Perio Plastic Surgery

• Examples:

  • frenoplasty
  • vestibuloplasty
  • laterally/coronally repositioned flap
  • free gingival graft
  • free connective tissue graft
  • tunnel procedure
  • root surgery - hemisection, root resection
  • implant soft tissue surgery
• what is mucogingival surgery?

  surgery performed to correct morphology defects, position or amount of gingival tissue surrounding teeth involving mucosal and gingival tissue
• indication for mucogingival surgery?

  • change in tissue morphology enable improved plaque control
  • recession leading to aesthetic issues or sensitivity
  • thin layer of gingivae labial to a tooth being orthodontically removed
• fraenoplasty?

  • rarely indicated|
  • deep cleft exists with high frenum
  • difficult plaque control
  • surgery if conservative approach fails
• Class I - marginal tissue recession not extending to mucogingival junction, no loss of interdental bone or soft tissue

  
• class II - marginal tissue regeneration extends to or beyond the mucogingival junction, no bone loss of interdental bone or soft tissue

  
• Class III - marginal tissue recession extending to or beyond mucogingival junction and loss of interdental bone or soft tissue is apical to CEJ but coronal to extent of marginal tissue recession

  
• Class IV - marginal tissue recession extends beyond mucogingival junction, loss of interdental bone extends apically to extent of marginal tissue recession

  
• lateral re positioned flap?

  rarely indicated, usually lower inciors as best for aesthetics
• Laterally re positioned flap

  
• four stages of healing?

  • adaptation
  • proliferation
  • attachment
  • maturation
• adaptation phase?

  • 0-4 days
  • fibrin layer adheres to underside of flap
• proliferation stage?

  • 4-21 days
  • fibroblasts infiltrate fibrin from under flat and appose the root surface
  • some might differentiate to cementoblasts
• attachment stage?

  • 27-28 days
  • collagen fibres insert into new cementum
• maturation stage?

  • 2-3 months
  • collagen matures
• free gingival graft?

  • rare
  • donor tissue taken from palate or tuberocity buccal to 7s
  • raise mucosal flab
  • difficult to perform well
• free gingival graft

  
• pre implant soft tissue grafting

  
• connective tissue graft:

  • rare
  • donor tissue from palate
  • flap de-epithelialised by sharp dissection
  • donor peristium left in place
  • more predicable
  • hard to perform
• connective tissue graft

  
• root surgery:

  • root resection
  • hemisection
• root resection:

  • molar teeth maxillary
  • where vertical/horizontal root fracture or bone loss
  • rct required
• hemisection:

  • molar of mandibular teeth
  • single root apically involved with perio/endo lesion or fractures
  • rct required
• post surgery complications:

  • sensitivity
  • recession - root caries
  • failure of procedure/recurrence
  • aesthetics
  • residual mobility/functional problems