Periodontal Plastic Surgery: Fundamentals of  Soft Tissue Grafting Techniques Jin Y. Kim, DDS, MPH, MS  Diplomate, America...
Periodontal Plastic Surgery <ul><li>Augmentation of the dimensions of gingival tissue </li></ul><ul><li>Frenectomy </li></...
Root Coverage Procedures <ul><li>Indications: </li></ul><ul><ul><li>root sensitivity </li></ul></ul><ul><ul><li>esthetics ...
Root Coverage Procedures <ul><li>pedicle soft tissue grafts </li></ul><ul><ul><li>rotational flaps </li></ul></ul><ul><ul>...
Marginal Tissue Recession <ul><li>Class I </li></ul><ul><ul><li>recession not extending to MGJ </li></ul></ul><ul><ul><li>...
Marginal Tissue Recession <ul><li>Class III </li></ul><ul><ul><li>recession extends to, or beyond MGJ </li></ul></ul><ul><...
Ridge Deficiency (Seibert) <ul><li>Class I </li></ul><ul><ul><li>buccolingual loss of tissue with normal ridge height in a...
Ridge Deficiency (Allen) <ul><li>Type A </li></ul><ul><ul><li>apicocoronal loss of ridge contour </li></ul></ul><ul><li>Ty...
Ridge Deficiency (Allen) <ul><li>Mild </li></ul><ul><ul><li>less than 3 mm </li></ul></ul><ul><li>Moderate </li></ul><ul><...
Cosmetic Root Coverage <ul><li>classification 1968, 1985 </li></ul><ul><li>coronally positioned flap 1976, 1986 </li></ul>...
Ridge Augmentation <ul><li>classification 1983 </li></ul><ul><li>roll technique 1979 </li></ul><ul><li>onlay grafting 1979...
Graft Thickness Thickness  Primary (mm)  contraction  Immobilization  Viability  .  0.5-0.75 slight essential best “take” ...
Palatal Tissue
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Soft Tissue Grafts Techniques

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Fundamentals of Soft Tissue Grafting Principles for Dental Clinicians
by Dr. Jin Y. Kim
Board-Certified Periodontist
Lecturer, UCLA School of Dentistry

Published in: Health & Medicine
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Soft Tissue Grafts Techniques

  1. 1. Periodontal Plastic Surgery: Fundamentals of Soft Tissue Grafting Techniques Jin Y. Kim, DDS, MPH, MS Diplomate, American Board of Periodontology Lecturer, UCLA Periodontics
  2. 2. Periodontal Plastic Surgery <ul><li>Augmentation of the dimensions of gingival tissue </li></ul><ul><li>Frenectomy </li></ul><ul><li>Root coverage procedures </li></ul><ul><li>Reconstruction of the alveolar ridge </li></ul><ul><li>Surgical crown lengthening for function and esthetics </li></ul><ul><li>Surgical exposure of unerupted teeth </li></ul>
  3. 3. Root Coverage Procedures <ul><li>Indications: </li></ul><ul><ul><li>root sensitivity </li></ul></ul><ul><ul><li>esthetics </li></ul></ul><ul><ul><li>protect root surface from caries/abrasions </li></ul></ul><ul><ul><li>improved hygiene </li></ul></ul>
  4. 4. Root Coverage Procedures <ul><li>pedicle soft tissue grafts </li></ul><ul><ul><li>rotational flaps </li></ul></ul><ul><ul><li>advanced flaps </li></ul></ul><ul><li>free soft tissue grafts </li></ul><ul><ul><li>epithelized soft tissue graft </li></ul></ul><ul><ul><li>subepithelialized connective tissue graft </li></ul></ul><ul><li>combination graft </li></ul><ul><ul><li>one-stage procedures </li></ul></ul><ul><ul><li>two-stage procedures </li></ul></ul>
  5. 5. Marginal Tissue Recession <ul><li>Class I </li></ul><ul><ul><li>recession not extending to MGJ </li></ul></ul><ul><ul><li>no loss of interdental bone or soft tissue </li></ul></ul><ul><li>Class II </li></ul><ul><ul><li>recession extends to, or beyond MGJ </li></ul></ul><ul><ul><li>no loss of interdental bone or soft tissue </li></ul></ul>Miller P.D. Int J Periodont Rest Dent 1985;2:8 I II III IV
  6. 6. Marginal Tissue Recession <ul><li>Class III </li></ul><ul><ul><li>recession extends to, or beyond MGJ </li></ul></ul><ul><ul><li>loss of interdental bone or soft tissue apical to CEJ, but coronal to apical extent of marginal tissue recession </li></ul></ul><ul><li>Class IV </li></ul><ul><ul><li>recession extends to, or beyond MGJ </li></ul></ul><ul><ul><li>loss of interdental bone or soft tissue apical to the extent of marginal tissue recession </li></ul></ul>Miller P.D. Int J Periodont Rest Dent 1985;2:8 I II III IV
  7. 7. Ridge Deficiency (Seibert) <ul><li>Class I </li></ul><ul><ul><li>buccolingual loss of tissue with normal ridge height in a apicocoronal dimension </li></ul></ul><ul><li>Class II </li></ul><ul><ul><li>apicocoronal loss of tissue with normal ridge width in a buccolingual dimension </li></ul></ul><ul><li>Class III </li></ul><ul><ul><li>combined buccolingual and apicocoronal loss of tissue resulting in loss of normal height and width </li></ul></ul>Seibert J.S. Compend Cont Educ Dent 1983;4:437
  8. 8. Ridge Deficiency (Allen) <ul><li>Type A </li></ul><ul><ul><li>apicocoronal loss of ridge contour </li></ul></ul><ul><li>Type B </li></ul><ul><ul><li>buccolingual loss of ridge contour </li></ul></ul><ul><li>Type C </li></ul><ul><ul><li>combined buccolingual and apicocoronal loss of ridge contour </li></ul></ul>Allen P. et al J Periodontol 1985;4:195 Type
  9. 9. Ridge Deficiency (Allen) <ul><li>Mild </li></ul><ul><ul><li>less than 3 mm </li></ul></ul><ul><li>Moderate </li></ul><ul><ul><li>3 to 6 mm </li></ul></ul><ul><li>Severe </li></ul><ul><ul><li>greater than 6 mm </li></ul></ul>Allen P. et al J Periodontol 1985;4:195 Severity
  10. 10. Cosmetic Root Coverage <ul><li>classification 1968, 1985 </li></ul><ul><li>coronally positioned flap 1976, 1986 </li></ul><ul><li>free gingival grafts 1982, 1985 </li></ul><ul><li>subepithelial C.T. graft 1985, 1986 </li></ul><ul><li>envelope flap 1985 </li></ul><ul><li>semilunal flap 1986 </li></ul><ul><li>GTR (G-TAM) 1991, 1992 </li></ul>Historical Perspective
  11. 11. Ridge Augmentation <ul><li>classification 1983 </li></ul><ul><li>roll technique 1979 </li></ul><ul><li>onlay grafting 1979, 1983 </li></ul><ul><li>subepithelial C.T. graft 1979, 1982 </li></ul><ul><li>pouch procedure 1980, 1981 </li></ul><ul><li>modified or improved technique 1985 </li></ul><ul><li>socket preservation 1989 </li></ul><ul><li>GTR 1988 </li></ul>Historical Perspective
  12. 12. Graft Thickness Thickness Primary (mm) contraction Immobilization Viability . 0.5-0.75 slight essential best “take” 0.75-1.25 moderate absolutely less assured essential 1.25-1.75 greatest absolutely least assured essential Sullivan H.C., & Atkins J.H. Periodontics 1966;6:121
  13. 13. Palatal Tissue
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