Periodontal Aesthetics

Soft tissue aesthetics Recession Crown fractures/Crown lengthening

CTG? BONE GRAFT

Recession Localised Generalised

Gingival Recession

Classification of Recession Class I Class III Class IV Class II Millers Classification (1985)

New causes of recession

1-19% of children have one or more recession lesions (Ruf 1998 ortho) 50 % of people 18 to 64 years of age have one or more sites with recession 88 % of people 65 years of age and older have one or more sites with recession (Kassab 2003) Prevalence of recession lesions

Gingival Biotype Two gingival biotypes have been described by Olsson & Lindhe (1991) Thick, flattened biotype (type 1) Thin, scalloped biotype (type 2 )

Gingival Biotype I TYPE 1

Gingival Biotype II TYPE 2

Anatomical influences Inflammation Keratinised tissue Position of tooth Fenestrations Dehiscences Trauma Bacteria Frenal attachment Relationship of anatomy and inflammation leading to recession

Gingival recession  Indications for surgical correction include:  increases in recession  Persistent inflammation  dentinal hypersensitivity  aesthetic concerns of the patient  Early Caries  Age

Can a clean site be maintained?

 Pedicle grafts:  Rotational flap: Lateral sliding flap, double papilla flap, oblique rotated flap.  Advanced flap: Coronally repositioned flap, semilunar coronally repositioned flap. Mucogingival surgery

 Free soft tissue grafts:  Epithelialised graft  Subepithelial connective tissue graft Mucogingival surgery

Healing phases HOURS DAYS 3 MTHS 6 MTHS

Lateral Sliding Flap

LSF Day 1 week 3 19 months

Lateral Sliding Flap

Coronally Repositioned Flap

Free Gingival Graft

Sub-epithelial CT graft

Sub-epithelial CT Graft

Frenectomy

Crown Lengthening Soft tissue resection – indicated when bone level is at correct height to ensure biologic width is accommodated Soft and hard tissue resection - indicated when bone level is not at the correct height to ensure biologic width is accommodated

Crown Lengthening