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Published byBriana Thomerson Modified over 9 years ago
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Periodontal Aesthetics
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Soft tissue aesthetics Recession Crown fractures/Crown lengthening
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CTG? BONE GRAFT
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Recession Localised Generalised
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Gingival Recession
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Classification of Recession Class I Class III Class IV Class II Millers Classification (1985)
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New causes of recession
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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
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Gingival Biotype Two gingival biotypes have been described by Olsson & Lindhe (1991) Thick, flattened biotype (type 1) Thin, scalloped biotype (type 2 )
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Gingival Biotype I TYPE 1
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Gingival Biotype II TYPE 2
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Anatomical influences Inflammation Keratinised tissue Position of tooth Fenestrations Dehiscences Trauma Bacteria Frenal attachment Relationship of anatomy and inflammation leading to recession
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Gingival recession Indications for surgical correction include: increases in recession Persistent inflammation dentinal hypersensitivity aesthetic concerns of the patient Early Caries Age
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Can a clean site be maintained?
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Pedicle grafts: Rotational flap: Lateral sliding flap, double papilla flap, oblique rotated flap. Advanced flap: Coronally repositioned flap, semilunar coronally repositioned flap. Mucogingival surgery
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Free soft tissue grafts: Epithelialised graft Subepithelial connective tissue graft Mucogingival surgery
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Healing phases HOURS DAYS 3 MTHS 6 MTHS
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Lateral Sliding Flap
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LSF Day 1 week 3 19 months
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Lateral Sliding Flap
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Coronally Repositioned Flap
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Free Gingival Graft
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Sub-epithelial CT graft
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Sub-epithelial CT Graft
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Frenectomy
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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
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Crown Lengthening
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