DEFINITION
INDICATION AND OBJECTIVES
PROCEDURES FOR INCREASING WIDTH OF ATTACHED GINGIVA
PROCEDURES FOR ROOT COVERAGE
TECHNIQUES FOR CORRECTION OF ABERRANT FRENUM
PAPILLA RECONSTRUCTION
RIDGE AUGMENTATION
PROCEDURES FOR INCREASING VESTIBULAR DEPTH
CROWN LENGTHENING PROCEDURES
2. CONTENTS
• DEFINITION
• INDICATION AND OBJECTIVES
• PROCEDURES FOR INCREASING WIDTH OF ATTACHED
GINGIVA
• PROCEDURES FOR ROOT COVERAGE
• TECHNIQUES FOR CORRECTION OF ABERRANT FRENUM
• PAPILLA RECONSTRUCTION
• RIDGE AUGMENTATION
• PROCEDURES FOR INCREASING VESTIBULAR DEPTH
• CROWN LENGTHENING PROCEDURES
3. DEFINITION
• AAP/ GPT 2001 MUCOGINGIVAL THERAPY
• Nathan Friedman 1957 MUCOGINGIVAL SURGERY
• Miller 1993 PERIODONTAL PLASTIC SURGERY
• World Workshop in Periodontics 1996 PERIODONTAL
PLASTIC SURGERY
4. OBJECTIVES
• Gingival augmentation
• Coverage of the denuded root surface
• Periodontal prosthetic corrections
• Crown lengthening
• Ridge augmentation
• Esthetic surgical corrections
• Esthetic surgical correction around implants
• Reconstruction of papillae
• Surgical exposure of unerupted teeth for orthodontics
• Lip repositioning
• Removal of aberrant frenulum
• Prevention of ridge collapse associated with tooth extraction
6. PROCEDURES FOR INCREASING WIDTH OF
ATTACHED GINGIVA
• Friedman et al 1922
• Lang and Loe 1972
• Gosalind et al 1977
TREATMENTS
• Gingival Augmentation Procedures
• FGG- Free Gingival Grafts/Auto grafts
• Modifications of FGG : Variant Technique
Accordion Technique
Strip Technique
7. GINGIVAL AUGMENTATION PROCEDURES
Vestibular/Gingival Extension
Denudation Technique
Ochsenbein 1960, Corn 1962, Wildermann 1964
Split-Flap Procedure
Staffileno et al 1962, Wildermann 1963, Pfeifer 1965, Staffileno et al
1966
10. FREE GINGIVAL AUTOGRAFT
• Bjorn 1963 and Sullivan & Atkins 1968
• Nabers 1966
CLASSIC TECHNIQUE
• Preparation of the recipient site
• Obtain graft from donor site/Preparation of the donor site
• Suturing of the graft/Transferring & Immobilization of graft
16. COMBINATION TECHNIQUE
• A deep strip graft taken from palate and is split into both an epithelial-
connective tissue strip and a pure connective tissue strip.
• Obtained by;
3-4mm thick strip is placed between two wet tongue depressor and a
split it longitudinally with #15c blade.
The superficial portion consists of epithelium and connective tissue.
Deeper portion, only connective tissue.
• Placed on recipient site as strip technique.
17. HEALING OF THE GRAFT
• Oliver et al 1968 & Nobuto et al 1988
– The Initial Phase (from 0-3 days)
– Revascularization Phase (from 2-11 days)
– Tissue Maturation Phase (from 11-42 days)
25. • In Deflection:
Staffileno- Used partial-thickness to avoid recession on donor site.
Pfeifer & Heller- Reattachment on the exposed root surface occur with
full-thickness laterally positioned flap.
• Knowles & Ramfjord used FGG to cover donor site
64. CROWN LENGTHENING
Classification of Procedures
• Gingival reduction only (bone removal not required)
Gingivectomy
Gingival Flap Surgery
• Mucoperiosteal Flap with Ostectomy (bone removal required)
One-Stage procedures, which require one the following:
Flap elevation, ostectomy, apical positioning of the flap.
Internal bevel gingivectomy, flap elevation, ostectomy, flap suturing
Two-Stage procedure, which requires:
Flap elevation, ostectomy, flap suturing at its original position
Gingivectomy, 4 to 6 weeks later
67. CONCLUSION
Periodontal plastic surgery refers to soft tissue relationships and
manipulations. In all of these procedures, blood supply is the most
significant concern and must be the underlying issue for all decisions
regarding the individual surgical procedure. A major complicating factor
is the avascular root surface, and many modifications to existing
techniques are used to overcome this. The practitioner should be aware
that new methods sometimes are published without adequate clinical
research to ensure the predictability of the results and the extent to which
the techniques may benefit the patient. Critical analysis of recently
presented techniques should guide the evolution toward better clinical
methods.
68. REFERENCES
• Atlas Of Cosmetic And Reconstructive Periodontal Surgery -Third
Edition
• Clinical Periodontology and Implant Dentistry-Sixth Edition Niklaus P.
Lang and Jan Lindhe
• Periodontal Surgery A Clinical Atlas – Naoshi Sato
• Periobasics – Nithin Saroch