Mucogingival Surgery Perio Plastic Surgery Lecture Handout Parts 3 and 4

Question 1

Autogenous Gingival Graft
* Techniques
(4)

Answer 1

– Free Gingival Graft
– Connective Tissue Graft
– Semi-lunar Coronally Positioned Flap
– Laterally Positioned Flap

Question 2

– Free Gingival Graft
* Miller’s Free Gingival Graft with use of —
* Holbrook’s Free Gingival Graft technique
with —

Answer 2

citric acid
“stretching” suture design

Question 3

“Free” Gingival Graft
* Clinical Technique: Immobilization
(3)

Answer 3

– Place graft in saline-soaked sponge
– Place first suture in graft (out of the
mouth).
– Place graft onto recipient site and suture
to immobilize the graft. (Suture at
coronal aspect.)

Question 4

Connective Tissue Graft
* Advantages
(4)

Answer 4

– High predictability of root coverage
– Good color blend
– Smaller palatal wound site
– Double blood supply at graft site

Question 5

Connective Tissue Graft
* Disadvantages
(1)

Answer 5

– Technical finesse to do procedure at
recipient and donor site

Question 6

Connective Tissue Graft
* Technique
(3)

Answer 6

–Horizontal incisions at CEJs
–Vertical incisions at line angles of
adjacent teeth (optional)
–Partial thickness flap/split thickness
graft bed

Question 7

Connective Tissue Graft
* Donor Tissue
(5)

Answer 7

– Parallel or “trap door” incisions
– 2 mm thickness of graft
– Place over denuded root surfaces
– Suture connective tissue to underlying
tissue with resorbable suture (optional)
– Recipient flap is coronally positioned over
the connective tissue graft and sutured

Question 8

Semi-Lunar Coronally Repositioned Flap
* Tarnow Procedure
* Advantages
(3)

Answer 8

–Superior esthetics and color blend
–“Flap” graft maintains blood supply
–No tension on flap

Question 9

Semi-Lunar Coronally Repositioned Flap
 Tarnow Procedure
 Disadvantages
(3)

Answer 9

-Requires 3-5 mm of keratinized gingiva
apical to area of recession
-Heals by secondary intention
-Needs underlying bone

Question 10

Lateral Sliding Flap
(Pedicle graft)
* Advantages
(3)

Answer 10

– Superior esthetics and color blend
– “Flap” (Pedicle) graft maintains blood supply
– No tension on flap

Question 11

Lateral Sliding Flap
(Pedicle graft)
Disadvantages
(2)

Answer 11

– Requires adequate adjacent keratinized tissue
– Loss of 1-2 mm of attachment at donor

Question 12

Localized Alveolar Ridge Deficiency

Answer 12

• Resorption of ridge following extraction or
  loss of teeth

Question 13

Localized Alveolar Ridge Deficiency
* Similar problems result from
(3)

Answer 13

– Developmental defects
– Advanced periodontal disease
– Excessive ridge resorption

Question 14

Localized Alveolar Ridge Deficiency
* Edentulous ridge augmentation
(2)

Answer 14

– Gingival onlay graft
– Connective tissue graft

Question 15

Localized Alveolar Ridge Deficiency
* Indications
(2)

Answer 15

– Pre-prosthetics
– Poor esthetics

Question 16

Localized Alveolar Ridge Defects
(Siebert Classification, 1983)
 Class I

Answer 16

facial-lingual defect with ridge collapse
to the lingual (usually) or facial (rarely)

Question 17

 Class II

Answer 17

coronal-apical defect with ridge
exhibiting loss of vertical height

Question 18

 Class III

Answer 18

combination defect (commonly seen
in anterior sextants)
SRM2023

Question 19

Localized Alveolar Ridge Deficiency
* Onlay graft (Siebert, 1983)
(5)

Answer 19

– Classification system
– Full thickness graft
– De-epithelialize recipient site
– Stabilize graft
– Slow healing

Question 20

Localized Alveolar Ridge
Deficiency
* Connective Tissue Graft
– Advantages
(4)

Answer 20

• Similar to root coverage procedures
• Improved blood supply
• Improved color match
• Minimal discomfort

Question 21

Localized Alveolar Ridge
Deficiency
* Connective Tissue Graft
– Disadvantages
(1)

Answer 21

• Limited thickness; multiple procedures

Question 22

Tooth Uncovery
(4)

Answer 22

• Often for orthodontics
• Try to maintain keratinized tissue
• Apically position tissue to retain KG
• May also require osseous surgery to expose the crown