Periodontal surgery symposium P3 Flashcards
what is gingival recession
- DISPLACEMENT OF THE MARGINAL TISSUE APICAL TO THE CEJ
- RECESSION INVOLVES
➢ MARGINAL GINGIVAE
➢ THE UNDERLYING BONE - MUST BE A BONY DEHISCENCE PRESENT
what is oral mucose
- Thin non-keratinised
epithelium - Mobile
- Not designed for
masticatory forces
what is attached gingivae
- Dense organised
collagen fibres - Attached firmly to
periosteum - Resists displacement
anatomy
Alveolar/oral mucosa
Mucogingival junction
Attached gingivae
(KM)
Free gingivae
aetiology of gingival recession
- plaque induced inflammations
- mechanical trauma
- iatrogenic
risk factors of gingival recession
orthodontics
general attachments
thin biotype
anatomy
tooth position
PLAQUE-INDUCED
INFLAMMATORY
DISEASE
- LOCALISED DISEASE
- EXACERBATING FACTORS (FRENUM, RETENTIVE FACTORS)
- GENERALISED PERIODONTITIS
- POST TREATMENT OF PERIODONTAL DISEASE
how does orthodontics cause gingival recession
- 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
greater risks of orthdontics causing gingival recession
Extent of tooth movement
Strength of forces
Dimensions of soft tissues
Plaque control
exmaples of mechanical trauma causing gingival recession
- 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
CERVICAL RESTORATIVE
MARGINS
- <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
IS KERATINISED MUCOSA IMPORTANT?
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.
case selection factors
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
Traditional classification (Millers) for gingival recssiom
Class 1
Class 2
Class 3
Class 4
3 factors for classifying gingival recession
attached gingivae
mucogingival junction
alveolar mucosa
what are management options for gingival recession
- 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
INDICATIONS FOR
RECESSION SURGERY
- FACILITATE ORAL HYGIENE (DISCOMFORT)
- PREVENT PROGRESSION
- AESTHETIC CONCERNS
- DENTINE SENSITIVITY?
- NCTSL/CARIES?
> LACK OF EVIDENCE THAT PREVENTS TOOTH LOSS
GOALS OF SURGICAL TREATMENT
- ENHANCE PERIODONTAL REGENERATION
- AVOIDANCE OF SCARRING (PROMOTE PRIMARY WOUND HEALING)
- OPTIMAL TISSUE BLEND AND COLOUR
- IMPROVE ACCESS FOR ORAL HYGIENE
- 100% ROOT COVERAGE (!)
general factors affecting gingival recession surgery
- Defect size - bigger=less favourable results
- Tissue blend and colour
* HEALTHY THICK BROAD KERATINISED MUCOSA
* COLOUR AND TEXTURE SHOULD BLEND WITH ADJACENT ENVIRONMENT
* ABSENCE OF SCARRING - improving access
- prominent frenum
patient factors affecting gingival recession surgery
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
what is primary wound healing
UNCOMPLICATED HEALING WITH LITTLE OR NO SCAR TISSUE
WOUND MARGINS
* SMOOTH
* PRECISELY APPROXIMATED
* TENSION FREE
MICRO VS TRADITIONAL SURGERY
99% VS 90% MEAN ROOT
COVERAGE
Surgical options
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
What is free grafts
- 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
adv and disadv of free grafts
LOW ROOT
COVERAGE
POTENTIAL
* POOR COLOUR
BLEND
* PALATE HEALS BY
SECONDARY
INTENSION
* FASTER
* PREDICTABLE
* INCREASES KM
WIDTH
CONNECTIVE TISSUE GRAFTS
- 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
