Week 1 Sharma: Aesthetic Periodontal Surgery Flashcards
What is the difference between tissue around implant vs teeth?
Implant: mucosa
Tooth: gingiva
What is recession?
Displacement of location of marginal periodontal tissues apical to CEJ
What are predisposing and precipitating factors for recession?
- Mechanical forces* (faulty toothbrushing, oral piercing, occlusal injury)
- Anatomy* (bone dehiscence, malocclusion, tooth position, gingival biotype, aberrant frenal attachment, quantity of attached gingiva)
- Ageing
- Pathological factors (plaque induced inflammation- smoking)
- Iatrogenic factors (ortho movement, resto’s)
What are the 4 millers classifications for recession?
Class I: No IP tissue loss, marginal tissue recession doesn’t extend to MGJ
Class II: No IP tissue loss, marginal tissue recession extend to/beyond MGJ
Class III: IP tissue loss, marginal tissue recession extend to/beyond MGJ
Class IV: IP tissue loss, severe bone/soft tissue loss in interdental area apical to B soft tissue margin
What are indications for root coverage?
- Reduce root sensitivity
- Improve aesthetics
- Manage muco-gingival defects
What are some factors that can complicate mucogingival issues in patients with recession?
- High frenal attachment: frenal pull keeps area detached and progresses recession (common in lower incisors)
- Shallow vestibule: can perform vestibuloplasty
What is a pedicle soft tissue graft?
- Once end of graft still attached to donor site
- Keeps intact supply of blood.
- Ideal for single tooth defects
What is a free soft tissue graft?
Graft is completely detached from donor site (palate) and sutured at site of recession
What are the 3 classes of grafts for treating recession?
- Pedicle soft tissue grafts
- Free soft tissue grafts
- Additive treatments (commercially sourced graft material)
What are the 4 types of pedicle soft tissue grafts?
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Rotational flaps:
- Laterally positioned flaps
- Double papilla flap
-
Advanced flaps:
- Coronally positioned flap
- Semilunar flap
What is a laterally positioned flap?
Take tissue from adjacent tooth and suture it to tooth with recession
- Partial thickness area created on root, ready to receive donor tissue
- Partial thickness pedicle flap created on adjacent tissue and moved laterally & sutured
What is a double papilla flap and its indications?
Flap using 2 adjacent papillae to cover a denuded root surface.
Indications:
- Wide adjacent IP papillae
- Insufficient attached gingiva for lateral pedicle graft
What is a coronally positioned flap?
Flap is released and moved up to cover root surface
What is a semilunar flap
- Limited in what you can achieve.
- Can treat minor recession.
- Release tissue from sulcus and slide down on area of recession. Place Coepak.
What are the 2 types of free soft tissue graft?
- Non-submerged grafts: free gingival graft (don’t cover graft material with epithelium/flap)
- Submerged grafts: subepithelial connective tissue graft (cover graft material with pedicle flaps)
What are indications and contraindications for laterally positioned flap?
-
Indications
- Used for minor recession (miller class I and II)
- Adequate adjacent donor tissue
-
Contraindications:
- Deep IP pocket and BL
- Excessive root prominences
- Significant loss of IP bone height
What are pros and cons of laterally positioned flaps?
-
Pros:
- Good vascularity of pedicle flap
-
Cons:
- Possibility of recession at donor site
- Limited by amount of adjacent tissue
- Dehiscence or fenestration at donor site
- Can be used in single or 2 teeth recession
What are main points to know about free gingival graft
- Inc width of attached gingiva
- Colour mismatch
- Raw wound on palate
- Single source of blood supply
- More useful in less visible areas
What is the most predicable method of root coverage?
Sub epithelial connective tissue graft
What is a subepithelial connective tissue graft?
A wedge of palatal connective tissue is inserted below the existing epithelium of recipient site. Pedicle flap placed on top.
What are main points with subepithelial connective tissue graft?
- More predicable root coverage
- Colour match
- Technique sensitive
- Primary closure of palate
- Dual source of blood supply
What is tunnel technique and indications?
Recipient area is not completely opened. Tunnel prepared and CT slides into tunnel and is sutured.
- Inc blood supply to CT graft
- Better adaptation and stability
- Useful in recession on multiple teeth
What are bioactive molecules? How are they obtained?
- Draw blood & place blood in centrifuge to separate PRP (platelet rich protein) and PRF (platelet rich fibrin) which has beneficial growth factors for perio.
- PRP/PRF fluid can be mixed with bone graft for placement
How can bone morphogenic proteins improve perio?
BMPs secreted by osteoblasts induce formation of osteoprogenitor cells and stimulate new bone formation. Need large amounts of native BMP’s in order to produce bone. Therefore recombinant BMP’s have been developed.
What can be used as carrier for BMP’s?
Ideal carrier still not found
- Demineralised bone matrix
- Collagen
- Resorbable polymers
- Calcium phosphate materials
What is enamel matrix derivates (emdogain)?
- Derived from porcine tooth germ, containing amelogenin (matrix produced by ameloblasts and REE of root sheaths)
- Raise flap, apply gel or mix with bone grafts and place in pocket
What are acellular dermal matrix derivatives (commercial sources of tissue graft)?
- Alloderm: human source
- Mucoderm: derived from porcine dermis
- Main content: collagen
- Advantage: Treatment of multiple defects
