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Lecture outline.
Terminology.\definition. Objective,indication and contraindication. Etiology of Marginal tissue recession. Factors that affect S outcome. Irregularity of teeth. Mucogingival line.
MUCOGINGIVAL PROBLEMS CAN ARISE FROM THE EFFECTS OF: 1-Chronic Periodontitis.
2-Frenum pull 3-Gingival recession
Indications .
1-Augmentation of the edentulous ridge. 2-prevention of ridge collapse associated with tooth extraction. 3- crown lengthening. Loss of interdental papilla (esthetic ,phonetic problem)
contraindications
CONTRAINDICATIONS TO SURGERY. 1-unsatisfactory plaque control
2-Smokers
FRENECTOMY.(complete
Its indicated where the attachment of a frenum or muscle attachment is so close to the gingival margin so that it interfere with efficient plaque removal and contribute for persistent gingival inflammation.for correction of diastema.
Technique.
1-anathetizing the area. 2-incise along the upper surface of hemostate.repeat to under surface. 3- Remove triangular resected portion exposre fibrous connection to bone, removing it. 4-close with interrupted suture.
Techniques to increase the width of attached gingiva.(G extention ) 1-free soft tissue autograft. Indications. A-an inadequate zone of att.G. B-abnormal muscle attachment. C-shallow vestibular depth . D-Gingival recession. E-Deep pocket to prevent epi rapid down growth.
Graft Properties .
1-it should be thin enough to allow for fluid diffusion . Too thinshrivel expose bed. Too thick..tissue separation. 2- ideal thickness 11.5mm.injurey to palatal arteries.
Variant techniques.
Four varients techniques. 1-Accordian technique. 2-Strip technique. 3-connective tissue technique. 4- combination of strip and CT.(thick3-4 graft and slice it to two portions.)
Indication: 1-Inadequte doner site for pedicle graft . 2-Isolated wide recessions not usually amenable to free gingival grafting(especially on the
3-Multiple root exposure
maxilla)
Localized Gin.Recession
.3-IT can be increased by strong muscle pull
4-It can be managed by surgical or conservative methods.
Class1
Wide or narrow
Recession
Not to mgj.100%c
Recession at or beyond MJL 100% coverage possible Recession at or beyond MJL.coverage only to papillary level.
Class 11
wide or narrow.
Class 111
May be malposed
Class 1V
PEDICLE GRAFT
INDICATION: 1-Isolated narrow-deep or shallow recession on mandi,R 2-Adequte band of keratinized gingiva on neighboring teeth. 3-Adequte vestibular depth 4-Isolated wide-shallow recession on maxillarly or mandibular teeth.
Pedicle graft
ADVANTAGE: 1Good color blend. 2-One stage procedure. 3-Blood supply from base of the flap , periosteum adjacent to denuded area. 4-Not necessity for second surgical site. 5-Minimal post-operative sequela.
PEDICLE GRAFT
DISADVANTAGE: 1-Limited to narrow or shallow isolated recessions. 2-not for multiple recessions. 3-limited success with wide maxillary recession especially on canines .4-Must have adequate dinner source on adjacent teeth.
Healing of graft,
Full coverage
RESORBABLE MEMBRANCES. 2-CLINICAL PROCEDURE FOR ONE STAGE PROCEDURE WITH RESORBABLE MEMBRANCE.
1-CLINICAL TRIALS OF ONE STAGE TECHNIQUE. 2- COMBINED PROCEDURES. A-FREE GINDIVAL GRAFT TO INCREAS THE THICKNESS OF KERATINIZED TISSUES.
B-REGENERATIVE TECHNIQUES.
Disadvantage.
1-Technically sensitive
2- Complicated suturing.
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