Periodontal Plastic Surgery To view this in Powerpoint click on the ...
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<str<strong>on</strong>g>Period<strong>on</strong>tal</str<strong>on</strong>g> <str<strong>on</strong>g>Plastic</str<strong>on</strong>g> <str<strong>on</strong>g>Surgery</str<strong>on</strong>g><br />
Judith M. Bordeaux, DMD, MSD<br />
Department of Period<strong>on</strong>tics<br />
Case School of Dental Medic<str<strong>on</strong>g>in</str<strong>on</strong>g>e<br />
<str<strong>on</strong>g>Period<strong>on</strong>tal</str<strong>on</strong>g> <str<strong>on</strong>g>Plastic</str<strong>on</strong>g> <str<strong>on</strong>g>Surgery</str<strong>on</strong>g><br />
� Surgical procedures performed to correct<br />
or elim<str<strong>on</strong>g>in</str<strong>on</strong>g>ate anatomic, developmental, or<br />
traumatic deformities of <strong>the</strong> g<str<strong>on</strong>g>in</str<strong>on</strong>g>giva or<br />
alveolar mucosa<br />
<str<strong>on</strong>g>To</str<strong>on</strong>g> <str<strong>on</strong>g>view</str<strong>on</strong>g> <str<strong>on</strong>g>this</str<strong>on</strong>g> <str<strong>on</strong>g>in</str<strong>on</strong>g> Powerpo<str<strong>on</strong>g>in</str<strong>on</strong>g>t<br />
<str<strong>on</strong>g>click</str<strong>on</strong>g> <strong>on</strong> <strong>the</strong> l<str<strong>on</strong>g>in</str<strong>on</strong>g>k below<br />
https://www.case.edu/dental/site/<str<strong>on</strong>g>in</str<strong>on</strong>g>sidecase/classnotes/year3/es<strong>the</strong>tics/lectures/lecture2.ppt<br />
<str<strong>on</strong>g>Period<strong>on</strong>tal</str<strong>on</strong>g> <str<strong>on</strong>g>Plastic</str<strong>on</strong>g> <str<strong>on</strong>g>Surgery</str<strong>on</strong>g><br />
<str<strong>on</strong>g>Period<strong>on</strong>tal</str<strong>on</strong>g> <str<strong>on</strong>g>Plastic</str<strong>on</strong>g> <str<strong>on</strong>g>Surgery</str<strong>on</strong>g> Gummy Smile<br />
1
Es<strong>the</strong>tic Crown Leng<strong>the</strong>n<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
2
G<str<strong>on</strong>g>in</str<strong>on</strong>g>gival Recessi<strong>on</strong><br />
3
� Class I<br />
Surgical Root Coverage<br />
Classificati<strong>on</strong> of G<str<strong>on</strong>g>in</str<strong>on</strong>g>gival<br />
Recessi<strong>on</strong><br />
� Marg<str<strong>on</strong>g>in</str<strong>on</strong>g>al tissue<br />
recessi<strong>on</strong> which does<br />
not extend to <strong>the</strong><br />
mucog<str<strong>on</strong>g>in</str<strong>on</strong>g>gival juncti<strong>on</strong><br />
� No period<strong>on</strong>tal b<strong>on</strong>e<br />
loss <str<strong>on</strong>g>in</str<strong>on</strong>g> <strong>the</strong> <str<strong>on</strong>g>in</str<strong>on</strong>g>terdental<br />
area<br />
� 100% root coverage<br />
Miller PD. Int J Period<strong>on</strong>tics Restorative Dent 1985;5:8-13<br />
� Class III<br />
� Marg<str<strong>on</strong>g>in</str<strong>on</strong>g>al tissue<br />
recessi<strong>on</strong> which extends<br />
to or bey<strong>on</strong>d <strong>the</strong><br />
mucog<str<strong>on</strong>g>in</str<strong>on</strong>g>gival juncti<strong>on</strong><br />
� B<strong>on</strong>e or soft tissue loss<br />
<str<strong>on</strong>g>in</str<strong>on</strong>g> <strong>the</strong> <str<strong>on</strong>g>in</str<strong>on</strong>g>terdental area<br />
or malpositi<strong>on</strong><str<strong>on</strong>g>in</str<strong>on</strong>g>g of <strong>the</strong><br />
teeth, prevent<str<strong>on</strong>g>in</str<strong>on</strong>g>g 100%<br />
root coverage<br />
� Partial root coverage<br />
Miller PD. Int J Period<strong>on</strong>tics Restorative Dent 1985;5:8-13<br />
C<strong>on</strong>diti<strong>on</strong>s Necessary for<br />
Successful Root Coverage<br />
� Appropriate case selecti<strong>on</strong><br />
� Sufficient blood supply ensured to d<strong>on</strong>or<br />
tissue<br />
� Root surface covered with thick d<strong>on</strong>or<br />
tissue<br />
� D<strong>on</strong>or tissue adapted closely to <strong>the</strong><br />
recipient site and sutured<br />
� Class II<br />
� Marg<str<strong>on</strong>g>in</str<strong>on</strong>g>al tissue<br />
recessi<strong>on</strong> which extends<br />
to or bey<strong>on</strong>d <strong>the</strong><br />
mucog<str<strong>on</strong>g>in</str<strong>on</strong>g>gival juncti<strong>on</strong><br />
� No period<strong>on</strong>tal loss <str<strong>on</strong>g>in</str<strong>on</strong>g><br />
<strong>the</strong> <str<strong>on</strong>g>in</str<strong>on</strong>g>terdental area<br />
� 100% root coverage<br />
Miller PD. Int J Period<strong>on</strong>tics Restorative Dent 1985;5:8-13<br />
� Class IV<br />
� Marg<str<strong>on</strong>g>in</str<strong>on</strong>g>al tissue<br />
recessi<strong>on</strong> which extends<br />
to or bey<strong>on</strong>d <strong>the</strong><br />
mucog<str<strong>on</strong>g>in</str<strong>on</strong>g>gival juncti<strong>on</strong><br />
� Severe b<strong>on</strong>e or soft<br />
tissue loss <str<strong>on</strong>g>in</str<strong>on</strong>g> <strong>the</strong><br />
<str<strong>on</strong>g>in</str<strong>on</strong>g>terdental area and/or<br />
malpositi<strong>on</strong><str<strong>on</strong>g>in</str<strong>on</strong>g>g of teeth<br />
� No root coverage<br />
Miller PD. Int J Period<strong>on</strong>tics Restorative Dent 1985;5:8-13<br />
4
Free Autogenous G<str<strong>on</strong>g>in</str<strong>on</strong>g>gival<br />
Graft<br />
Root Coverage Us<str<strong>on</strong>g>in</str<strong>on</strong>g>g Free<br />
Autogenous G<str<strong>on</strong>g>in</str<strong>on</strong>g>gival Grafts<br />
� Disadvantages<br />
� Poor ability to provide blood supply to <strong>the</strong><br />
graft for root coverage<br />
� Exposed deep and large wound <strong>on</strong> <strong>the</strong><br />
palatal mucosa<br />
� Inferior es<strong>the</strong>tic results due to scarr<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
� <str<strong>on</strong>g>Surgery</str<strong>on</strong>g> required <str<strong>on</strong>g>in</str<strong>on</strong>g> 2 areas<br />
Root Coverage Us<str<strong>on</strong>g>in</str<strong>on</strong>g>g Free<br />
Autogenous G<str<strong>on</strong>g>in</str<strong>on</strong>g>gival Grafts<br />
� Indicati<strong>on</strong>s<br />
� All cases where root coverage is necessary<br />
except when a graft of sufficient thickness<br />
(1.5-2.0 mm) cannot be harvested<br />
� C<strong>on</strong>tra<str<strong>on</strong>g>in</str<strong>on</strong>g>dicati<strong>on</strong>s<br />
� Extensive g<str<strong>on</strong>g>in</str<strong>on</strong>g>gival recessi<strong>on</strong><br />
� Es<strong>the</strong>tic cases<br />
5
Criteria of Successful Root<br />
Coverage<br />
� G<str<strong>on</strong>g>in</str<strong>on</strong>g>gival marg<str<strong>on</strong>g>in</str<strong>on</strong>g> is <strong>on</strong> <strong>the</strong><br />
CEJ or <str<strong>on</strong>g>in</str<strong>on</strong>g> Class I or II<br />
g<str<strong>on</strong>g>in</str<strong>on</strong>g>gival recessi<strong>on</strong>.<br />
� Depth of g<str<strong>on</strong>g>in</str<strong>on</strong>g>gival sulcus<br />
is with<str<strong>on</strong>g>in</str<strong>on</strong>g> 2 mm.<br />
� No bleed<str<strong>on</strong>g>in</str<strong>on</strong>g>g <strong>on</strong> prob<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
� No hypersensitivity<br />
� Es<strong>the</strong>tically harm<strong>on</strong>ious<br />
color match with<br />
adjacent tissue<br />
Miller PD. <str<strong>on</strong>g>Period<strong>on</strong>tal</str<strong>on</strong>g> plastic surgical technique for<br />
regenerati<strong>on</strong>. (1994)<br />
C<strong>on</strong>nective Tissue Grafts<br />
6
C<strong>on</strong>nective Tissue Grafts<br />
� 88% root coverage <str<strong>on</strong>g>in</str<strong>on</strong>g> areas of severe<br />
g<str<strong>on</strong>g>in</str<strong>on</strong>g>gival recessi<strong>on</strong><br />
� Greater amount of root coverage and rate<br />
of complete coverage with <strong>the</strong> use of<br />
c<strong>on</strong>nective tissue grafts as compared to<br />
free g<str<strong>on</strong>g>in</str<strong>on</strong>g>gival grafts<br />
Root Coverage Us<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
C<strong>on</strong>nective Tissue Grafts<br />
� Disadvantages<br />
� Technically demand<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
� G<str<strong>on</strong>g>in</str<strong>on</strong>g>givoplasty may be necessary<br />
postoperatively<br />
Root Coverage Us<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
C<strong>on</strong>nective Tissue Grafts<br />
� Advantages<br />
� High predictability<br />
� Graft receives abundant blood supply from 2<br />
sources<br />
� Wound closed at palatal d<strong>on</strong>or site after<br />
harvest of c<strong>on</strong>nective tissue graft<br />
� Es<strong>the</strong>tically pleas<str<strong>on</strong>g>in</str<strong>on</strong>g>g results<br />
� Applicable for g<str<strong>on</strong>g>in</str<strong>on</strong>g>gival recessi<strong>on</strong> <strong>on</strong> multiple<br />
teeth<br />
7
Guided Tissue Regenerati<strong>on</strong><br />
Indicati<strong>on</strong>s for GTR<br />
� Deep and wide, <strong>on</strong>e-tooth g<str<strong>on</strong>g>in</str<strong>on</strong>g>gival<br />
recessi<strong>on</strong> with >5 mm attachment loss,<br />
particularly <strong>on</strong> <strong>the</strong> maxillary can<str<strong>on</strong>g>in</str<strong>on</strong>g>e<br />
� Thick graft cannot be obta<str<strong>on</strong>g>in</str<strong>on</strong>g>ed from <strong>the</strong><br />
palate<br />
8
� Advantages<br />
� Ga<str<strong>on</strong>g>in</str<strong>on</strong>g> of new<br />
attachment<br />
� D<strong>on</strong>or site not<br />
necessary<br />
� Root coverage highly<br />
predictable <str<strong>on</strong>g>in</str<strong>on</strong>g> deep<br />
and wide, but limited,<br />
g<str<strong>on</strong>g>in</str<strong>on</strong>g>gival recessi<strong>on</strong> area<br />
� Es<strong>the</strong>tic results<br />
GTR<br />
� Disadvantages<br />
� Technically demand<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
� Costly due to<br />
materials required<br />
9
No Papilla Papilla Rec<strong>on</strong>structi<strong>on</strong><br />
10
Preparati<strong>on</strong> of <strong>the</strong> Period<strong>on</strong>tium<br />
for Restorative Dentistry<br />
Miss<str<strong>on</strong>g>in</str<strong>on</strong>g>g Teeth Implants<br />
12
Ridge Augmentati<strong>on</strong><br />
Papilla Preservati<strong>on</strong><br />
Indentati<strong>on</strong>s <str<strong>on</strong>g>in</str<strong>on</strong>g> <strong>the</strong> Gum and<br />
Jawb<strong>on</strong>e<br />
13
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