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Surgical procedures/ dentistry dental implants

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Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.

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Surgical procedures/ dentistry dental implants Surgical procedures/ dentistry dental implants Presentation Transcript

  • SURGICAL PROCEDURES IN FPD INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • CONTENTS INTRODUCTION GINGIVECTOMY AND GINGIVOPLASTY METHODS OF INCREASING THE WIDTH OF ATTACHED GINGIVA AND COVERAGE OF DENUDED ROOTS. CROWN LENGTHNING ROOT RESECTION AND HEMISECTION RIDGE AUGMENTATION BONE GRAFT MATERIALS AND MEMRANES USED FOR GUIDED TISSUE BONE REGENERATION. FRENECTOMY ELECTRO SURGERY FOR GINGIVAL RETRACTION CONCLUSION REFRENCES www.indiandentalacademy.com
  • INTRODUCTION www.indiandentalacademy.com
  • 1. Gingivectomy and Gingivoplasty Gingivectomy – excisional removal of gingival tissue for pocket reduction or elimination. Gingivoplasty – reshaping of the gingiva to attain a more physiologic contour. Indications - Presence of suprabony pockets - An adequate zone of keratinized tissue - Gingival enlargements - Unaesthetic or asymmetrical gingival topography - To facilitate restorative dentistry www.indiandentalacademy.com
  • Contraindications - Inadequate width of keratinized tissue - Pockets beyond mucogingival junction - Presence of intrabony pockets www.indiandentalacademy.com
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  • 2. Width of attached gingiva Goldman and Cohen (1979) – “ tissue barrier concept” They postulated that a dense collagenous band of connective tissue retards or obstucts the spread of inflammation better than does loose fiber arrangement of the alveolar mucosa. www.indiandentalacademy.com
  • Techniques 1. Free gingival autograft Bjorn (1963) - Advantages 1. High degree of predictability. 2. Ability to treat multiple teeth at the same time. 3. Can be performed when keratinized gingiva adjacent to the involved site is insufficient. 4. Simplicity. - Disadvantages 1. Two operative sites 2. Compromised blood supply 3. Greater discomfort www.indiandentalacademy.com
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  • 2. Laterally positioned pedicle graft Grupe and Warren (1956) - Advantages 1. One surgical site 2. Good vascularity of pedicle flap 3. Ability to cover a denuded root surface - Disadvantages 1. Limited by the amount of adjacent keratinized gingiva 2. Possibility of recession at donor site 3. Limited to one or two teeth with recession www.indiandentalacademy.com
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  • 3.Coronally displaced pedicle graft - Advantages 1. No need for involvement of adjacent teeth. 2. High degree of success for gingival recession and sensitivity. - Disadvantages 1. Cannot be used if the zone of keratinized gingiva is inadequate / two surgical procedures may be required. www.indiandentalacademy.com
  • Since the results of a coronally displaced flap are often not favourable owing to the presence of insufficient keratinized gingiva the following procedure can be performed to increase the chances of success – 1. Gingival extension operation with free autogenous graft. 2. After 2 months a coronally displaced flap operation can be performed. www.indiandentalacademy.com
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  • 4. Subepithelial connective tissue graft Langer and Langer (1985) Single most effective way to achieve predictable root coverage with a high degree of cosmetic enhancement. - Advantages 1. Esthetics 2. Predictability 3. One step procedure 4. Minimum palatal trauma 5. Used for multiple teeth - Disadvantage 1. High degree of skill 2. Complicated suturing www.indiandentalacademy.com
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  • 3. Crown lengthening procedure It is a surgical procedure designed to increase the extent of supragingival tooth structure for restorative or aesthetic purposes by apically positioning the the gingival margin,removing supporting bone, or both. - 2 types 1. Esthetic - to improve appearance 2. Functional – when the clinical crown is too short to provide adequate retention without restoration impinging on the biologic width. www.indiandentalacademy.com
  • Biologic Width The biologic width is the apicocoronal distance that the junctional epithelium and supra crestal connective tissue (gingival ) fibres are attached to the tooth. Average measurement:2.04 mm i.e The junctional epithelium – 0.97mm The connective tissue attachment – 1.07mm www.indiandentalacademy.com
  • Why is the biologic width important? The body maintains the biologic width as a stable dimension. When the biologic width is encroached upon and injured by the extension of restorative preparations and materials into this area ,uncontrolled inflammation may occur as the body tries to reestablish this dimension.This ultimately results in gingival recession and bone loss.www.indiandentalacademy.com
  • Esthetic Crown Lengthening www.indiandentalacademy.com
  • Functional Crown Lengthening www.indiandentalacademy.com
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  • 4. Furcation involvement Classification Glickman (1953) www.indiandentalacademy.com
  •  Treatment of furcation involvement Grade I - Scaling Root planing Gingivectomy Odontoplasty Grade II - Odontoplasty Osteoplasty Tunneling Root resection Grafting GTR www.indiandentalacademy.com
  • Grade III & Grade IV - Tunneling Root resection Grafting GTR Extraction www.indiandentalacademy.com
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  • Root resection - Indications 1. Grade II & Grade III involvement 2. Severe vertical bone loss involving one root 3. Endodontic failure 4. Extensive root caries 5. Root resorption - Contraindications 1. Teeth with poor crown root ratio 2. Inadequate bone support on the roots to be retained 3. Fused roots 4. Poor surgical accesswww.indiandentalacademy.com
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  • Hemisection www.indiandentalacademy.com
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  • 5. Ridge Augmentation Classification Seibert (1983) Class I Class II Class IIIwww.indiandentalacademy.com
  • 1.Immediate ridge augmentation -Performed at the time of tooth extraction - Advantages 1. Eliminates need for multiple surgical interventions to augment loss. 2. Over contouring of the edentulous ridge allows for later gingivoplasty to optimize pontic to soft tissue relationship. - Disadvantages 1. Pre surgical restorative planning must be done prior to surgical procedure. 2. Flap management and survival over large augmentation areas. www.indiandentalacademy.com
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  • 2. Onlay graft - The Onlay graft is of value and predictable in small areas. - Limitations 1. Limited amount of donor material 2. Two surgical sites are necessary 3. Reliance of vascular perfusion at recepient site. 4. Unpredictable post operative tissue shrinkage. www.indiandentalacademy.com
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  • 3. Pouch technique - Garber and Rosenberg (1981) - Used for soft tissue ridge augmentation - Usually for Class I type of defects www.indiandentalacademy.com
  • 3. Roll technique - Used for soft tissue ridge augmentation - Class I defects www.indiandentalacademy.com
  • 4. Ridge augmentation - improved technique - Allen et al (1985) www.indiandentalacademy.com
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  • 5.Controlled tissue expansion - Newer modality which assists in achieving excess tissue - Advantages 1. Generates sufficient tissue at defect site. 2. Good colour matching. 3. Avoids the need of multiple phases of flap transfer or a residual defect with subsequent secondary intention healing. - Disadvantages 1. Multiple office visits for gradual expansion of expander. 2. Possible infection. 3. Tissue necrosis as a result of overexpansion. 4. Perforation of the bag during suturing. www.indiandentalacademy.com
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  • 6. Bone graft materials and membranes used for guided tissuebone regeneration - Classification I. Acc to the type of graft 1. Autograft – eg) iliac crest marrow,osseous coagulum,bone swaging,bone from extraction site,etc 2. Allograft – eg) FDBA.DFDBA 3. Alloplast – eg) bioactive silica based glass,non resorbable hydroxyapatite. 4. Xenograft – eg) bovine and procine matrix proteins. www.indiandentalacademy.com
  • II. Acc to inductive potential 1. Osteoinductive - eg) hip marrow,osseous coagulum,bone from extraction site,tuberosity,DFDBA,etc. 2. Osteoconductive - eg) FDBA,DFDBA 3. Osteoneutral - eg) tricalcium phosphate • Types of membranes 1. Resorbable – eg)Guidor membrane (polylactic acid resorbable membrane) 2. Nonresorbable – eg)Gore-tex membrane (polytetrafluoroethylene membrane) www.indiandentalacademy.com
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  • Guided tissue regeneration - Indications 1. Grade II furcation 2. 2-3 walled vertical defects 3. Good oral hygiene 4. Adequate keratinized gingiva Contraindications 1. Horizontal defect 2. Flap perforation 3. Very severe defect – minimal remaining periodontium www.indiandentalacademy.com
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  • 7. Frenectomy www.indiandentalacademy.com
  • 8. Electrosurgery for Gingival Retraction www.indiandentalacademy.com
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  • Conclusion www.indiandentalacademy.com
  • References 1) Rosensteil “Contemporary fixed prosthodontics”, 3rd Edition. 2) Shillengburg “Fundamentals of fixed prosthodontics”, 3rd Edition. 3) Caranza “Clinical periodontology”, 8th Edition. 4) Cohen “Atlas of cosmetic and reconstructive periodontal surgery”, 2nd Edition. 5) Francis G. Serio “Manual of clinical periodontics”. 6) Wilson “Advances in periodontics”. 7) Dr. Ratnadeep Patil “Esthetic dentistry - an artists science”. 8) “Extension of clinical crown length”, JPD, 55;547: 1986.www.indiandentalacademy.com
  • Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com