Gingival Recession Surgical Management Quiz
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Questions and Answers

Which of the following modifications to the pedicle flap were made by Hattler?

  • The flap was made using a split thickness. (correct)
  • The flap was sutured with fine interrupted sutures.
  • The flap was used to cover multiple exposed root surfaces. (correct)
  • The flap was repositioned laterally.
  • What is the primary function of applying pressure after suturing the pedicle flap?

  • To ensure good union between donor and recipient tissues. (correct)
  • To minimize the clot underneath the flap. (correct)
  • To reduce the risk of infection.
  • To prevent bleeding from the donor site.
  • What is the primary advantage of the double-papilla repositioned flap described by Cohen and Ross?

  • It is less prone to complications like flap tension.
  • It is suitable for areas with insufficient keratinized gingival tissue on one side of the defect. (correct)
  • It can be used to cover larger recession defects.
  • It requires minimal suturing.
  • What is the recommended treatment for the donor site after a pedicle flap procedure?

    <p>Healing by secondary intention. (D)</p> Signup and view all the answers

    What can increase the risk of failure for the pedicle flap procedure?

    <p>Excessive movement and poor stabilisation. (B)</p> Signup and view all the answers

    What is the primary goal of the pedicle flap procedure?

    <p>To cover exposed root surfaces. (A)</p> Signup and view all the answers

    Which of the following is NOT a benefit of the pedicle flap procedure?

    <p>It can be used to treat recession defects on both sides of the tooth. (C)</p> Signup and view all the answers

    What is the most important factor in determining the success of the pedicle flap procedure?

    <p>The stability of the flap. (B)</p> Signup and view all the answers

    What is the recommended suture placement in relation to the cementoenamel junction (CEJ) when suturing a coronally repositioned flap?

    <p>0.5 mm to 1 mm coronal to the CEJ (D)</p> Signup and view all the answers

    What type of suture technique is recommended for the papilla regions and reliving incisions?

    <p>Interrupted sutures (A)</p> Signup and view all the answers

    What is the primary purpose of applying gentle pressure after suturing the flap?

    <p>To ensure proper flap adaptation (C)</p> Signup and view all the answers

    Which of the following factors can make it difficult to suture a coronally repositioned flap with optimal tension?

    <p>Presence of a large recession defect (D)</p> Signup and view all the answers

    What is the primary treatment modality used in conjunction with a coronally advanced flap for large recession defects?

    <p>Connective tissue graft (A)</p> Signup and view all the answers

    What is the main reason for avoiding excessive tension when suturing a coronally advanced flap?

    <p>Increased likelihood of flap necrosis (E)</p> Signup and view all the answers

    Which of the following is considered the gold standard treatment for recession defects?

    <p>Coronally advanced flap (A)</p> Signup and view all the answers

    Which of the following is a potential outcome of using a coronally advanced flap for recession defects?

    <p>Reduced root coverage (C), All of the above are possible outcomes. (E)</p> Signup and view all the answers

    What type of recession defect is shown in Figures 1e-g?

    <p>Miller’s Class III (C)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of the laterally repositioned pedicle flap technique?

    <p>The technique involves grafting of the recession defect. (B)</p> Signup and view all the answers

    What is the primary goal of the laterally repositioned pedicle flap technique?

    <p>To completely cover the recession defect with soft tissue. (D)</p> Signup and view all the answers

    What is the significance of the one-week post-surgery observation in Figures 1e-g?

    <p>It shows significant coverage of the exposed root surface, indicating the success of the technique. (A)</p> Signup and view all the answers

    What is the main reason why grafting of a Miller’s Class III recession defect of this size is unlikely to provide full coverage?

    <p>The defect is too large for the graft to cover effectively. (D)</p> Signup and view all the answers

    What is the purpose of the second surgical procedure with a coronally repositioned flap mentioned in the text?

    <p>To cover the remaining exposed root surface after the first procedure. (B)</p> Signup and view all the answers

    What is the primary factor determining the thickness of the flap used in the double-papilla flap technique?

    <p>The thickness of the gingival tissues. (D)</p> Signup and view all the answers

    What is the primary purpose of using citric acid to treat the root surface before a surgical procedure?

    <p>To remove the smear layer on the root surface. (B)</p> Signup and view all the answers

    What is the significance of measuring the width of the recession defect before raising the donor tissue?

    <p>To determine the size of the pedicle flap required. (C)</p> Signup and view all the answers

    Which of the following factors is NOT considered critical in determining the success of a periodontal plastic surgery procedure?

    <p>The height of the recession defect. (D)</p> Signup and view all the answers

    What is the recommended minimum thickness for split thickness pedicle flaps raised for periodontal plastic surgery procedures?

    <p>1.0 mm (B)</p> Signup and view all the answers

    What is the primary function of the split thickness pedicle flaps raised during periodontal plastic surgery procedures?

    <p>To nourish the grafted tissue. (D)</p> Signup and view all the answers

    Why is it important to consider carrying out a frenectomy before or as part of periodontal plastic surgery?

    <p>To relieve tension on the gingival tissues caused by a prominent frenum. (D)</p> Signup and view all the answers

    Which of the following agents has been suggested to help promote healing response post-surgery, but has not shown significant improvement in clinical studies?

    <p>Tetracycline hydrochloride (A)</p> Signup and view all the answers

    What is the primary role of the graft tissue in periodontal plastic surgery procedures?

    <p>To replace lost gingival tissue and cover the root surface. (C)</p> Signup and view all the answers

    What is the significance of the depth of the vestibule in periodontal plastic surgery?

    <p>It influences the choice of surgical procedure based on available attached gingival tissue. (C)</p> Signup and view all the answers

    What is the name of the procedure described in the content?

    <p>Coronally advanced flap (C)</p> Signup and view all the answers

    Where are the incisions placed in the coronally advanced flap?

    <p>Both A and B (A)</p> Signup and view all the answers

    Which of the following steps is NOT a part of the coronally advanced flap procedure?

    <p>Releasing the periosteum (C)</p> Signup and view all the answers

    What is the purpose of de-epithelializing the intact part of the papilla?

    <p>To prepare the site for a graft (A)</p> Signup and view all the answers

    According to the content, what is the aim of the coronally advanced flap procedure?

    <p>To cover the recession defect (A)</p> Signup and view all the answers

    What does the content say about the effect of smoking on the healing process after this procedure?

    <p>Smoking may hinder the healing process (C)</p> Signup and view all the answers

    What is the purpose of the split-thickness pedicle flap?

    <p>To cover the recession defect (C)</p> Signup and view all the answers

    What is the significance of the periosteum being released during the procedure?

    <p>It allows for freedom of movement of the flap (A)</p> Signup and view all the answers

    What is a significant factor influencing the outcome of root coverage procedures?

    <p>Size of the initial recession defect (B)</p> Signup and view all the answers

    Which classification is referenced for marginal tissue recession?

    <p>Miller Classification (A)</p> Signup and view all the answers

    What percentage of complete and mean root coverage is observed in recession defects less than 4 mm?

    <p>Significantly higher percentage (D)</p> Signup and view all the answers

    What have studies shown regarding the treatment of patients with advanced periodontal disease?

    <p>More patients achieve successful outcomes (A)</p> Signup and view all the answers

    What technique shows variability in mean root coverage achieved?

    <p>Double papilla flap (A)</p> Signup and view all the answers

    What is the significance of using citric acid application in treatment?

    <p>Facilitates autograft success (C)</p> Signup and view all the answers

    What aspect of mucogingival therapy is highlighted in the literature?

    <p>Critical reviews of root coverage procedures (D)</p> Signup and view all the answers

    What was the objective of the systematic review mentioned?

    <p>To assess techniques for complete root coverage (D)</p> Signup and view all the answers

    Flashcards

    Graft thickness

    The graft should be thick enough to prevent necrosis.

    Citric acid treatment

    Citric acid is used to remove the smear layer on the root surface pre-surgery.

    Recession defect height

    Height is less critical than width in surgical planning for recessions.

    Tetracycline hydrochloride

    Used post-surgery to promote healing, but no significant improvement shown in studies.

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    Prominent frenal attachments

    Can cause gingival recession and may need a frenectomy prior to surgery.

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    Split thickness flaps

    Flaps raised during surgery must have adequate thickness (≥1 mm) for success.

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    Frenectomy

    Surgical removal of a frenulum to relieve tension on gingival tissue.

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    Grafted tissue nourishment

    Tissue thickness of flaps aids in nourishing grafted tissue for better healing.

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    Vertical relieving incision

    An incision made to allow for even thickness flaps during surgery.

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    Coronally advanced flap

    A surgical technique to reposition gum tissue towards the crown of the tooth.

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    Split thickness pedicle flap

    A flap that includes some underlying tissue but preserves the epithelial layer.

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    De-epithelialization

    The process of removing the surface epithelium from a tissue flap.

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    Graft tissue preparation

    Steps taken to ready a site for the application of graft tissue.

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    Root coverage

    Achieving complete coverage of the exposed tooth root with gum tissue.

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    Incisions around recession defect

    Cuts made around an area of gum recession to facilitate flap raising.

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    Minor enameloplasty

    A minor procedure to reshape or reduce the length of a tooth's enamel.

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    Pedicle flap

    A surgical technique involving repositioning full thickness tissue over a defect.

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    Donor tissue

    Tissue taken from one area to be used for repair in another area.

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    Full thickness flap

    A flap that includes all layers of the skin and underlying tissue.

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    Vascularization

    The formation of blood vessels in a grafted tissue to ensure healing.

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    Secondary intention healing

    Healing process where the wound is left open to close naturally over time.

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    Double-papilla repositioned flap

    A technique to cover recession defects when keratinized tissue is insufficient.

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    Suturing and pressure application

    Technique used to secure the flap and minimize clot formation.

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    Miller’s Class III recession

    A type of gingival recession that is unlikely to achieve full root coverage with grafting.

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    Lateral repositioned pedicle flap

    A surgical technique to cover recession defects by repositioning adjacent tissue.

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    Single tooth recession defects

    Gingival recession that affects only one tooth, typically treated with local surgical techniques.

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    Double papilla flap

    A surgical flap technique allowing coverage of multiple recession defects using two papillae.

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    Coronally repositioned flap

    A surgical technique that moves tissue toward the crown of the tooth to cover recession defects.

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    Post-surgery recovery

    The assessment phase after surgical procedures to evaluate healing and tissue coverage.

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    Suturing Technique

    The method of stitching the repositioned flap in place, ideally free of tension to ensure healing.

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    CEJ (Cementoenamel Junction)

    The area where the enamel of the tooth meets the cementum, critical in flap positioning.

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    Interrupted Sutures

    Individual stitches placed periodically, often in papilla regions, to secure the flap.

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    Periodontal Dressing

    A protective covering that may be applied after surgery to promote healing.

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    Tension-Free Flap

    A flap that is sutured without any pulling or tension to ensure proper healing.

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    Root Coverage Outcome

    The success measure of surgical procedures aimed at covering root surfaces exposed due to recession.

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    Connective Tissue Graft

    A graft taken from the palate used to enhance the flap procedure's outcomes for recession defects.

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    Mucogingival grafting

    A procedure that involves grafting tissue to improve gingival health and aesthetics.

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    Gingival recession defect size

    Larger initial defects can affect the success rate of root coverage procedures.

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    Root coverage percentage

    Proportion of cases that achieve complete root coverage after treatment.

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    Miller classification

    A system to classify marginal tissue recession types for treatment planning.

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    Laterally repositioned flap

    A surgical technique that moves gum tissue to cover recession sites.

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    Evidence based mucogingival therapy

    Therapies backed by systematic reviews and studies for mucogingival conditions.

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    Long-term effect of treatment

    The lasting impact of surgical and non-surgical periodontal disease treatments over time.

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    Study Notes

    Gingival Recession: Surgical Management using Pedicle Grafts

    • Gingival recession is the apical displacement of the gingival margin from the cemento-enamel junction (CEJ).
    • Most patients have aesthetic or sensitivity complaints.
    • Periodontal plastic surgery corrects recession defects.
    • Surgical options aim for aesthetic improvement, reduced sensitivity, better plaque control, and preventing further recession.

    Miller's Classification of Gingival Recession

    • Class I: Recession does not reach the mucogingival junction, no interdental bone loss.
    • Class II: Recession reaches or extends past the mucogingival junction, no interdental bone loss.
    • Class III: Recession reaches or extends past the mucogingival junction, with some interdental attachment loss or tooth malposition.
    • Class IV: Recession reaches or extends past the mucogingival junction, with significant bone and/or soft-tissue loss, and/or severe tooth malposition.

    Factors Affecting Surgical Outcome

    • Root Surface: Calculus, caries, contaminated cementum, or restorations should be removed.
    • Frenal Attachments: Prominent frenums can exert tension, leading to surgical failure.
    • Vestibule Depth: Shallow vestibules are contraindicated for pedicle grafts.
    • Tissue Type: Thin gingival biotypes have poorer outcomes.
    • Recession Defect Size: Narrow defects have better outcomes compared to wide ones. The width, rather than the height, is critical.
    • Thickness of Flaps: Flaps need sufficient thickness (≥1mm) to nourish grafted tissue and ensure successful healing.
    • Smoking: Smoking compromises healing.
    • Oral Hygiene: Patients with active periodontal disease should not undergo surgery.

    Surgical Techniques (Pedicle Grafts)

    • Pedicle Grafts: Donor tissue adjacent to the recession defect is repositioned over the exposed root.
    • Laterally Repositioned Pedicle Flap: Donor tissue is repositioned over the exposed root
    • Double Papilla Repositioned Flap: Tissue from both sides of the recession defect is moved over exposed roots for multiple-tooth defects.
    • Coronally Repositioned Flap: Tissue apical to the recession defect is repositioned coronally over the exposed root .

    Contraindications

    • Smoking: Complicates healing and negatively affects outcomes.
    • Poor Oral Hygiene and active periodontal disease hinder successful grafting.

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    Description

    Test your knowledge on the surgical management of gingival recession using pedicle grafts. This quiz covers Miller's classification, surgical options, and factors affecting treatment outcomes. Understand how periodontal plastic surgery can improve aesthetics and sensitivity in patients.

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