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SURGICAL PROCEDURES
IN FPD
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com
CONTENTS
INTRODUCTION
GINGIVECTOMY AND GINGIVOPLASTY
METHODS OF INCREASING THE WIDTH OF ATTACHED
GINGIVA AND COVERAGE OF D...
INTRODUCTION
www.indiandentalacademy.com
1. Gingivectomy and Gingivoplasty
Gingivectomy – excisional removal of gingival tissue
for pocket reduction or elimination...
Contraindications
- Inadequate width of keratinized tissue
- Pockets beyond mucogingival junction
- Presence of intrabony ...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
2. Width of attached gingiva
Goldman and Cohen (1979) – “ tissue barrier
concept” They postulated that a dense collagenous...
Techniques
1. Free gingival autograft
Bjorn (1963)
- Advantages
1. High degree of predictability.
2. Ability to treat mult...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
2. Laterally positioned pedicle graft
Grupe and Warren (1956)
- Advantages
1. One surgical site
2. Good vascularity of ped...
www.indiandentalacademy.com
www.indiandentalacademy.com
3.Coronally displaced pedicle graft
- Advantages
1. No need for involvement of adjacent teeth.
2. High degree of success f...
Since the results of a coronally displaced flap
are often not favourable owing to the
presence of insufficient keratinized...
www.indiandentalacademy.com
4. Subepithelial connective tissue graft
Langer and Langer (1985)
Single most effective way to achieve predictable root
co...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
3. Crown lengthening procedure
It is a surgical procedure designed to increase
the extent of supragingival tooth structure...
Biologic Width
The biologic width is the apicocoronal distance
that the junctional epithelium and supra crestal
connective...
Why is the biologic width important?
The body maintains the biologic width as a stable
dimension. When the biologic width ...
Esthetic Crown Lengthening
www.indiandentalacademy.com
Functional Crown Lengthening
www.indiandentalacademy.com
www.indiandentalacademy.com
4. Furcation involvement
Classification
Glickman (1953)
www.indiandentalacademy.com
 Treatment of furcation involvement
Grade I - Scaling
Root planing
Gingivectomy
Odontoplasty
Grade II - Odontoplasty
Oste...
Grade III & Grade IV - Tunneling
Root resection
Grafting
GTR
Extraction
www.indiandentalacademy.com
www.indiandentalacademy.com
Root resection
- Indications
1. Grade II & Grade III involvement
2. Severe vertical bone loss involving one root
3. Endodo...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
Hemisection
www.indiandentalacademy.com
www.indiandentalacademy.com
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 sur...
www.indiandentalacademy.com
www.indiandentalacademy.com
2. Onlay graft
- The Onlay graft is of value and predictable in
small areas.
- Limitations
1. Limited amount of donor mate...
www.indiandentalacademy.com
3. Pouch technique
- Garber and Rosenberg (1981)
- Used for soft tissue ridge augmentation
- Usually for Class I type of d...
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
www.indiandentalacademy.com
5.Controlled tissue expansion
- Newer modality which assists in achieving excess
tissue
- Advantages
1. Generates sufficie...
www.indiandentalacademy.com
www.indiandentalacademy.com
6. Bone graft materials and membranes
used for guided tissuebone regeneration
- Classification
I. Acc to the type of graft...
II. Acc to inductive potential
1. Osteoinductive - eg) hip marrow,osseous
coagulum,bone from extraction
site,tuberosity,DF...
www.indiandentalacademy.com
www.indiandentalacademy.com
Guided tissue regeneration
- Indications
1. Grade II furcation
2. 2-3 walled vertical defects
3. Good oral hygiene
4. Adeq...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
7. Frenectomy
www.indiandentalacademy.com
8. Electrosurgery for Gingival
Retraction
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
Conclusion
www.indiandentalacademy.com
References
1) Rosensteil “Contemporary fixed
prosthodontics”, 3rd
Edition.
2) Shillengburg “Fundamentals of fixed
prosthod...
Thank YouThank You
www.indiandentalacademy.com
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Surgical procedures/certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit 
www.indiandentalacademy.com

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Surgical procedures/certified fixed orthodontic courses by Indian dental academy

  1. 1. SURGICAL PROCEDURES IN FPD INDIAN DENTAL ACADEMY Leader in continuing Dental Education www.indiandentalacademy.com
  2. 2. 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
  3. 3. INTRODUCTION www.indiandentalacademy.com
  4. 4. 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
  5. 5. Contraindications - Inadequate width of keratinized tissue - Pockets beyond mucogingival junction - Presence of intrabony pockets www.indiandentalacademy.com
  6. 6. www.indiandentalacademy.com
  7. 7. www.indiandentalacademy.com
  8. 8. www.indiandentalacademy.com
  9. 9. 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
  10. 10. 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
  11. 11. www.indiandentalacademy.com
  12. 12. www.indiandentalacademy.com
  13. 13. www.indiandentalacademy.com
  14. 14. www.indiandentalacademy.com
  15. 15. www.indiandentalacademy.com
  16. 16. 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
  17. 17. www.indiandentalacademy.com
  18. 18. www.indiandentalacademy.com
  19. 19. 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
  20. 20. 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
  21. 21. www.indiandentalacademy.com
  22. 22. 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
  23. 23. www.indiandentalacademy.com
  24. 24. www.indiandentalacademy.com
  25. 25. www.indiandentalacademy.com
  26. 26. www.indiandentalacademy.com
  27. 27. 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
  28. 28. 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
  29. 29. 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
  30. 30. Esthetic Crown Lengthening www.indiandentalacademy.com
  31. 31. Functional Crown Lengthening www.indiandentalacademy.com
  32. 32. www.indiandentalacademy.com
  33. 33. 4. Furcation involvement Classification Glickman (1953) www.indiandentalacademy.com
  34. 34.  Treatment of furcation involvement Grade I - Scaling Root planing Gingivectomy Odontoplasty Grade II - Odontoplasty Osteoplasty Tunneling Root resection Grafting GTR www.indiandentalacademy.com
  35. 35. Grade III & Grade IV - Tunneling Root resection Grafting GTR Extraction www.indiandentalacademy.com
  36. 36. www.indiandentalacademy.com
  37. 37. 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
  38. 38. www.indiandentalacademy.com
  39. 39. www.indiandentalacademy.com
  40. 40. www.indiandentalacademy.com
  41. 41. www.indiandentalacademy.com
  42. 42. Hemisection www.indiandentalacademy.com
  43. 43. www.indiandentalacademy.com
  44. 44. 5. Ridge Augmentation Classification Seibert (1983) Class I Class II Class IIIwww.indiandentalacademy.com
  45. 45. 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
  46. 46. www.indiandentalacademy.com
  47. 47. www.indiandentalacademy.com
  48. 48. 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
  49. 49. www.indiandentalacademy.com
  50. 50. 3. Pouch technique - Garber and Rosenberg (1981) - Used for soft tissue ridge augmentation - Usually for Class I type of defects www.indiandentalacademy.com
  51. 51. 3. Roll technique - Used for soft tissue ridge augmentation - Class I defects www.indiandentalacademy.com
  52. 52. 4. Ridge augmentation - improved technique - Allen et al (1985) www.indiandentalacademy.com
  53. 53. www.indiandentalacademy.com
  54. 54. 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
  55. 55. www.indiandentalacademy.com
  56. 56. www.indiandentalacademy.com
  57. 57. 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
  58. 58. 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
  59. 59. www.indiandentalacademy.com
  60. 60. www.indiandentalacademy.com
  61. 61. 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
  62. 62. www.indiandentalacademy.com
  63. 63. www.indiandentalacademy.com
  64. 64. www.indiandentalacademy.com
  65. 65. 7. Frenectomy www.indiandentalacademy.com
  66. 66. 8. Electrosurgery for Gingival Retraction www.indiandentalacademy.com
  67. 67. www.indiandentalacademy.com
  68. 68. www.indiandentalacademy.com
  69. 69. Conclusion www.indiandentalacademy.com
  70. 70. 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
  71. 71. Thank YouThank You www.indiandentalacademy.com

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