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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$niue "or +ree
Gingival Gra"t
'ree 9ingival 9raft( :ncreaset"e Band of eratinied issuein Preparation for 6rt"odontics
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1ec$niue "or +ree Gingival Gra"t
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1ec$niue "or +ree Gingival Gra"t
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Peri:imlant Gingival 1issues
#ontroversy over te need for 6eratini!ed
attaced gingiva aro$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%