week 15

Question 1

Width of AG =

what is minimum?

Answer 1

= (distance between gingival margin and MGJ) – probe depth

*No minimal width of AG is required for gingival health (was formerly believed to be 2 mm)

Question 2

BENEFITS OF WIDENED AG

Answer 2

Enhanced plaque removal at gingival margin
• Improved esthetics
• Reduced inflammation around restored teeth
• Margin binds better around teeth/implants with attached gingiva (vs mucosa)

Question 3

ABERRANT FRENUM

Answer 3

• If frenum encroaches on gingival margin, plaque removal could be compromised
• Tension of frenum on margin may open sulcus, could lead to inflammation or recession

Question 4

ESTHETIC SURGERY

Answer 4

• “black hole” syndrome – very difficult to treat

* “gummy smile” – much easier to tre

Question 5

gingival recession

1) etiology
2) causes

Answer 5

1) Most common etiology: abrasive/traumatic toothbrushing habit
Other etiologies:
• periodontal disease (chronic marginal inflammation)
• orthodontics (development of dehiscence defects)
• aberrant frenum/muscle attachments
2) exposes cementum causing ditching

Question 6

SOFT TISSUE GRAFTING TECHNIQUES

Answer 6

• Free gingival graft (FGG):
• Alloderm graft (ADG):
• Connective tissue graft (CTG)
• Lateral (double) pedicle

Question 7

Free gingival graft (FGG)

Answer 7

harvested from palate, indicated for increasing KG, not indicated for root coverage, uncomfortable for patient postoperatively

• Indicated for increasing KG/AT, not meant for root coverage!
• Not meant for esthetic zone, will leave “tire patch” look
• Consider prior to implant placement on edentulous ridge

Question 8

Alloderm graft (ADG)

• compare expense and longevity?

Answer 8

cadaver donor tissue, indicated for increasing KG and root coverage, studies show that does not last as long as CTG, increased expense

• Human cadaver source, first pioneered in treating burn wounds (skin grafts)
• Can achieve root coverage and increased KG/AT
• Some studies show that will “degenerate” over time
• Much easier on patient as no need for harvest wound
• Can do multiple sites at one time
• FGG/CT grafts are dependent on palatal tissue regeneration/healing
• Adds considerable expense to overall procedure

Question 9

Connective tissue graft (CTG)

• advantage over FFG is?

Answer 9

harvested from palate or tuberosity, indicated for increasing KG and root coverage
• Flap technique
• Pouch/tunnel technique
• Pinhole technique*

• Indicated for increasing KG/AT as well as root coverage
• Requires harvest wound, typically from palate or MX tuberosity
• Allows closure of palatal donor wound – huge advantage over FGG

Question 10

Lateral (double) pedicle

Answer 10

flap technique that may or may not include a CT graft

Question 11

Millers Classification of gingival recession

Answer 11

1- doesn’t extend beyound, no IP loss, 1005
2- beyound or to MGJ, no IP loss, 100%
3- to or beyound MGJ, some IP loss, IP bone still coronal, 70%
4- extend to or past MGJ, severe IP tissue/bone loss or tooth rotation, 50% root coverage expected

Question 12

CORONALLY ADVANCED FLAP (FOR ROOT COVERAGE) requires

Answer 12

Requires at least 4 mm KG apical to recession defect.

Question 13

Frenectomy vs Frenotomy

Answer 13

Frenectomy: complete removal of the frenum including its attachment to bone

Frenotomy: relocation of the frenum, typically to a more apical position