Treatment of Gingival Recession PDF

TREATMENT OF GINGIVAL RECESION drg. Neira Najatus Sakinah, Sp.Perio Jember, 03 Oktober 2022 Short Review of GR classification MILLER CLASSIFICATION (based on the vertical measurement of recession and MGJ involvement) Class I Class II...

TREATMENT OF GINGIVAL RECESION drg. Neira Najatus Sakinah, Sp.Perio Jember, 03 Oktober 2022 Short Review of GR classification MILLER CLASSIFICATION (based on the vertical measurement of recession and MGJ involvement) Class I Class II Recession does not extend to the Recession extend to the MGJ MGJ (mucogingival junction) (mucogingival junction) Interdental → intact Interdental → intact Short Review of GR classification MILLER CLASSIFICATION (based on the vertical measurement of recession and MGJ involvement) Class III Class IV Recession extend to the MGJ Recession extend to the MGJ (mucogingival junction) (mucogingival junction) Interdental → mild recession and Interdental → severe recession and bone loss bone loss Therapeutic Classes of Gingival Recession Class I and II Root surfaces exposed by gingival recession may be hypersensitive → DESENSITIZING Root coverage → REPOSITION FLAP TISSUE GRAFTING Therapeutic Classes of Gingival Recession Class III and IV Root surfaces exposed by gingival recession may be hypersensitive → DESENSITIZING Root coverage → GINGIVAL MASK DESENSITIZING Desensitizing agents can be applied by the patient at home or by the dentist or hygienist in the dental office. The most likely mechanism of action is the reduction of the diameter of the dentinal tubules to limit the displacement of fluid. According to Trowbridge and Silver, this can be attained in the following ways: (1) by the formation of a smear layer produced by burnishing the exposed surface, (2) via the topical application of agents that form insoluble precipitates within the tubules, (3) with the impregnation of tubules with plastic resins, (4) by sealing the tubules with plastic resins. DESENSITIZING Agents Used by the Patient Sensodyne and Thermodent, which contain strontium chloride Crest Sensitivity Protection, Denquel, and Promise, which contain potassium nitrate Protect, which contains sodium citrate Fluoride rinsing solutions and gels can also be used after the usual biofilm control procedures DESENSITIZING Agents Used by the Patient Although many dentifrice products contain fluoride, additional active ingredients for desensitization are strontium chloride, potassium nitrate, and sodium citrate. Desensitizing agents act through the precipitation of crystalline salts on the dentin surface that block dentinal tubules. Patients must be aware that their use will not prove to be effective unless they are used continuously for at least 2 weeks. DESENSITIZING Agents Used in Dental Office These products and treatments aim to decrease hypersensitivity by blocking dentinal tubules with: a crystalline salt precipitation or an applied coating (varnish or bonding agent) on the root surface potassium oxalate (Protect) and ferric oxalate (Sensodyne Sealant) solutions are the preferred agents, and special applicators have been developed for their use. These agents form insoluble calcium oxalate crystals that occlude the dentinal tubules. DESENSITIZING Agents Used in Dental Office Certain agents, such as chlorhexidine, decrease the ability of fluoride to bind with calcium on the root surfaces → important to advise patients not to rinse or eat for 1 hour after a desensitizing treatment The most current method of treatment for hypersensitive dentin is the use of varnishes or bonding agents to occlude dentinal tubules The crystalline salts, varnishes, and other sealants can be washed away over time, and the hypersensitivity may return. Repeated therapy will be necessary to help alleviate the hypersensitivity for these patients. REPOSITION FLAP Coronally displaced flap TISSUE GRAFTING The passive and active categories recognize the roles cells play in tissue engineering. Passive engineering involves the following treatments and materials: 1. Therapies based on GTR-based therapies; barrier membranes 2. Biologically based acellular dermal matrix (ADM) Active engineering involves the following treatments and materials: 1. Enamel matrix derivative (EMD) 2. Growth factors: recombinant human platelet-derived growth factor-BB (rhPDGF-BB) plus beta-tricalcium phosphate (TCP) plus collagen wound dressing 3. Cell therapy Autologous ibroblast: Isolagen Bilayered cell therapy (BLCT): Celltx Human ibroblast-derived dermal substitute (HFDDS): Dermagraft TISSUE GRAFTING (CTG) TISSUE GRAFTING (CTG) TISSUE GRAFTING (CTG) GINGIVAL MASK (artificial gum) Artificial Gingiva is also known as gingival mask, gingival prosthesis, gingival slip, and party gums. Artificial Gingiva can replace a large volume of tissue that has been lost to the disease process or its treatment. The advantage of the prosthesis: easily cleaned creates an ideal contour with removable prosthodontic materials does not disturb the other teeth provided an esthetic result reduced hypersensitivity significantly prevented food loadegement improved phonetics GINGIVAL MASK (artificial gum) TERIMA KASIH