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SURGICAL TECHNIQUES
CRITERIA FOR SELECTION OF TECHNIQUES
CONCLUSION
INTRODUCED in 1950s
FRIEDMAN 1957 SURGERY DESIGNED TO PRESERVE THE ATTACHED GINGIVA, TO REMOVE FRENA OR MUSCLE ATTACHMENT AND TO INCREASE THE DEPTH OF THE VESTIBULE.
MILLER 1988
TO CORRECT OR ELIMINATE ANATOMIC, DEVELOPMENTAL OR TRAUMATIC DEFORMITIES OF GINGIVA OR ALVEOLAR MUCOSA
DEFINITIONS
GLOSSARY OF PERIODONTAL TERMS (AAP-1992)
PERIODONTAL SURGICAL PROCEDURES DESIGNED TO CORRECT DEFECTS IN THE MORPHOLOGY, POSITION AND/ OR AMOUNT OF GINGIVA , SURROUNDING THE TEETH.
CARRANZA -1996 (8th Ed) PLASTIC SURGICAL PROCEDURES FOR THE CORRECTION OF GINGIVA - MUCOUS MEMBRANE RELATIONSHIPS THAT COMPLICATE PERIODONTAL DISEASE AND MAY INTERFERE WITH THE SUCCESS OF PERIODONTAL TREATMENT.
ERUPTION PATTERNS
TEETH IN LABIOVERSION ROTATED TEETH
THICKNESS OF PERIODONTIUM
TYPE-I NORMAL OR IDEAL DIMENSION OF KERATINIZED TISSUE NORMAL OR IDEAL LABIOLINGUAL WIDTHOF ALVEOLAR PROCESSES 3-5 mm WIDTH
TYPE II
THINNER KERATINIZED TISSUE NORMAL LABIOLINGUAL WIDTH OF ALVEOLAR PROCESS 2 mm KERATINIZED TISSUE
TYPE III
NORMAL OR IDEAL DIMENSION OF KERATINIZED TISSUE THIN LABIOLINGAUL WIDTH OF ALVEOLAR PROCESS ATTACNMENT LOSS DURING ORTHODONTIC TREATMENT
TYPE IV THIN KERATINIZED TISSUE & THIN LABIOLINGUAL DIMENSIONOF ALVEOLAR PROCESS AT RISK FOR MUCOGINGIVAL PROBLEMS
HALL 1984
1) TEETH THAT ERUPT IN PROMINENCE INADEQUATE ATTACHED GINGIVA GINGIVAL RECESSION 2) DO NOT BRING BONE AS THEY ERUPT OFF BASAL BONE 3) INADEQUATE ATTACHED GINGIVA & THIN ALVEOLAR BONE PREDISPOSES TO RECESSION NO RECESSION IN THE ABSENCE OF DISEASE
b)
KRAMER 1980
BIOLOGIC RATIONALE FOR MUCOGINGIVAL SURGERIES
TOPOGRAPHY OF PERIODONTIUM GINGIVAL FIBRE CONNECTION TO TOOTH MOST RELIABLE & NATURALLY OCCURING DEFENCE STRUCTURE
LESS FIBRES
GOLDMAN 1980
EPITHELIAL MIGRATION FOLLOWING DESTRUCTION OF
GINGIVAL FIBRES
REDUCED VASCULATURE & DENSE CONNECTIVE TISSUE
FIBRES
ACT AS A DETERENT TO INITIATION & PROGRESSION OF
PERIODONTAL DISEASE
LANG NP, LOE H - 1972 1 mm ATTACHED GINGIVA ADEQUATE TO MAINTAIN GINGIVAL HEALTH
GINGIVAL RECESSION
LOCATION OF MARGINAL TISSUE APICAL TO CEMENTO-ENAMEL JUNCTION
TYPES
a. ASSOSCIATED WITH MECHANICAL FACTORS b. ASSOSCIATED WITH DESTRUCTIVE PERIODONTAL DISEASES c. ASSOSCIATED WITH TOOTH MALPOSITION, ALVEOLAR BONE DEHISCENCES, HIGH MUSCLE ATTACHMENT & FRENAL PULL, IATROGENIC FACTORS
MILLER 1985
CLASS I- IV APICAL EXTENSION , INTER PROXIMAL TISSUE INTEGRITY & MALOCCLUSION.
II
III
IV
OBJECTIVES
WIDENING THE ZONE OF ATTACHED GINGIVA TREATMENT OF ABNORMAL FRENUM SOFT TISSUE GRAFTING FOR GINGIVAL RECESSION CROWN LENGTHENING TO ELIMINATE EXCESSIVE
GINGIVAL DISPLAY
RIDGE AUGMENTATION
SURGICAL PROCEDURES
INDICATIONS
AREAS WHERE A CHANGE IN GINGIVAL MARGIN
CONTROL
LOCALIZED SOFT TISSUE RECESSION THIN GINGIVA FACIAL TO TOOTH WHICH IS
TECHNIQUES
GINGIVAL ENHANCEMENT or AUGMENTATION OF DIMENSIONS
ROOT COVERAGE
RIDGE AUGMENTATION REMOVAL OF FRENA
ROBINSON 1963
FENESTRATION or PERIOSTEAL SEPARATION OPERATION
Bjorn 1963
FRIEDMAN - 1962
INCISIONS
FLAP REFLECTED
BONE RECONTOURING
STEP I
STEP II
STEP III
STEP IV
STEP V
VARIANT TECHNIQUES
ACCORDIAN TECHNIQUE RATEISCHAK 1983 STRIP TECHNIQUE - HANS et al 1993
1) 2) 3)
INITIALPHASE ( 0 3 days) REVASCULARIZATION PHASE ( 2- 11 days) TISSUE MATURATION PHASE ( 11-42 days)
HEALING OF GRAFTS
FREE GINGIVAL GRAFT IN POSITION
HEALING PHASES
II
III
HEALING OF GRAFT OF INTERMEDIATE THICKNESS (0.75 mm) - 10& 1/2 weeks THICKER GRAFTS (1.75 mm) - 16 weeks
A) ROTATIONAL FLAPS
II
REMOVAL OF FRENA
FRENECTOMY and FRENOTOMY INDICATIONS a) GINGIVAL RETRACTION & LOCALIZED GINGIVAL RECESSION b) HINDERED ORAL HYGIENE c) HINDERED PROSTHETIC CONSTRUCTION d) DIASTEMA e) TONGUE TIE
SIEBERT JS 1997
CLASS- I BUCCOLINGUAL LOSS OF TISSUE WITH NORMAL
CLASS- II
CLASS- III
INDICATIONS
CONNECTIVE TISSUE GRAFTS 1) SERIALLY LAYERED DOUBLE CTG TECHNIQUE 2) PALATAL POUCH PROCEDURE 3) IN COMBINATION WITH BONE GRAFT MATERIALS AND WITH ENAMEL MATRIX DERIVATIVES
1)
POCKETS EXTENDING UPTO MGJ a) APICALLY POSITIONED FLAP b) FREE MUCOSAL GRAFTS ABSENCE OF ATTACHED GINGIVA 1) FREE GINGIVAL GRAFT 2) NO TREATMENT
2)
II TARNOWS - FOR ISOLATED UPPER TEETH III GTR- TECHNIQUE DEEP RECESSION DEFECTS
CONCLUSION
LONG TERM STUDY RESULTS NEWER TECHNIQUES BONE AND SOFT TISSUE AUGMENTATION
AROUND IMPLANTS