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. DENUDED ROOT COVERAGE INDIAN DENTAL ACADEMY Leader in Continuing Dental Education www.indiandentalacademy.com www.indiandentalacademy.com
- 3. ETIOLOGY Abnormal frenal and muscle attachment Orthodontic tooth movement through a thin buccal osseous plate Direct gingival trauma from occlusion(eg :deep bite) Gingival quality and quantity Iatrogenic factors Hard tooth brushing Traumatic tooth brushing Tooth malpostion www.indiandentalacademy.com
- 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 www.indiandentalacademy.com
- 5. CLASSIFICATION MILLER (1985) Class I – Recession not extending to the muco-gingival junction. No loss of interdental bone or soft tissue. Class II –Recession extending to or beyond the mucogingival junction. No loss of interdental bone or soft tissue. Class III –Recession extending to or beyond the mucogingival junction. Loss of interdental bone or soft tissue is apical to cemento enamel junction but coronal to extent of marginal soft tissue recession. Class IV – Recession extending to or beyond mucogingival junction. Loss of interdental bone extends to a www.indiandentalacademy.com level apical to extent of marginal soft tissue
- 6. CLASSIFICATION Sullivan and atkins (1968) Shallow narrow Shallow wide Deep narrow Deep wide www.indiandentalacademy.com
- 8. LATERALLY POSITIONED FLAP The LPF was introduced by Grupe and Warren in 1956. This was the first predictable method for covering the avascular root surfaces by maintaining its vascular connections through the base and the body of transposed tissue.9 www.indiandentalacademy.com
- 9. The success for LPF is dependent clinically on the recognition and utilization of several biologically based principles. These include: www.indiandentalacademy.com
- 10. INDICATIONS Single sites Narrow recessions Mandibular central and lateral incisor defects only www.indiandentalacademy.com
- 11. CONTRAINDICATIONS Multiple contiguous sites Inadequate tissue thickness on adjacent teeth Inadequate keratinized tissue on adjacent teeth Loss of interdental soft tissue or bone www.indiandentalacademy.com
- 12. ADVANTAGES 1. Good tissue blend 2. Usually one surgical site 3. Usually complete root coverage DISADVANTAGE 1. Only one surgical site can be considered i.e. no contiguous sites 2. Possible recession at the donor site www.indiandentalacademy.com
- 14. FREE GINGIVAL AUTOGRAFTS Free gingival autografts are used to create a widened zone of attached gingival. They were initially described by Bjorn in 1963 and have been extensively investigated since that time. www.indiandentalacademy.com
- 15. INDICATIONS 1. 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. CONTRAINDICATIONS 1. Need for esthetic root coverage. 2. Anatomic limitations (external oblique ridge). 3. Mandibular lingual recession. 4. Heavy smokers. www.indiandentalacademy.com
- 17. CORONALLY DISPLACED FLAP The purpose of the coronally displaced flap operation is to create a split thickness flap in the area apical to the denuded root and displace it coronally to cover the root. www.indiandentalacademy.com
- 18. INDICATIONS 1. Gingival recession with minimal labial sulcus depth present 2. Adequate band of existing keratinized tissue 3. Maxillary arch usually restricted to the anterior sextant www.indiandentalacademy.com
- 19. CONTRA INDICATIONS 1. Mandibular defects 2. Lack of keratinized gingiva Two techniques are available for this purpose. www.indiandentalacademy.com
- 20. SEMILUNAR CORONALLY REPOSTIIONED FLAP The 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”. www.indiandentalacademy.com
- 21. ADVANTAGE Semilunar coronally repositioned flap 1. 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. DISADVANTAGES 1. Must have keratinized tissue. 2. Limited to the maxially arch. www.indiandentalacademy.com
- 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. www.indiandentalacademy.com
- 23. INDICATIONS 1. 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 www.indiandentalacademy.com
- 24. ADVANTAGES 1. 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. www.indiandentalacademy.com
- 26. GUIDED TISSUE REGENERATION (GTR) Since many periodontal surgeons have been approaching certain problems with procedures aimed at greater, more predictable regeneration of periodontal tissue and functional attachment, beyond the use of bone grafts and synthetic bone substitutes, treatment approaches grouped under the term GTR have been developed, analyzed and employed in clinical practice. Thus GTR for exposed root coverage of human gingival recession sites was introduced by Tiniti et al in 1992. www.indiandentalacademy.com
- 27. INDICATIONS 1. 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. www.indiandentalacademy.com
- 28. CONTRAINDICATIONS 1. 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. www.indiandentalacademy.com
- 29. RECENT ADVANCEMENTS The recent mode of treatment of denuded roots is by using platelet concentrate get in a collagen sponge carrier combined with a coronally positioned flap. www.indiandentalacademy.com
- 30. The non surgical techniques include 1. 1. Fugi VII – pink glass inomer cement 2. 2. Gum veneers www.indiandentalacademy.com
- 31. GUM VENEERS Provides lip support restores symmetrical gingival architecture replaces lost interdental papillae www.indiandentalacademy.com
- 32. TYPES Acrylic resin gingival veneer Flexible silicon gingival mask www.indiandentalacademy.com
- 33. INDICATIONS In correction of gingival deformities Root coverage after inflammation has been controlled Temporary splint As interim measure in cases where final treatment planning decisions are delayed www.indiandentalacademy.com
- 34. CONTRAINDICATIONS PATIENTS WITH Poor plaque control Unstable periodontal health High caries activity Heavy smoking www.indiandentalacademy.com
- 35. ADVANTAGES Painless procedure Relatively inexpensive Easily maintained by patients www.indiandentalacademy.com
- 36. DISADVANTAGES Silicon gingival masks cannot be used in patients with known allergy to silicon Acrylic veneers are hard and rigid hence has difficulties in fitting accurately around the teeth www.indiandentalacademy.com
- 37. CONCLUSION www.indiandentalacademy.com