Plastic and Esthetic Surgery (Richardson) Flashcards
What are some indications for mucogingival surgery?
- Lack of keratinized, attached tissue,
- Recession causing root exposure and sensitivity, E. Esthetics
- Failing gingival restorations
- Thin gingiva with planned restorative or ortho,
- Frenum pulls causing recession or eversion
At what time during ortho treatment could mucogingival surgery be performed?
Prior to, during, or after
What are 5 contraindications for mucogingival surgery?
- Undiagnosed ecology
- Uncontrolled periodontal disease in site
- Severe malposed teeth
- Noncompliant patient
- Smoker
What are 8 possible etiologies for gingival recession?
- Position of tooth during eruption
- Deep restorative margin
- Orthodontic tooth movement
- Tooth brush abrasion / erosion
- Occlusion (clenching, grinding, fremitus)
- Genetic predisposition
- Trauma
- Strange habits
Lang and Loe suggest how much keratinized gingiva is adequate to maintain gingival health?
2.0mm keratinized (1.0mm of attached)
In the Dorfman and Kennedy study, what was the key between patients who received a free gingival graft and those that did not with respect to maintenance and further recession?
Those patients who had a free gingival graft but were poorly maintained showed no recession whereas those patients who were not grafted and were poorly maintained showed progression of the recession
Did the Coatam study show that if a crowded-out tooth has not keratinized tissue, would orthodontic movement back into the arch result in a gain of keratinzied tissue?
No
Coatam demonstrated that the potential for recession of keratinized tissue covered tooth is increased or decreased?
Increased
What is the prevalence of mucogingival problems in the general population?
12-19%
Miller class in which recession does not extend to or beyond the mucogingival junction and no loss of interdental bone or soft tissue?
Miller Class I
What root coverage can be anticipated for a gingival graft over Miller Class I recession?
Full coverage is anticipated
What is the Miller class in which recession DOES extend to or beyond the mucogingival junction and no loss of interdental bone or soft tissue?
Miller Class II
What root coverage can be anticipated for a gingival graft over Miller Class II recession?
Full root coverage may be anticipated
What is the Miller class in which severe recession extends to or beyond the mucogingival junction and there is loss of interdental bone or soft tissue (tooth may be severely malposed)?
Miller Class IV
Is root coverage likely in a Miller Class IV?
No
Why do Miller Class I and Class II have a better prognosis for root coverage by the graft?
They have a vascular bed from the interdental bone to go across the defect
What are 2 primary techniques to cover mucogingival defects?
- Free gingival grafts (FGG)
2. Subepithelial Connective Tissue Graft (SECT)
What are 3 healing stages for a free gingival graft?
- Plasmatic circulation 0-2 days
- Vascularization 3 days
- Organic union 4-10 days
A study in the 1970s by Brackett and Gargulo showed that blood supply not reestablished until how many days post-op from the graft placement?
7-10 days
Jahnke in 1993 showed what percentages of root coverage with Free Gingival Graft versus Subepithelial Connective Tissue Graft?
43% FGG
80% SECT
What is the primary technique for root coverage?
SECT graft
What is the major benefit of the sub epithelial connective tissue graft?
Augments the amount of keratinized gingival in ESTHETIC manner
What percentage of root coverage from a SECT if there is less than 3mm of recession?
100%
What percentage of root coverage from SECT if 4-6mm of recession?
90%
What percentage of root coverage from SECT if 7-10mm recession?
85%
What are 3 advantages of an SECT graft?
- Effective root coverage
- Esthetic color match
- Long term stability
What are 3 advantages of Free Gingival Graft?
- Effective at establishing zone of keratinized tissue
- Does not require coverage at recipient site
- Long term stability