W1 - Aesthetic Perio Surgery - Sharma Flashcards
Marginal Tissue Recession
- Displacement of the location of marginal perio tissues apical to CEJ
What is the tissue around an implant called?
Mucosa
Ginig
What is the tissue around an implant called?
Mucosa
NOT gingiva - gingiva is a TOOTH associated landmark
Predisposing and precipitating factors to marginal tissue recession (5)
Mechanical Forces
- Toothbrushing, piercings
Anatomy
- Tooth position, thin gingival biotype
Iatrogenic
- Ortho
Aging
Pathological
- Plaque
Describe Millers Class 1 Recession
Marginal tissue recession that doesn’t extend to mucogingival junction
- No interproximal tissue loss
Describe Millers Class 2 Recession
Marginal tissue recession that extends to mucogingival junction
- NO interproximal tissue loss
Describe Millers Class 3 Recession
Marginal tissue recession that extends beyond mucogingival junction
WITH interproximal attachment loss
Describe Millers Class 4 Recession
Marginal tissue recession that extends beyond mucogingival junction WITH:
- Severe bone / tissue loss interproximally to a level apically to the soft tissue margin
Millers Class 1 Recession
Millers Class 2 Recession
Millers Class 3 Recession
Millers Class 4 Recession
Indications for root coverage (3)
- Reduce root sensitivity
- Improve esthetics
- Manage muco-gingival defects (shallow vestibule, frenums)
What anatomic feature can worsen marginal recession?
High frenums
What is a pedicle soft tissue graft?
- When is it used?
- Why?
One end of graft is still attached to donor site
- Allows for continuous blood supply
- Often used for OAC coverage
What is a free soft tissue graft?
Graft which is completely dettached from the donor site
What are “additive treatments”?
Materials that are sourced commercially and are added to treatment
- Ex. grafts from animals, other humans, GTR, etc.
2 Subcategories of pedicle soft tissue grafts
Rotational (laterally positioned, double papilla flap)
Advanced flaps (coronally positioned flap, semilunar flap)
Laterally positioned flap
- Type of rotational pedicle flap
Double papilla flap
- type of rotational pedicle flap
Coronally positioned flap
- Type of advanced pedicle flap
Semilunar flap
- Type of advanced pedicle flap
2 subcategories of free soft tissue grafts
Nonsubmerged grafts (connective tissue and epithelium graft)
Submerged grafts (subepithelial connective tissue graft)
Indications of laterally positioned flap (2)
- Millers class 1 and 2
- Adequate adjacent donor
(small defects)
Contra indications for laterally positioned flap (3)
- Deep proximal pocket and bone loss
- Excessive root prominences
- Significant loss of interproximal bone height
Why must bone height be considered with soft tissue grafts?
Despite the flap placement, tissues will ultimately heal / remodel and form to wherever the bone is
Describe the steps of a laterally positioned flap
- V shape incision on denuded root
- Parallel incision at oblique angle toward recipient tooth
- PARTIAL THICKNESS FLAP extends into mucosa
- Pedicle flap positioned laterally
- Sutures placed
- Sutures removed in 2 weeks
Pros (1) and cons (4) of laterally positioned flaps
Pros
- Good vascularity
Cons
- Possibility of recession at donor site
- Limited by amount of adjacent tissue
- Fenestration at donor site
- Can be used in single or two teeth recession
Indication for double papilla laterally positioned flap (2)
- Wide adjacent interproximal papilla
- Insufficient attached gingiva for lateral pedicle graft
Where is free gingival graft material usually sourced from
palate
What is an aesthetic issue with free gingival grafts
Permanent colour mismatch
- Tissue on palate is more fibrous
- Graft will always look like a patch
Pros (1) and cons (3)of free gingival graft
Pros:
increases width of attached gingiva
Cons:
- Colour mismatch
- Raw wound in the palate
- Single source of blood supply
What is the best grafting technique that provides consistent results?
Subepithelial connective tissue graft
Pros (4) and cons (1) of subepithelial connective tissue graft
Pros:
- More predictable root coverage
- Color match (surface layer is local epithelium)
- Primary closure in palate
- Dual source of blood supply (periosteum/bed + epithelial lateral flap)
Cons:
- Technique sensitive (requires you to cut out exclusively connective tissue from palate, no epithelium)
What is the tunnel technique? What is it good for? Advantages?
Recipient site is not open completely → “tunnel”
- Increased blood supply
- Better adaptation and stability
- Can be used for multiple teeth
What are two commercially availble graft materials
Alloderm (human source)
Mucoderm
Main content is collagen
What is PRP and PRF? (perio tx)
Platelet Rich Plasma and Platelet Rich Fibrin
- Blood sample is taken from pt and sample is put in centrifuge to separate the PRP which has beneficial growth factors for perio
- PRP fluid can be mixed with bone graft for placement
Do bone grafts actually create new bone?
No, replaces the missing space
- Needs to be resorbed and replaced by host bone
- Essentially acts as “scaffolding”
How can bone morphogenic proteins improve perio?
BMPS secreted by osteoblasts induce formation of osteogenitor cells and stimulare new bone formation
Need large armounts of native BMPS in order to produce bone
Therefore recombinant BNPS have been developed
What can be used as carrier for BMPs? (perio)
Ideal carrier still ntof ound
- demineralised bone matrix
- collagen Resorbable polymers
- Calcium phosphate materials
