Periodontalplastic and Esthetic Procedures

8/11/2019 Periodontalplastic and Esthetic Procedures

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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



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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



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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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Objectives:B- To increase the vestibular depth for

1) Proper plaque control

2) Retention of removable prostheses


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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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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

Periodontalplastic and Esthetic Procedures

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