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5th ICP - ACS - PERIO > Gingival Recession > Flashcards

Gingival Recession Flashcards

1
Q

What is gingival recession?

A

Migration of gingival margin apical to CEJ (cement-enamel junction)

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2
Q

Is recession indicator active disease?

A

No

Can indicate past active or active disease

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3
Q

Why is recession part of informed consent?

A

Recession is risk of healing and periodontal therapy

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4
Q

How can recession present?

A

Generalised or localised

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5
Q

When may see general recession?

A

Toothbrush trauma

Periodontal disease

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6
Q

When may see localised recession?

A

Localised labial defects

Localised pockets

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7
Q

Aetiology of recession?

A

Predisposing and precipitating factors?

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8
Q

Predisposing factors of recession?

A

Thin periodontal phenotype
Tooth position
Previous ortho tx - too far labail
Position muscle attachment

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9
Q

What are precipitating factors of recession?

A 
Gingival inflamamtion
Toothbrush trauma
Iatrogenic trauma
Self-inflicted trauma
Deep OB
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10
Q

Stages of gingival recession?

A

Stage 1 = normal tissue w/ subclinical inflammation
Stage 2 = clinical inflammation
Stage 3 = increased epithelium proliferation, loss CT core
Stage 4 = merging epithelium = separation and recession gingival tissue

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11
Q

What is gingival phenotype?

A

Gingival thickness and keratinised tissue width

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12
Q

What keratinised tissue width?

A

Dimension from mucogingival junction to gingival margin

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13
Q

What is an adequate keratinised tissue width?

A

3mm

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14
Q

Is keratinised tissue width consistent in mouth?

A

No

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15
Q

What may be indication of thin gingival pheotype?

A

See periodontal probe - less 1mm thickness

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16
Q

How does sub gingival plaque interact with tissue?

A

Lateral/apical extension inflammatory cells

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17
Q

How does sub-gingival plaque affect thin and thick tissue?

A

In thick gingival tissue infiltrate only occupy small amount CT

In thin gingival tissue entirity CT can be affected by inflammatory infiltrate = degradation tissue = recession

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18
Q

Where more common to see recession in healing of periodontitis?

A

In areas of bone loss

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19
Q

Different traumatic elements that can be precipitating factor?

A

Mechanical - toothbrushing
Physical - piercings, poorly designed dentures
Chemical - drygs/ tobacco

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20
Q

What pattern recession expect to see in toothbrush recession?

A

Even distribution - buccal surface

Side opposite to dominant hand

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21
Q

Where might see recession associated w/ ill-fitting dentures?

A

Around abutment teeth

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22
Q

How can smoking contribute to recession?

A

Reduced gingival blood flow = reduced immune response

Altered cellular response

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23
Q

How can tooth position affect recession?

A

Position and orientation of tooth can influence thickness overlying gingival tissue

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24
Q

What teeth are most prone to recession?

A

Mandibular incsiors

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25
Q

How can ortho cause recession?

A

Movement of teeth labial - move through buccal plate

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26
Q

What is dehiscence?

A

Occur margin bone

27
Q

What is fenestration?

A

Hole in bone which root can be seen to protrude

28
Q

How does deep overbite influence recession?

A

Trauma to palatal tissue

29
Q

Examples physical trauma?

A

Piercings
Poorly designed denture
Habitual - pen chewing

30
Q

How can position of muscle attachment influence recession?

A

Don’t directly cause recession

Can impede OH = plaque build up, if thin phenotype more likely experience recession

31
Q

Examples of iatrogenic damage?

A

Overheated scaler tip
Poorly contoured restoration = plaque retentive
Surgical proceudre
Rubber dam clamp

32
Q

How do pt w/ recession present?

A

Dentine hypersensitivtity
Impaired aeshetics
Non-carious root lesion

33
Q

Why are aesthetic impaired w/ gingival recession?

A

Open embrasure = black triangle

Exposed crown margin

34
Q

How dx recession?

A

Thorough hx
Clinical assessment
Radiographic assessment

35
Q

What anatomy want to assess when dx recession?

A

Gingival phenotype

Bone morphology

36
Q

What classification is used to grade recession?

A

Millers classification

37
Q

What is Millers Class I?

A

Marginal tissue recession doesn’t extend to MGJ
No loss inter proximal bone/soft tissue
Full root coverage

38
Q

What is Millers Class II?

A

Marginal tissue recession extend to or beyond MGJ

No loss inter proximal bone//tissue

39
Q

What expect Millers Class III?

A

Partial root coverage

40
Q

What is Millers Class III?

A

Marginal tissue recession extend to/beyond

Loss interdental bone/ soft tissue

41
Q

What is Miller Class III

A

Marginal recession to/beyond MGC

Severe loss interdental bone/soft tissue

42
Q

What does Millers classification consider?

A

4 types recesison defect

Consider hard and soft periodontal tissue

43
Q

Limitation of Millers?

A 
Hard to identify muco-gingival junction
Hard differentiate class I/II
44
Q

Aims of management gingival recession?

A

Address pt concern
Prevent further recession
Cover exposed root surface

45
Q

What is conservative management of recession?

A

Reassure
Take baseline measurements so can monitor
Manage sensitivity - F- vanrish, seal exposed surface
NCRL restored
Manage contirbuting factors

46
Q

How manage contibuting factors of gingival recession?

A

Remove plaque retentive factors
Ortho - address tooth position
Atruamative tooth brushing technique

47
Q

How management aesthetic concern of recession?

A

Pink composite - careful not create overhangs
Pink ceramic
Gingival veneers

48
Q

What is a gingival veneer?

A

Provisional measure - make acrylic/silicone

Incorporates embrasure for retention

49
Q

Issue gingival veneer?

A

Need optimum perio health - plaque retention

Minimal colour of acrylic

50
Q

What is aim of surgical management of recession?

A

Complete root coverage and integration of tissue

51
Q

3 main types surgical management of recession?

A

Pedicle flap procedure
Free soft tissue graft
Regeneration proceudre

52
Q

Difference pedicle flaps and free soft tissue graft?

A

Pedicle flap - flap displaced which maintains vascular supply

Soft tissue graft - displace flap w/ no attached vascular supply

53
Q

Examples regenerative procedures?

A

GTR

Enamel matrix derivative

54
Q

Indication surgical management?

A

Progressive breakdown
Poor aeshtetic
Hypersensitivity
Unfavourable contour gingival margin

55
Q

Contraindication surgical management?

A 
Poor OH
Smoking
Periodontal pockets
Uncontrolled aetiological factor 
Poor access 
MH
56
Q

What included pre-op assessment for perio surgery?

A 
Hx 
Pt complaint and expectation
Conservative tx tried?
MH
Clinical assessment
Clinical records
Sensibility
Radiograph exam
ICG
57
Q

What is included in clinical assessment prior surgery?

A

EO: smile line, access, muscle insertion
IO: dimension defect, presence interproximal tissue/bone, phenotype

58
Q

What is a pedicle flap procedure?

A

Flap remains attached at base - retains own blood supply

59
Q

Example of pedicle flaps?

A

Coronal advanced flap

Rotation flap

60
Q

What is free soft tissue graft?

A

Displacement of tissue tissue w/ no attached vasculature supply

61
Q

When are free gingival grafts used?

A

Narrow, isolated recession defects - increase band of keratinised tissue

62
Q

If taking palatal graft what should avoid?

A

Palatine blood vessel

63
Q

When is guided tissue regeneration used?

A

Manage alveolar bone loss - localised bony defect

Aim periodontal regeneration to exposed root surface

64
Q

When can referral to periodontal be made?

A

Conservative options exhausted

Tx of lesions expected to involve tissue augmentation/regeneration

5th ICP - ACS - PERIO (6 decks)

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