Denuded root coverage /certified fixed orthodontic courses by Indian dental academy


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Denuded root coverage /certified fixed orthodontic courses by Indian dental academy

  1. 1. DENUDED ROOT COVERAGE INDIAN DENTAL ACADEMY Leader in Continuing Dental Education
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  3. 3. ETIOLOGYAbnormal frenal and muscle attachmentOrthodontic tooth movement through a thin buccalosseous plateDirect gingival trauma from occlusion(eg :deep bite)Gingival quality and quantityIatrogenic factorsHard tooth brushingTraumatic tooth brushingTooth malpostion
  4. 4. HALL(1977)-CRITICAL FACTORS: 1.Patients age 2.Patients dental needs 3.Level of oral hygiene 4.Teeth involved 5.Existing esthetics problem 6.Existing recession with sensitivity problem
  5. 5. CLASSIFICATIONMILLER (1985)Class I – Recession not extending to the muco-gingivaljunction. No loss of interdental bone or soft tissue.Class II –Recession extending to or beyond themucogingival junction. No loss of interdental bone orsoft tissue.Class III –Recession extending to or beyond themucogingival junction. Loss of interdental bone or softtissue is apical to cemento enamel junction but coronalto extent of marginal soft tissue recession.Class IV – Recession extending to or beyondmucogingival junction. Loss of interdental bone extendsto a level apical to extent of marginal soft tissue
  6. 6. CLASSIFICATIONSullivan and atkins (1968) Shallow narrow Shallow wide Deep narrow Deep wide
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  8. 8. LATERALLY POSITIONED FLAPThe LPF was introduced by Grupe and Warrenin 1956. This was the first predictable method forcovering the avascular root surfaces bymaintaining its vascular connections through thebase and the body of transposed tissue.9
  9. 9. The success for LPF is dependent clinically on the recognition and utilization of several biologically based principles. These include:
  10. 10. INDICATIONS Single sites Narrow recessions Mandibular central and lateral incisor defects only
  11. 11. CONTRAINDICATIONS Multiple contiguous sites Inadequate tissue thickness on adjacent teeth Inadequate keratinized tissue on adjacent teethLoss of interdental soft tissue or bone
  12. 12. ADVANTAGES1. Good tissue blend2. Usually one surgical site3. Usually complete root coverageDISADVANTAGE1. Only one surgical site can be considered i.e. no contiguous sites2. Possible recession at the donor site
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  14. 14. FREE GINGIVAL AUTOGRAFTSFree gingival autografts are used to create awidened zone of attached gingival. They wereinitially described by Bjorn in 1963 and havebeen extensively investigated since that time.
  15. 15. INDICATIONS1. Inadequate zone of keratinized tissue.2. Restorative concerns.3. Shallow buccal vestibule.4. Progressive active recession.5. Multiple area of recession.6. Anterior and posterior sextant defects of maxilla and mandible.CONTRAINDICATIONS1. Need for esthetic root coverage.2. Anatomic limitations (external oblique ridge).3. Mandibular lingual recession.4. Heavy smokers.
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  17. 17. CORONALLY DISPLACED FLAPThe purpose of the coronally displaced flapoperation is to create a split thickness flap in thearea apical to the denuded root and displace itcoronally to cover the root.
  18. 18. INDICATIONS1. Gingival recession with minimal labial sulcus depth present2. Adequate band of existing keratinized tissue3. Maxillary arch usually restricted to the anterior sextant
  19. 19. CONTRA INDICATIONS1. Mandibular defects2. Lack of keratinized gingiva Two techniques are available for this purpose.
  20. 20. SEMILUNAR CORONALLY REPOSTIIONED FLAPThe coronally positioned flap has been in periodontics for many years with seve4al different variations.A technique originally described in the early part of this century was presented recently by Tarnow (1986) under the term “semi lunar coronally repositioned flap”.
  21. 21. ADVANTAGESemilunar coronally repositioned flap1. There is no tension on the flap after coronally repositioning it.2. There is no shortening of the vestibule.3. The papillae mesial and distal to the tooth being treated remain cosmetically unchanged.4. No sutures are needed because of the lack of tension of the tissue being coronally positioned.DISADVANTAGES1. Must have keratinized tissue.2. Limited to the maxially arch.
  22. 22. SUB-EPITHELIAL CONNECTIVE TISSUE GRAFT This technique uses a connective tissue graft to cover denuded roots. It was described in 1985 by Langer and Langer, although similar approaches had been previously reported by Perez-Fernandez and Raetzke.
  23. 23. INDICATIONS1. Inadequate donor site for a horizontal sliding flap.2. Isolated wide gingival recession.3. Multiple root exposures.4. Multiple root exposures in combination with minimal attached gingiva.Recession adjacent to an edentulous area that also requires ridge augmentation
  24. 24. ADVANTAGES1. Covers the receded root with fibrotic tissue and shows closer color blend of the graft with adjacent tissue.2. Donor site heals by primary intention with” less discomfort than after a free gingival graft.
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  26. 26. GUIDED TISSUE REGENERATION (GTR)Since many periodontal surgeons have beenapproaching certain problems with procedures aimed atgreater, more predictable regeneration of periodontaltissue and functional attachment, beyond the use ofbone grafts and synthetic bone substitutes, treatmentapproaches grouped under the term GTR have beendeveloped, analyzed and employed in clinical practice.Thus GTR for exposed root coverage of human gingivalrecession sites was introduced by Tiniti et al in 1992.
  27. 27. INDICATIONS1. Narrow two-wall or three-wall intra bony defects with atleast 4 mm of attachment loss and 4 mm intrabony component.2. Circumferential defects.3. Class III furcation defects accompanied by a medium- to-long root trunk.4. Augmentation of ridge deficiencies.5. Coverage of root recession.6. Repair of apicoectomy defects.7. Osseous fill around immediate implants placement sites. Repair of osseous defects associated with failing implants.
  28. 28. CONTRAINDICATIONS1. Poor oral hygiene.2. Generalized horizontal bone loss.3. Class III furcation defects.4. Advanced defects with a minimal amount of remaining periodontium.5. Multiple adjacent defects.6. Areas with an inadequate zone of attached gingival.7. Class II furcations on the mesial and distal of maxillary molars.8. Premolar furcations.9. One-walled intrabony defects.
  29. 29. RECENT ADVANCEMENTSThe recent mode of treatment of denuded roots is by using platelet concentrate get in a collagen sponge carrier combined with a coronally positioned flap.
  30. 30. The non surgical techniques include1. 1. Fugi VII – pink glass inomer cement2. 2. Gum veneers
  31. 31. GUM VENEERSProvides lip supportrestores symmetrical gingival architecturereplaces lost interdental papillae
  32. 32. TYPESAcrylic resin gingival veneerFlexible silicon gingival mask
  33. 33. INDICATIONSIn correction of gingival deformitiesRoot coverage after inflammation has beencontrolledTemporary splintAs interim measure in cases where finaltreatment planning decisions are delayed
  34. 34. CONTRAINDICATIONSPATIENTS WITH  Poor plaque control  Unstable periodontal health  High caries activity  Heavy smoking
  35. 35. ADVANTAGESPainless procedureRelatively inexpensiveEasily maintained by patients
  36. 36. DISADVANTAGESSilicon gingival masks cannot be used inpatients with known allergy to siliconAcrylic veneers are hard and rigid hence hasdifficulties in fitting accurately around the teeth
  37. 37. CONCLUSION
  38. 38. Thank