week 15 Flashcards
(13 cards)
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)
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)
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
ESTHETIC SURGERY
- “black hole” syndrome – very difficult to treat
* “gummy smile” – much easier to tre
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
SOFT TISSUE GRAFTING TECHNIQUES
- Free gingival graft (FGG):
- Alloderm graft (ADG):
- Connective tissue graft (CTG)
- Lateral (double) pedicle
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
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
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
Lateral (double) pedicle
flap technique that may or may not include a CT graft
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
CORONALLY ADVANCED FLAP (FOR ROOT COVERAGE) requires
Requires at least 4 mm KG apical to recession defect.
Frenectomy vs Frenotomy
Frenectomy: complete removal of the frenum including its attachment to bone
Frenotomy: relocation of the frenum, typically to a more apical position
