Transcript Implants & Peri

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