Mucogingival Surgery I

7/25/2019 Mucogingival Surgery I

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Welcome!

DENS 3723Advance Periodontics

Course DirectorSrinivas Ayilavarapu BDS,DScAssociate ProfessorDept of Periodontics & DentalHygiene

January 7, 20!


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Mucogingival Surgery

American Academy of Periodontology 2012 Glossary of Periodontal Terms, On-line access

A surgical procedure indicated to

correct or en"ance t"e t"ic#ness ora$ount of, or c"ange t"e positionof, $ucogingival tissue%


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Periodontal Plastic Surgery

Periodontal plastic surgery is dened as t"e surgicalprocedures perfor$ed to correct or eli$inate anato$ic,develop$ental, or trau$atic defor$ities of t"e gingiva oralveolar $ucosa


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Gingiva

Keratinied tissue comosed o" adense# collagen ric$ connectivetissue# covered %y a &eratiniingeit$elium'

Gingiva e(tends "rom t$e "reegingiva margin to t$emucogingival line'

'ree gingiva(dept" of t"e

sulcus

)Attac"ed gingiva( *idt" of gingiva

$inus pro+ingdept"


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W$y do )e need attac$ed or

&eratinied gingiva**

+unction against mec$anicaland micro%ial damage'

,arrier to enetration %ymicro%es and t$eir to(icagents into deeer tissues

Ho* to detect $ucogingival -unction.


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-o) muc$ attac$ed gingiva is necessary to

maintain gingival $ealt$*

Lang & Loe, 1972(Proposed t"at t"e $ova+ility of t"e soft tissue$argin at sites *it" $ini$al attac"ed gingiva/$$1 $ay favor t"e esta+lis"$ent ofsu+gingival plaue, and t"us $a#e t"e tissues

$ore vulnera+le to destruction%Dorfman, etal; Miyasato etal; Wennstrometal(Clinical studies evaluating t"e signs ofin3a$$ation or progression of recession over one$ont" to ! years, found t"at teet" e4"i+iting

$ini$al attac"ed gingiva or $ucosal$argins*ere co$pati+le *it" periodontal "ealt"%

AAP World Workshop,1996:A $ini$al a$ount or a+sence of gingiva

alone is 56 -ustication for gingivalau $entation%


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8ill 9ingival Di$ensions :n3uence;estorative "erapy.

Studies +y


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.ndications "or

Mucogingival Surgery

Gingival Augmentation/0 W$ere toot$ movement results in

alveolar %one de$iscence'0 1o $alt rogressive marginal tissue

recession'0Around teet$ or imlants to "acilitatelaue control and or imroveatient com"ort'

0 .n conunction )it$ rost$eticdentistry/

0 1eet$ )it$ intracrevicularrestoration margins

0 W$ere maor or minor connectorsor remova%le artials in"ringeuon t$e marginal mucosa'


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.ndications "or

Mucogingival Surgery4oot 5overage/

0 4educe root sensitivity

0 .mrove est$etics

0 Manage de"ects resulting"rom root caries removal or

cervical a%rasion

0 Manage mucogingival

de"ects )$ic$ "ail to resondto altering a%usive

toot$%rus$ing tec$niues and

or laue removal


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+ree So"t 1issue Gra"ts

Free Gingival Graft

(Epiteliali!ed"

#onnective Tiss$e Graft

(%on-epiteliali!ed"


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Pedicle Gra"ts/ 4otational Gra"ts

&ateral sliding graft 'o$le papilla graft


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Pedicle Gra"ts/ Advanced +las

#oronally Positioned

Flap

)emil$nar Flap


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5om%ination Gra"ts

One-stage proced$res*

+#onnective tiss$e graft pl$s pedicle flap

+iodegradale memrane pl$s pedicle flap

To-stage proced$res* +#oronally positioned previo$sly placed free gingival graft

+%on-resorale arrier pl$s pedicle flap*


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G.NG.6A A8GMEN1A1.9N

0 Te placement of a restoration it an

intracrevic$lar margin

0 .nstances ere ma/or and minor connectorsof P' infringe $pon te gingiva

0 Ortodontic movement0 Association it a fren$m p$ll

0 Aro$nd implants0 esti$lar elongation0 alt progression of recession

.ndications to increase te and of attaced gingiva*


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+ree Gingival Gra"t

.ndications*

+increase te idt of attaced

gingiva+increase vesti$lar dept

+root coverage


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1ec$ni2ue"or+reeGingival

Gra"t

+.f root coverage is needed, root

plane te e3posed root s$rface4

+Preparation of te recipient ed*

emove s$rface m$cosa

maintaining an intact perioste$m

Apico-coronal dimensionso$ld e tice te desired

idt of attaced gingiva


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1ec$niue "or +ree Gingival Gra"t

Otain te graft from te donor site*

0 5eratini!ed gingiva ta6en from

te palate or an edent$lo$s ridge

0 Graft so$ld e tin eno$g to

allo diff$sion of n$trients from

te recipient site vasc$lat$re (1-

147mm"

Transfer and immoili!e te graft


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1ec$niue "or +ree Gingival

Gra"t

+ree Gingival Gra"t "or 4oot 5overage


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1ec$niue "or +ree

Gingival Gra"t

'ree 9ingival 9raft( :ncreaset"e Band of eratinied issuein Preparation for 6rt"odontics


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Peri:imlant Gingival 1issues

#ontroversy over te need for 6eratini!ed

attaced gingiva aro$nd implants*

)evor etal4, 1889* Attaced gingiva is more

sec$rely attaced to te $nderlying one andcontains connective tiss$e in te form of circ$lar

fiers4 Tis may render attaced gingiva more

resistant to deflection and arasion

:ennstrom etal4, 188;< )tr$ etal4, 1881* &ac6 of

attaced gingiva did not adversely affect temaintenance of soft tiss$e ealt aro$nd dental

implants4


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+ree Gingival Gra"t at .mlant

E(osure

ed Preparation Graft sec$red To ee6s post-op


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-ealing

0 +i%rous organiation o" t$einter"ace %et)een t$e gra"tand reciient %ed occurs)it$in 2 days'

0 1$e gra"t is initially maintained%y a di""usion o" nutrient "luid"rom t$e %ed# adacent gingivaand alveolar mucosa'

0 4evasculariation o" t$e gra"t

starts %y t$e second or t$irdday' 6essels "rom t$ereciient %ed roli"erate intot$e gra"t and anastomose )it$re:e(isting vessels'


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-ealing

0 1$e gra"t eit$elium undergoesdegeneration and sloug$ing and isrelaced %y ne) eit$elium "rom t$e%orders o" t$e reciient site' ;1$ec$aracter o" t$e eit$elium is

determined %y t$e underlyingconnective tissue'p to 1? ee6s post-op* coral pin6

(epitelial mat$ration"


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+renectomy

:ndications(

)o relieve $uscle pull on

t"e gingiva

)Closure of a diaste$aspace associated *it"

ort"odontic $ove$ent


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+renectomy

)


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+renectomy

)a#e a "oriontal incision,separating t"e +rousattac"$ent +luntly dissect to

t"e +one%):f necessary, e4tend t"eincision laterally and suture

t"e la+ial $ucosa to t"eapical periosteu$% So$eti$est"e e4posed area is covered*it" a free gingiva graft%


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+renectomy

Depending on t"e a$ount and need for#eratinied gingiva, t"e frenecto$y is

perfor$ed in con-unction *it" a free


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1o Summarie?

ucogingival surgeries are perfor$ed to i$prove t"e uality anduantity ofgingival tissues *"ic" *ill facilitate plaue control, i$prove patientco$fort

and overall toot" prognosis%

Co$$on indications are gingival recession, lac# of vesti+ulardept",and #eratinied gingiva, in con-unction *it" restorative and

ort"odontic procedures%

ec"niues routinely utilied are free soft tissue grafts *it" or*it"out pedicle 3aps, frenecto$y%

Documents

Mucogingival Surgery I