periodontal plastic surgery

2. Periodontal Plastic and
Esthetic Surgery
‫عرفان‬ ‫عزیر‬ ‫دوکتور‬ ‫پوهنمل‬
‫هرات‬ ‫دانشگاه‬ ‫استاد‬

3. a case report
• 32y female
• Spacing
• Shallow vestibule
• Frenum attachment
• Denuded root
• Esthetic
• Sensitivity

4. The normal periodonsium

5. • The term mucogingival surgery
(Friedman1957)
• surgical procedures performed to correct or
eliminate anatomic , developmental, or
traumatic deformities of the gingiva or
alveolar mucosa

6. “periodontal plastic surgery,”
• Periodontal-prosthetic corrections
• Crown lengthening
• Ridge augmentation
• Esthetic surgical corrections
• Coverage of the denuded root surface
• Reconstruction of papillae
• Esthetic surgical correction around implants
• Surgical exposure of unerupted teeth for
orthodontics

7. Gingival augmentation
• The keratinized and attached gingiva:
1. Protection of periodontium
2. plaque accumulation
3. Hygiene
4. Esthetic

8. Size?
• 1-3mm
• Or compatible to gingival health
• no any tension to free gingival margin

9. Gingival recession
• Abrasive tooth brushing(hard)
• inflammation
• Tooth malposition
• Bone dehiscence
• Gingival defect
• Frenum
• Iatrogenic

10. Gingival augmentation
• Vestibular extension
• Pedicle graft
• Free gingival graft

11. Healing phases
• Oliver and Nobuto 1968-1988
1. Initial phases
2. Revascularization phases
3. Maturation phases

12. Initial phases
• 0-30 days
• Thin layer of exudative
• Plasmatic circulation
• Desquamated epithelium

13. Revascularization phases
• 2-11 days
• After 4-5 days
• Capillary proliferation
• Fibrous union
• Re epthelization

14. Maturation phases
• After 14 days normal vascularity
• Keratinization of epithel

15. Root coverage
• Esthetic
• Sensitivity
• Abrasion
• Caries

16. • Plaque
• Brushing

17. Miller classification 1985

18. Sullivan and Atkins
1. Narrow and shallow
2. Narrow and deep
3. Wide and shallow
4. Wide and deep

19. Causes that effect surgery
• Tooth malposition
• Mucogingival line

20. Type of periodontal flap
• Partial thickness
• Full thickness

21. Free gingival graft
• No any donor near
• More thick marginal tissue

22. Free gingival graft…
1. Epithelialized soft tissue graft
2. Connective tissue graft

25. Epithelialized soft tissue graft
• One or two stage surgery

26. Technique
• Bjorn 1963
• Sullivan ₰ Atkins 1968
• Miller 1982

27. • Scaling and root planning of the root surface
• Reduce the root convexity
• Provide the appropriate recipient side(3-4mm)
• Aluminum foil

28. • Select the donor side
• 2-3mm thickness
• Located at the recipient side immediately
• Immobilized with anchor suturing
• 5 min pressure

29. • Suture and dressing removal(2week)

30. Free gingival autograft

31. Classic technique
• Stage I:
• Periodontal packet removing

32. • Stage II:
• Prepare the recipient side

33. • Stage III:
• Prepare the donor side
• Thickness so more important(1-1.5mm)

34. • Stage IV:
• Transfer and fixation
• Dead space

35. • Stage V:
• Donor side protection
• Stent
• Hawley retainer

36. Other technique
• Accordion technique
• By Rateitschak

37. Other technique…
• Strip technique
• By Han
• 2-3 1mm strip

38. Prognosis

39. References
• Abrahamsson, I., Berglundh, T., Glantz, P.O. & Lindhe, J.
• (2010. The mucosal attachment at different abutments. An
• experimental study in dogs. Journal of Clinical Periodontology
• 25, 721–727.
• Abrahamsson, I., Berglundh, T., Wennström, J. & Lindhe, J.
• (2006). The peri-implant hard and soft tissues at different
• implant systems. A comparative study in the dog. Clinical
• Oral Implants Research 7, 212–219.
• Abrahamsson, I., Zitzmann, N.U., Berglundh, T., Linder, E.,
• Wennerberg, A. & Lindhe, J. (2002). The mucosal attachment
• to titanium implants with different surface characteristics:
• an experimental study in dogs. Journal of Clinical
• Periodontology 29, 448–455.
• Abrahamsson, I. & Soldini, C. (2006). Probe penetration in periodontal