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?
-
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)