Flashcards in week 15 Deck (13)
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1
Width of AG =
what is minimum?
= (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)
2
BENEFITS OF WIDENED AG
Enhanced plaque removal at gingival margin
• Improved esthetics
• Reduced inflammation around restored teeth
• Margin binds better around teeth/implants with attached gingiva (vs mucosa)
3
ABERRANT FRENUM
• 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
4
ESTHETIC SURGERY
• “black hole” syndrome – very difficult to treat
• “gummy smile” – much easier to tre
5
gingival recession
1) etiology
2) causes
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
6
SOFT TISSUE GRAFTING TECHNIQUES
• Free gingival graft (FGG):
• Alloderm graft (ADG):
• Connective tissue graft (CTG)
• Lateral (double) pedicle
7
Free gingival graft (FGG)
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
8
Alloderm graft (ADG)
* compare expense and longevity?
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
9
Connective tissue graft (CTG)
* advantage over FFG is?
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
10
Lateral (double) pedicle
flap technique that may or may not include a CT graft
11
Millers Classification of gingival recession
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
12
CORONALLY ADVANCED FLAP (FOR ROOT COVERAGE) requires
Requires at least 4 mm KG apical to recession defect.
13
