periodontalplastic and esthetic procedures
TRANSCRIPT
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"(151)
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Periodontal Plastic Esthetic Surger
Procedures to Increase the Width
Attached Gingiva
Chapter 63
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Three specific mucogingival Problem areas
(width of attached gingiva, depth of vestibule, aberr
frenum)
Different techniques to increase the width of atta
gingiva
Depth of vestibule
Frenectomy frenotomy
Criteria for technique selection
Lecture Outline
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Periodontal Plastic Surgery
Historical Background:
Originally proposed by Miller in
1993
Utilized by the World
Workshop in Clinical Period
(
1996
) instead of
mucogingival
surgery
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Definition:
Surgical procedures of the mucogingival therap
are performed to correct or eliminate ana
developmental, or traumatic deformities of the gin
alveolar mucosa
Periodontal Plastic Surgery
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Objectives:
A- Problems associated with inadequate attache
gingiva
B- Problems associated with a shallow vestibule
C- Problems associated with an aberrant frenum
D- Esthetic surgical therapy
E- Tissue engineering
Periodontal Plastic Surgery
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Periodontal Plastic Surgery
Objectives:A- To increase the width of attached gingiva in or
1) Enhance plaque removal around the gingival m
2) Improve esthetics.
3) Reduce inflammation around restored teeth
4) Gingival margin binds better around teeth & iwith attached gingiva.
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Periodontal Plastic Surgery
Objectives:B- To increase the vestibular depth for
1) Proper plaque control
2) Retention of removable prostheses
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Periodontal Plastic Surgery
Objectives:C- To remove the frenum/muscle attachment in o
1) Improve plaque control
2) Eliminate its pulling action on the gingival marg
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Widening the Attached gingiva
Free or pedicle grafts placed either
a) apical to the gingival recession:
1- enhance the oral hygiene
b) coronal to the gingival recession
1- enhance the oral hygiene
2- correct the esthetic.c) apical and coronal to the recession
1- for pre-prosthetic reasons
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Grafting apical to Recession
1) Free gingival autograft
2) Free connective tissue autograft
3) Apically positioned flap
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Free Gingival Autograft
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Free Connective Tissue Autograft
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Free Connective Tissue Autograft
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Free Connective Tissue Autograft
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Apically Displaced Flap
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Techniques to Deepen Vestibule
Free gingival or connective tissue autogenous graft, but it m
placed over a nonmobile recipient site that is cover
immobile periosteal tissue.
In case of a lack of periosteal connective tissue, the dono
may be placed over bone.
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Aberrant Frenum
Frenum:
A fold of mucous membrane with enclosed muscle fib
attaches the lips and cheeks to the alveolar mucosa, giunderlying periosteum.
It is a problem:
if the attachment is too close to the marginal gingiva.
Origin:
1- Genetic condition
2- Gingival recession reaching the frenum.
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Aberrant Frenum
Clinical effects:
1- Pulling of the gingival margin away from the tooth resultin
plaque accumulation & improper brushing (most often in themandibular anterior areas)
2- Esthetic problem in a patient with a high lip line if the abefrenum is located between the maxillary central incisors.
Common sites:
1- Facial surface between the maxillary & mandibular centrincisors
2- Canine & premolar areas
3- less often on the mandibular lingual surface
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Techniques to Remove the Frenum
1) Frenectomy:
Definition: Complete removal of the frenum, including its att
to underlying bone.
Indication:
Correction of the abnormal diastema between the maxillaryincisors.
2) Frenotomy
Definition: Relocation of the frenum in a more apical position
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Techniques to Remove the Frenum
Frenectomy & frenotomy are most often accomplished as
surgical procedures but can be performed in conjunction
periodontal surgeries like a free gingival graft to de
vestibule in the mandibular anterior area.
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Criteria for Technique Selection
1- Surgical site free of inflammationThis allows for meticulous, precise incisions and proper flap reflection
2- Adequate blood supplyApical grafting provides better blood supply than coronal grafting, sirecipient site is entirely periosteal tissue. Therefore, if esthetics is not aapical grafting may be more predictable.
3- Anatomy of recipient site
Apical grafting needs enough vestibular depth to provide space for Free (gingival /connective tissue) grafts can be used to deepen the widen the attached gingiva.Lateral/ coronal pedicle flaps and tunnel procedures require vestibuto be present before the surgery.
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Criteria for Technique Selection
4- Anatomy of the donor sitePedicle grafts necessitate the presence of adjacent donor sites with
gingival thickness and width. Palatal tissue thickness is also necessaconnective tissue autograft.
5- Stability of the graft to the recipient siteA stable environment is necessary for good blood supply. It is achievsutures to stabilize the graft firmly against the recipient site. The leastsutures and maximum stability should be achieved.
6- Minimal trauma to the surgical sitePoor incisions, flap perforations, tears, or traumatic & excessive placsutures cause unnecessary tissue trauma & can lead to tissue necrosUse of sharp blades, smaller-diameter needles & resorbable monofilsutures are important in achieving atraumatic surgery.
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Summary