W1 - Aesthetic Perio Surgery - Sharma

Question 1

Answer 1

Marginal Tissue Recession

• Displacement of the location of marginal perio tissues apical to CEJ

Question 2

What is the tissue around an implant called?

Answer 2

Mucosa

Ginig

Question 3

What is the tissue around an implant called?

Answer 3

Mucosa

NOT gingiva - gingiva is a TOOTH associated landmark

Question 4

Predisposing and precipitating factors to marginal tissue recession (5)

Answer 4

Mechanical Forces

• Toothbrushing, piercings

Anatomy

• Tooth position, thin gingival biotype

Iatrogenic

• Ortho

Aging

Pathological

• Plaque

Question 5

Describe Millers Class 1 Recession

Answer 5

Marginal tissue recession that doesn’t extend to mucogingival junction

• No interproximal tissue loss

Question 6

Describe Millers Class 2 Recession

Answer 6

Marginal tissue recession that extends to mucogingival junction

• NO interproximal tissue loss

Question 7

Describe Millers Class 3 Recession

Answer 7

Marginal tissue recession that extends beyond mucogingival junction

WITH interproximal attachment loss

Question 8

Describe Millers Class 4 Recession

Answer 8

Marginal tissue recession that extends beyond mucogingival junction WITH:

• Severe bone / tissue loss interproximally to a level apically to the soft tissue margin

Question 9

Answer 9

Millers Class 1 Recession

Question 10

Answer 10

Millers Class 2 Recession

Question 11

Answer 11

Millers Class 3 Recession

Question 12

Answer 12

Millers Class 4 Recession

Question 13

Indications for root coverage (3)

Answer 13

• Reduce root sensitivity
• Improve esthetics
• Manage muco-gingival defects (shallow vestibule, frenums)

Question 14

What anatomic feature can worsen marginal recession?

Answer 14

High frenums

Question 15

What is a pedicle soft tissue graft?

• When is it used?
• Why?

Answer 15

One end of graft is still attached to donor site

• Allows for continuous blood supply
• Often used for OAC coverage

Question 16

What is a free soft tissue graft?

Answer 16

Graft which is completely dettached from the donor site

Question 17

What are “additive treatments”?

Answer 17

Materials that are sourced commercially and are added to treatment

• Ex. grafts from animals, other humans, GTR, etc.

Question 18

2 Subcategories of pedicle soft tissue grafts

Answer 18

Rotational (laterally positioned, double papilla flap)

Advanced flaps (coronally positioned flap, semilunar flap)

Question 19

Answer 19

Laterally positioned flap

• Type of rotational pedicle flap

Question 20

Answer 20

Double papilla flap

• type of rotational pedicle flap

Question 21

Answer 21

Coronally positioned flap

• Type of advanced pedicle flap

Question 22

Answer 22

Semilunar flap

• Type of advanced pedicle flap

Question 23

2 subcategories of free soft tissue grafts

Answer 23

Nonsubmerged grafts (connective tissue and epithelium graft)

Submerged grafts (subepithelial connective tissue graft)

Question 24

Indications of laterally positioned flap (2)

Answer 24

1. Millers class 1 and 2
2. Adequate adjacent donor

(small defects)

Question 25

Contra indications for laterally positioned flap (3)

Answer 25

1. Deep proximal pocket and bone loss 2. Excessive root prominences 3. Significant loss of interproximal bone height

Question 26

Why must bone height be considered with soft tissue grafts?

Answer 26

Despite the flap placement, tissues will ultimately heal / remodel and form to wherever the bone is

Question 27

Describe the steps of a laterally positioned flap

Answer 27

* V shape incision on denuded root * Parallel incision at oblique angle toward recipient tooth * PARTIAL THICKNESS FLAP extends into mucosa * Pedicle flap positioned laterally * Sutures placed * Sutures removed in 2 weeks

Question 28

Pros (1) and cons (4) of laterally positioned flaps

Answer 28

Pros * Good vascularity Cons * Possibility of **recession** at donor site * **Limited by amount** of adjacent tissue * **Fenestration** at donor site * Can be used in **single or two teeth** recession

Question 29

Indication for double papilla laterally positioned flap (2)

Answer 29

1. Wide adjacent interproximal papilla 2. Insufficient attached gingiva for lateral pedicle graft

Question 30

Where is free gingival graft material usually sourced from

Answer 30

palate

Question 31

What is an aesthetic issue with free gingival grafts

Answer 31

Permanent colour mismatch * Tissue on palate is more fibrous * Graft will always look like a patch

Question 32

Pros (1) and cons (3)of free gingival graft

Answer 32

Pros: increases width of attached gingiva Cons: * Colour mismatch * Raw wound in the palate * Single source of blood supply

Question 33

What is the best grafting technique that provides consistent results?

Answer 33

Subepithelial connective tissue graft

Question 34

Pros (4) and cons (1) of subepithelial connective tissue graft

Answer 34

Pros: * More predictable root coverage * Color match (surface layer is local epithelium) * Primary closure in palate * Dual source of blood supply (periosteum/bed + epithelial lateral flap) Cons: * Technique sensitive (requires you to cut out exclusively connective tissue from palate, no epithelium)

Question 35

What is the tunnel technique? What is it good for? Advantages?

Answer 35

Recipient site is not open completely → “tunnel” * Increased blood supply * Better adaptation and stability * Can be used for multiple teeth

Question 36

What are two commercially availble graft materials

Answer 36

**Alloderm (human source)** **Mucoderm** Main content is collagen

Question 37

What is PRP and PRF? (perio tx)

Answer 37

Platelet Rich Plasma and Platelet Rich Fibrin * Blood sample is taken from pt and sample is put in centrifuge to separate the PRP which has beneficial growth factors for perio * PRP fluid can be mixed with bone graft for placement

Question 38

Do bone grafts actually create new bone?

Answer 38

No, replaces the missing space - Needs to be resorbed and replaced by host bone * Essentially acts as “scaffolding”

Question 39

How can bone morphogenic proteins improve perio?

Answer 39

BMPS secreted by osteoblasts induce formation of osteogenitor cells and stimulare new bone formation Need large armounts of native BMPS in order to produce bone Therefore recombinant BNPS have been developed

Question 40

What can be used as carrier for BMPs? (perio)

Answer 40

Ideal carrier still ntof ound * demineralised bone matrix * collagen Resorbable polymers * Calcium phosphate materials