surgical procedures/ dentistry dental implants
TRANSCRIPT
SURGICAL PROCEDURES IN FPD
INDIAN DENTAL ACADEMY
Leader in continuing dental education www.indiandentalacademy.com
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CONTENTS
INTRODUCTION
GINGIVECTOMY AND GINGIVOPLASTY
METHODS OF INCREASING THE WIDTH OF ATTACHED GINGIVA AND COVERAGE OF DENUDED ROOTS.
CROWN LENGTHNING
ROOT RESECTION AND HEMISECTION
RIDGE AUGMENTATION
BONE GRAFT MATERIALS AND MEMRANES USED FOR GUIDED TISSUE \ BONE REGENERATION.
FRENECTOMY
ELECTRO SURGERY FOR GINGIVAL RETRACTION
CONCLUSION
REFRENCES www.indiandentalacademy.com
INTRODUCTION
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1. Gingivectomy and Gingivoplasty
Gingivectomy – excisional removal of gingival tissue for pocket reduction or elimination.
Gingivoplasty – reshaping of the gingiva to attain a more physiologic contour.
Indications
- Presence of suprabony pockets
- An adequate zone of keratinized tissue
- Gingival enlargements
- Unaesthetic or asymmetrical gingival topography
- To facilitate restorative dentistry
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Contraindications
- Inadequate width of keratinized tissue
- Pockets beyond mucogingival junction
- Presence of intrabony pockets
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2. Width of attached gingivaGoldman and Cohen (1979) – “ tissue barrier concept” They postulated that a dense collagenous band of connective tissue retards or obstucts the spread of inflammation better than does loose fiber arrangement of the alveolar mucosa.
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Techniques1. Free gingival autograft Bjorn (1963) - Advantages
1. High degree of predictability.2. Ability to treat multiple teeth at the same time.3. Can be performed when keratinized gingiva
adjacent to the involved site is insufficient.4. Simplicity.
- Disadvantages1. Two operative sites2. Compromised blood supply 3. Greater discomfort
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2. Laterally positioned pedicle graft
Grupe and Warren (1956)
- Advantages1. One surgical site
2. Good vascularity of pedicle flap
3. Ability to cover a denuded root surface
- Disadvantages1. Limited by the amount of adjacent keratinized
gingiva
2. Possibility of recession at donor site
3. Limited to one or two teeth with recession
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3.Coronally displaced pedicle graft
- Advantages1. No need for involvement of adjacent teeth.
2. High degree of success for gingival recession and sensitivity.
- Disadvantages1. Cannot be used if the zone of keratinized
gingiva is inadequate / two surgical procedures may be required.
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Since the results of a coronally displaced flap are often not favourable owing to the presence of insufficient keratinized gingiva the following procedure can be performed to increase the chances of success –
1. Gingival extension operation with free autogenous graft.
2. After 2 months a coronally displaced flap operation can be performed.
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4. Subepithelial connective tissue graft
Langer and Langer (1985)
Single most effective way to achieve predictable root
coverage with a high degree of cosmetic enhancement.
- Advantages1. Esthetics
2. Predictability
3. One step procedure
4. Minimum palatal trauma
5. Used for multiple teeth
- Disadvantage1. High degree of skill
2. Complicated suturingwww.indiandentalacademy.com
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3. Crown lengthening procedureIt is a surgical procedure designed to increase the extent of supragingival tooth structure for restorative or aesthetic purposes by apically positioning the the gingival margin,removing supporting bone, or both.
- 2 types
1. Esthetic - to improve appearance
2. Functional – when the clinical crown is too short to provide adequate retention without restoration impinging on the biologic width.
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Biologic Width
The biologic width is the apicocoronal distance
that the junctional epithelium and supra crestal
connective tissue (gingival ) fibres are attached to
the tooth.
Average measurement:2.04 mm
i.e The junctional epithelium – 0.97mm
The connective tissue attachment – 1.07mm
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Why is the biologic width important? The body maintains the biologic width as a stable
dimension. When the biologic width is encroached upon and injured by the extension of restorative
preparations and materials into this area ,uncontrolled inflammation may occur as the body tries to reestablish
this dimension.This ultimately results in gingival recession and bone loss.www.indiandentalacademy.com
Esthetic Crown Lengthening
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Functional Crown Lengthening
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4. Furcation involvementClassification
Glickman (1953)
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Treatment of furcation involvement
Grade I - Scaling Root planing Gingivectomy Odontoplasty
Grade II - Odontoplasty Osteoplasty Tunneling Root resection Grafting GTR
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Grade III & Grade IV - Tunneling
Root resection
Grafting
GTR
Extraction
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Root resection- Indications
1. Grade II & Grade III involvement2. Severe vertical bone loss involving one root3. Endodontic failure4. Extensive root caries5. Root resorption
- Contraindications1. Teeth with poor crown root ratio2. Inadequate bone support on the roots to be
retained3. Fused roots4. Poor surgical accesswww.indiandentalacademy.com
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Hemisection
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5. Ridge AugmentationClassification
Seibert (1983)
Class I
Class II
Class IIIwww.indiandentalacademy.com
1.Immediate ridge augmentation
-Performed at the time of tooth extraction
- Advantages 1. Eliminates need for multiple surgical interventions to
augment loss.
2. Over contouring of the edentulous ridge allows for later gingivoplasty to optimize pontic to soft tissue relationship.
- Disadvantages 1. Pre surgical restorative planning must be done prior to
surgical procedure.
2. Flap management and survival over large augmentation areas.
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2. Onlay graft- The Onlay graft is of value and predictable in
small areas.- Limitations
1. Limited amount of donor material
2. Two surgical sites are necessary
3. Reliance of vascular perfusion at recepient site.
4. Unpredictable post operative tissue shrinkage.
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3. Pouch technique
- Garber and Rosenberg (1981)- Used for soft tissue ridge augmentation- Usually for Class I type of defects
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3. Roll technique- Used for soft tissue ridge augmentation- Class I defects
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4. Ridge augmentation - improved technique
- Allen et al (1985)
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5.Controlled tissue expansion- Newer modality which assists in achieving excess
tissue - Advantages1. Generates sufficient tissue at defect site.
2. Good colour matching.
3. Avoids the need of multiple phases of flap transfer or a residual defect with subsequent secondary intention healing.
- Disadvantages1. Multiple office visits for gradual expansion of expander.
2. Possible infection.
3. Tissue necrosis as a result of overexpansion.
4. Perforation of the bag during suturing.
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6. Bone graft materials and membranes used for guided tissue\bone regeneration
- Classification
I. Acc to the type of graft1. Autograft – eg) iliac crest marrow,osseous
coagulum,bone swaging,bone from extraction site,etc
2. Allograft – eg) FDBA.DFDBA
3. Alloplast – eg) bioactive silica based glass,non resorbable hydroxyapatite.
4. Xenograft – eg) bovine and procine matrix proteins.
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II. Acc to inductive potential1. Osteoinductive - eg) hip marrow,osseous
coagulum,bone from extraction site,tuberosity,DFDBA,etc.
2. Osteoconductive - eg) FDBA,DFDBA
3. Osteoneutral - eg) tricalcium phosphate
• Types of membranes1. Resorbable – eg)Guidor membrane (polylactic
acid resorbable membrane)
2. Nonresorbable – eg)Gore-tex membrane (polytetrafluoroethylene membrane)
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Guided tissue regeneration
- Indications1. Grade II furcation
2. 2-3 walled vertical defects
3. Good oral hygiene
4. Adequate keratinized gingiva
Contraindications1. Horizontal defect
2. Flap perforation
3. Very severe defect – minimal remaining periodontium
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7. Frenectomy
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8. Electrosurgery for Gingival Retraction
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Conclusion www.indiandentalacademy.com
References1) Rosensteil “Contemporary fixed
prosthodontics”, 3rd Edition.
2) Shillengburg “Fundamentals of fixed prosthodontics”, 3rd Edition.
3) Caranza “Clinical periodontology”, 8th Edition.
4) Cohen “Atlas of cosmetic and reconstructive periodontal surgery”, 2nd Edition.
5) Francis G. Serio “Manual of clinical periodontics”.
6) Wilson “Advances in periodontics”.
7) Dr. Ratnadeep Patil “Esthetic dentistry - an artists science”.
8) “Extension of clinical crown length”, JPD, 55;547: 1986.www.indiandentalacademy.com
Thank you
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