Soft Tissue Grafting

Question 1

Mucogingival Surgery definition

Answer 1

“Surgical procedures designed to preserve gingiva, remove aberrant frenulum or muscle attachment, and increase the depth of the vestibule”

Invovles the soft tissue - specifically the gingiva, frenum and vestibule

Question 2

Periodontal Plastic Surgery definition

Answer 2

“Surgical procedures performed to prevent or correct anatomical, developmental, traumatical, or plaque-induced defects of the gingiva, alveolar mucosa, or bone”

Broad definition - related to hard tissues as well

Question 3

How much gingival width is necessary to maintain periodontal health?

Answer 3

The width of the gingival has no impact on resistance to attachment loss
Periodontal health can be maintained independent of gingival width

Question 4

Marginal Tissue Recession definition

Answer 4

The displacement of the soft tissue margin apical to the CEJ

Question 5

Root coverage procedures definition

Answer 5

Surgical techniques designed to reduce the amount of root exposure

Question 6

What are the Recession Classificaitons

Answer 6

Miller Classifications

Class I-IV

Question 7

Miller Class I

Answer 7

Interproximal height is normal

Recession does not extend past the MGJ

Question 8

Miller Class II

Answer 8

Interproximal height is normal

Recession extends past the MGJ

Question 9

Miller Class III

Answer 9

Recession is present interproximally

‘Reasonable’ height discrepancy between the IP and the mid-facial

Question 10

Miller Class IV

Answer 10

Recession present interproximally

The interproximal recession is close to or at the same level as the mid-facial recession

Question 11

Recession incidence and extent increases with/in what/who?

Answer 11

Age
Males
African-Americans

Question 12

On what surface is recession most often seen?

Answer 12

Buccal

If it is on the linguals, it is usually the anteriors

Question 13

In younger patients, what teeth most commonly have recession?

Answer 13

Premolars

Question 14

What are the different etiologies for recession?

Answer 14

Mechanical Trauma
Inflammation
Perio disease

Question 15

What different types of mechanical trauma can cause recession?

Answer 15

Brushing and Flossing Improperly
Self-inflicted (tooth-picks and fingers)
Malocclusion
Iatrogenic
Oral piercings

Question 16

What are some different iatrogenic examples that cause recession?

Answer 16

Appliances

Poorly fitting partials

Question 17

What are some indications for Gingival Augmentation to resolve gingival recession?

Answer 17

• Patient discomfort while brushing or chewing because of lining mucosa
• Orthodontic tooth movement leading to bone dehiscence
• Subgingival restorations in thin tissue areas

Question 18

What are the steps for Gingival Augmentation

Answer 18

1) Partial thickness bed
2) Harvest graft from the palate
3) Immobilize the graft

Question 19

What should be the characteristics of the harvest for a Gingival Augmentation?

Answer 19

1.5-2.0mm thick

It should come from an area near the premolars

Question 20

Which step in the Gingival Augmentation is most critical and why?

Answer 20

Immobilization

Because we are trying to reestablish the blood supply

Question 21

T/F - Gingival Augmentation has a very predictable outcome

Answer 21

True

Question 22

What are the steps for a Free Gingival Graft?

Answer 22

1) Split thickness bed
2) Use a surgical foil as a template
3) Harvest and place the graft

Question 23

What are the accomplishments for a Free Gingival Graft?

Answer 23

Covered recession
Vestibule is deeper
Gingival thickness is better
Area is easier to maintain

Question 24

What are the healing phases associated with a Free Gingival Graft?

Answer 24

Initial phase (0-3 days)
Revascularization phase (2-11 days)
Tissue maturation phase (11-42 days)

Question 25

What are some characteristics of Free Gingival Graft Healing?

Answer 25

The bed has to be smooth
We don’t want a big clot (could cause dehiscence or necrosis)
We will slowly get anastomoses and more blood supply