOPERATIVE BLEEDING
Smoking
- NON-SMOKERS MORE LIKELY TO ACHIEVE COMPLETE ROOT COVERAGE

21
Q

what is primary wound healing

A

UNCOMPLICATED HEALING WITH LITTLE OR NO SCAR TISSUE
WOUND MARGINS
* SMOOTH
* PRECISELY APPROXIMATED
* TENSION FREE

22
Q

MICRO VS TRADITIONAL SURGERY

A

99% VS 90% MEAN ROOT
COVERAGE

23
Q

Surgical options

A

PEDICLED FLAPS
1. LATERALLY REPOSITIONED FLAP
2. DOUBLE PAPILLAE FLAP
3. CORONALLY ADVANCED FLAP -/+ SCTG
LATERALLY REPOSITIONED FLAP
3-SIDED CORONALLY ADVANCED FLAP (DESANCTIS)
FREE GRAFTS

24
Q

What is free grafts

A
  • HARVESTING SOFT TISSUE FROM A DISTANT SITE IN THE MOUTH
    AND GRAFTING IT OVER A LOCALISED RECESSION DEFECT
  • TWO SURGICAL SITES
  • GRAFT DOES NOT HAVE ITS OWN BLOOD SUPPLY - RELIES ON
    RECIPIENT SITE
    ➢ FREE GINGIVAL GRAFT
    ➢ CONNECTIVE TISSUE GRAFT
    ➢ CORONAL ADVANCED FLAP
    ➢ CORONAL ADVANCED TUNNEL
25
Q

adv and disadv of free grafts

A

LOW ROOT
COVERAGE
POTENTIAL
* POOR COLOUR
BLEND
* PALATE HEALS BY
SECONDARY
INTENSION
* FASTER
* PREDICTABLE
* INCREASES KM
WIDTH

26
Q

CONNECTIVE TISSUE GRAFTS

A
  • CT HARVESTED FROM THE PALATE
  • A THREE-SIDED/TWO-SIDED/SINGLE INCISION TO CREATE A TRAP DOOR
  • EPITHELIAL LAYER IS DISSECTED AWAY TO HARVEST CONNECTIVE TISSUE
  • GRAFT PLACED BETWEEN A SPLIT THICKNESS FLAP AT THE RECIPIENT SITE
  • GOLD STANDARD FOR MUCOGINGIVAL PROCEDURES

Y4 - CAD (5 decks)

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