32016Oct

PERIODONTAL PLASTIC SURGERY

Use of the grafts for root coverage

The periodontal plastic surgeries are done for the prevention or the correction of any anatomic deformities in the gingiva.

Gingival recession is a muco gingival anomaly characterized by migration of the gingival margin toward the amelocemental junction resulting in the loss of attachment and protective connective tissue fibers followed by resorption of the alveolar bone and necrosis of cement tissue. This results in the symptoms of gingival sensitivity to tooth brushing, dentin hypersensitivity by hot stimuli, aesthetic concerns.


PREDISPOSING FACTORS TRIGGER FACTORS
Bone dehiscence Traumatic brushing
Bone fenestration Non carious cervical lesions
Thin cortical bone Inflammation
Absence of keratinized tissue Misfit or fixed dental prosthesis
Small thickness of keratinized tissue Clip, bar or saddle removable prosthesis causing compression
Low height of keratinized tissue Violation of biological space
Poor tooth positioning Incision at the base of the flap, cutting the subjacent periosteum
Tension on frenula and frena Poorly located relaxing incision
Shallow vestibule Extraction
Orthodontic movement outside bone limits
Occlusal traumatism
Harmful habits

Classification of Periodontal Recession (Sullivan And Atkin’s Classification)

  1. Deep and wide recession
  2. Shallow and wide recession
  3. Deep and narrow recession
  4. Shallow and narrow recession

 

Miller’s Classification of Periodontal Recession

 

  1. Class I – the recession does not attain the Mucogingival line and there is no loss of interproximal tissue.
  2. Class II — the recession attains or exceeds the Mucogingival line and there is no loss of interproximal tissue.
  3. Class III – the recession attains or exceeds the Mucogingival line with interproximal tissue loss located apical to the amelocemental junction, although the tissues will remain in a coronal position in relation to the base of the gingival recession.
  4. Class IV – the recession attains or exceeds the Mucogingival line with interproximal tissue loss located apical to the amelocemental junction, with the latter situated on the level at the base of the gingival recession; involvement of more than one surface of the tooth.

Treatment and its indications

  1. To prevent the development of Mucogingival defects
  2. When there is an esthetic demand
  3. Dentin hypersensitivity
  4. Root caries or cervical abrasions
  5. Change in topography to facilitate plaque control

SURGICAL TECHNIQUE FOR ROOT COVERING

GRAFTS FREE GRAFTS COMBINED GRAFTS
Laterally positioned flap Free gingival graft Connective graft associated with coronally positioned flap
Double papilla flap Gingival connective tissue graft Connective graft associated with laterally positioned flap
Coronally displaced flap Connective graft with envelope technique
Half moon flap

  1. HALF MOON FLAP

Mainly used for single recession.

ADVANTAGES

  1. Less post-operative pain
  2. Absence of sutures to stabilize the flap due to the lack of tension on the flap
  3. Maintenance of the papilla
  4. Simple and fast technique
  5. Satisfactory coverage rate

 

 

Free grafts

  1. Techniques of removal of free grafts
  2. This technique was developed with the purpose of minimizing the patient’s postoperative discomfort and improving healing in the donor area.
  3. The palate is the region most used as the donor area, with the best region being the one located between premolars and molars due to its thickness.

CONJUNCTIVE TISSUE GRAFT (CG)


The main advantage of this graft is that it favors healing by first intention in the donor area, because the epithelium is preserved and only the connective tissue is removed.

In addition, more harmonious esthetic appearance is obtained, because of the grafted tissue color being adjusted to that of the adjacent areas.


MODIFIED ENVELOPE TECHNIQUE

  1. This consists of making a lateral, partial thickness incision distal to the recession located in the alveolar mucosa; this is united to the sulcular incision and then the connective tissue graft is slid through this window.

The graft may be introduced by means of a suture thread drawn from the mesial to the distal side, passing over the papillae, the graft is gently drawn into place by means of the suture thread, and it is sutured with a simple stitch on each side