Gingival recession part 2. surgical management

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Questions and Answers

What is one of the main indications for surgical intervention to correct recession defects?

Increase tooth sensitivity

Decreased risk of periodontal disease

Increase the rate of plaque buildup

Improve localised soft tissue aesthetics (correct)

Which of Miller's classifications indicates a recession defect that can result in full coverage?

Class I and IV

Class II and III

Class III and IV

Class I and II (correct)

Which class of gingival recession is likely to result in only partial coverage?

Class I

Class IV

Class II

Class III (correct)

What is a potential factor that can affect the outcome of periodontal plastic surgery?

Presence of chronic periodontal disease Signup and view all the answers

What is a goal of periodontal plastic surgery?

To restore aesthetics Signup and view all the answers

When should factors affecting the outcome of surgery be addressed?

Before surgery Signup and view all the answers

Why should periodontal plastic surgery be avoided in certain cases?

Due to a risk of further recession progression Signup and view all the answers

Which class of gingival recession can be used to predict the possible outcome of surgery?

Any class of gingival recession Signup and view all the answers

What technique was first described by Grupe and Warren?

Laterally repositioned pedicle flap Signup and view all the answers

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

To minimize clot formation underneath the flap Signup and view all the answers

Who modified the technique using a split thickness flap?

Hattler Signup and view all the answers

When is a periodontal dressing recommended?

Only if deemed necessary Signup and view all the answers

What condition can increase the risk of procedure failure?

Leaving the flap under tension Signup and view all the answers

What should the donor site ideally do after a flap is repositioned?

Heal by secondary intention Signup and view all the answers

What was the focus of Cohen and Ross’s contribution to flap techniques?

Technique for double-papilla repositioned flap Signup and view all the answers

What is a potential consequence of using a flap that is too narrow?

Increased chance of procedure failure Signup and view all the answers

What is the main purpose of using citric acid on the root surface before surgery?

To remove the smear layer for connective tissue attachment Signup and view all the answers

How does the width of the recession defect influence surgical procedures?

It influences the choice of surgical procedure Signup and view all the answers

What thickness is necessary for split thickness flaps to ensure successful graft nourishment?

At least 1 mm Signup and view all the answers

What was the outcome of using tetracycline hydrochloride in clinical studies post-surgery?

No improvement in outcomes Signup and view all the answers

What potential issue can arise from prominent frenal attachments during periodontal surgery?

Tension on gingival tissues that may lead to surgical failure Signup and view all the answers

Which factor is less critical when assessing recession defects?

Height of the defect Signup and view all the answers

What is a recommended procedure to address tension caused by prominent frenal attachments before periodontal surgery?

Frenectomy Signup and view all the answers

How does tissue thickness relate to the success of periodontal procedures?

Adequate thickness is essential for graft nourishment Signup and view all the answers

What is the first step taken if there is insufficient keratinized tissue before performing surgery?

Carry out a free gingival graft Signup and view all the answers

What is the minimum width of keratinized tissue required for a one-stage technique?

3 mm Signup and view all the answers

When repositioning the gingival tissue, what suture technique is primarily used?

Interrupted suture Signup and view all the answers

What outcome should be avoided due to inadequate suturing during the procedure?

Separation of the two pedicle flaps Signup and view all the answers

What purpose does gentle pressure serve after the tissue is grafted?

To minimize the formation of the clot Signup and view all the answers

How is the amount of coronal advancement determined during the procedure?

By measuring the recession defect height Signup and view all the answers

What should be assessed before a coronally repositioned flap is performed?

The interproximal bone loss Signup and view all the answers

What type of flap is raised if adequate keratinized tissue is available?

Split thickness pedicle flap Signup and view all the answers

What is primarily indicated for treating Class I gingival defects?

Connective tissue graft Signup and view all the answers

What is one advantage of using a connective tissue graft?

It retains its own blood supply Signup and view all the answers

What surgical technique can follow a connective tissue graft for improved outcomes?

Coronally repositioned pedicle flap Signup and view all the answers

Which class of gingival recession defect is primarily mentioned for procedures discussed?

Class I Signup and view all the answers

What is the primary goal of the surgical techniques mentioned in the text?

To provide complete root coverage Signup and view all the answers

Which procedure is suggested to decrease the overall length of the tooth?

Enameloplasty Signup and view all the answers

What characteristic defines Class I recession defects?

Interdental papilla is preserved Signup and view all the answers

What was the purpose of conducting enameloplasty in the context described?

To improve the tooth's shape Signup and view all the answers

What is the primary benefit of periodontal plastic surgery?

Reduction of gingival recession defects Signup and view all the answers

In which case is it more appropriate to consider a free graft?

Thin gingival biotype with limited keratinised tissue Signup and view all the answers

What does achieving full root coverage primarily indicate?

A significant decrease in the exposed root surface Signup and view all the answers

What is the main consideration for using a double papillae repositioned flap?

Presence of sufficient keratinised tissue Signup and view all the answers

What is one of the challenges associated with coronal positioning of existing gingiva?

Difficulty in achieving root coverage Signup and view all the answers

What is a potential outcome of successful periodontal plastic surgery?

Improved attachment levels Signup and view all the answers

Which surgical technique is advisable when the gingival biotype is thick?

Double papillae repositioned flap Signup and view all the answers

What is suggested to be governed by the presence of keratinised tissue in gingival procedures?

Long-term stability of the surgical outcome Signup and view all the answers

Study Notes

Gingival Recession: Surgical Management with Pedicle Grafts

Gingival recession is the apical displacement of the gingival margin from the cemento-enamel junction (CEJ).
This paper discusses using pedicle soft tissue grafts to treat localized gingival recession.
Non-surgical management and aetiology were discussed in a previous article in the series.
Surgical procedures aim to improve soft tissue aesthetics, reduce hypersensitivity, improve plaque control, and prevent further recession.

Miller's Classification of Gingival Recession

Class I: Recession does not reach the mucogingival junction, no interdental bone loss.
Class II: Recession extends to or beyond the mucogingival junction, no interdental bone loss.
Class III: Recession extends to or beyond the mucogingival junction, some interdental attachment loss or tooth malpositioning.
Class IV: Severe bone and/or soft tissue loss in interdental areas and/or severe tooth malpositioning. Class IV recession defects are often unsuitable for surgical correction.

Factors Affecting Surgical Outcome

Root Surface Condition: Calculus, caries, and contaminated cementum on the root surface must be removed before surgery.
Frenal Attachments: Prominent frenum can cause tension on gingival tissues, and frenectomy may be necessary.
Vestibule Depth: Shallow vestibules are not suitable for pedicle grafts, alternative techniques are recommended.
Tissue Type: Thin gingiva typically results in poorer outcomes compared to thick gingiva. Keratinized tissue adjacent to the recession defect is also assessed.
Recession Defect Size: Smaller defects respond better to surgery, with grafting material extending beyond the defect for adequate blood supply.
Smoking: Smoking impairs healing after periodontal procedures, and smoking cessation is advised.
Poor Oral Hygiene: Active periodontal disease makes surgical success unlikely.

Surgical Techniques (Pedicle Flaps)

Laterally Repositioned Pedicle Flap: Donor tissue from adjacent areas is repositioned over the receded area to cover exposed root surface. Donor site heals by secondary intention.
Double Papilla Repositioned Flap: Used when insufficient keratinised tissue exists on one side; donor tissue from both sides is repositioned.
Coronally Repositioned Flap: Procedure for moving existing gingiva coronally; usually in combination with other grafting to improve tissue thickness in the case of thin biotype.

Classification of Recession Defect Outcome

Class I and II: Can achieve full root coverage.
Class III: Can offer partial coverage to the level of interdental bone.
Class IV: Root coverage is unlikely due to significant bone and/or tissue loss and malpositioning.

Prognosis

Pedicle grafts are effective in correcting small recession defects, especially Class I and II.
Success depends on various factors including the patient's gingival biotype, amount of keratinized tissues, and the depth of the vestibule.
Achieving full root coverage after a single procedure is difficult, and some degree of root coverage is usually considered successful.

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