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1996 ucla connective tissue-grafts

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UCLA perio

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1996 ucla connective tissue-grafts

  1. 1. TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS
  2. 2. UCLA SCHOOL OF DENTISTRY 2
  3. 3. Presents Dr. E. Barrie Kenney Professor & Chairman Section of Periodontics 3
  4. 4. E. Barrie Kenney B.D.Sc., D.D.S., M.S., F.R.A.C.D.S.Tarrson Family Endowed Chair in Periodontics.Professor and Chairman Division of Associated Clinical Specialties UCLASchool of Dentistry
  5. 5. ConnectiveTissue Graft
  6. 6. Treatment of Gingival Recession Adequate Recession More Adequate Adequate Esthetic Problem Yes Yes Yes Adjacent No Palatal Keratinized than 2 mm. No Gingiva Donor Site Donor Site Adequate No Yes Keratinized Yes No No Connective Gingiva Coronally Gingival Graft for Root Lateral Tissue Graft Yes No Repositioned Sliding Coverage or Gingival Graft Coronally Semi-Lunar Flap Flap3 Month and Coronally Repositioned RepositionedEvaluation for Gingival Flap Flap withProgression Graft Membrane or Emdogain
  7. 7. Treatment of Gingival Recession Adequate Recession More Adequate Adequate Esthetic Problem Yes Yes Yes Adjacent No Palatal Keratinized than 2 mm. No Gingiva Donor Site Donor Site Adequate No Yes Keratinized Yes No No Connective Gingiva Coronally Gingival Graft for Root Lateral Tissue Graft Yes No Repositioned Sliding Coverage or Gingival Graft Coronally Semi-Lunar Flap Flap3 Month and Coronally Repositioned RepositionedEvaluation for Gingival Flap Flap withProgression Graft Membrane or Emdogain
  8. 8. Smoking and RootCoverage with Connective Tissue Grafts • 18 Recessions in 15 PatientsSmoking may affect root coverage • 7 smokers, 8 non-smokers outcome. A prospective clinical • Clinical evaluation at 30, 60, trial in humans. 90 and 120 days post surgery Martins A.G. et al J. Periodontol. 2004 75:586
  9. 9. Non Smokers SmokersPercent Root Coverage 74.73 58.84Attachment Level Gain 2.54 2.00
  10. 10. Root Resorption assosiated with a subepithelial connective tissue • 2 year post surgery graft:Clinical and histologic report • Clinically successful of a case. • Patient changed to full denture • Conventional surgery Int. J. Periodont. Rest. Dent. 2003, 4:391 • 50% citric acid for 3 minutes Carnio J,Camargo P.M, Kenney E.B.
  11. 11. Connective Tissue Graft Plus Emdogain • 4 upper teeth with Miller class II or III recession Histological evaluation of 4 cases with root • Connective tissue graft plus Emdogain coverage following a connective tissue graft combined with an Enamel Matrix Derivative • Root treated with EDTA for 2 minutes Preparation • 2 sectioned at 6 months, 2 at 1 year • Light microscopyCarnio J, Camargo, P.M., Kenney, E.B., Scheak, R.K. • Notch placed above bone crest J. Periodontol. 2002 73:1534
  12. 12. Gingival Recession• All teeth obtained root coverage Original 6 months 1 year• Connective tissue adjacent to root 4 0• 1 case of new cementum after 6 months 6 2• No significant new bone formation 5 1• No long junctional epithelium 6 3
  13. 13. 6 MONTH
  14. 14. 6 MONTH
  15. 15. 1 YEAR
  16. 16. AlloDerm• Processed human skin •Basement membrane side white, rough and dull• Developed in 1994 for burns •Collagen elastin and ground substance• Cells removed •No epithelium• Antiviral treatment •Vessels intact• Freeze-dried •All donors• Dermal side red, shiny Negative for HIV, hepatitis B & C, syphilis
  17. 17. A short-term and long-term comparison of root coverage • 25 patientswith an acellular dermal matrix and a subepithelial graft • Evaluated at 12 to 13 weeks and 48 to 49 months Harris RJ, • Non-random assignment J Periodont 2004, 75:734
  18. 18. Percentage of Root Coverage 12 - 13 weeks 48 – 49 monthsAlloDerm 93.4 65.8Connective Tissue Graft 96.6 97.0
  19. 19. UCLA SCHOOL OF DENTISTRY 59

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