Surgical procedures/ dentistry dental implants

SURGICAL PROCEDURES IN FPD

INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

www.indiandentalacademy.com

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


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


Contraindications

- Inadequate width of keratinized tissue

- Pockets beyond mucogingival junction

- Presence of intrabony pockets


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.


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


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


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.


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.


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

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.


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


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


Functional Crown Lengthening


4. Furcation involvementClassification

Glickman (1953)


Treatment of furcation involvement

Grade I - Scaling Root planing Gingivectomy Odontoplasty

Grade II - Odontoplasty Osteoplasty Tunneling Root resection Grafting GTR


Grade III & Grade IV - Tunneling

Root resection

Grafting

GTR

Extraction


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

Hemisection


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.


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.


3. Pouch technique

- Garber and Rosenberg (1981)- Used for soft tissue ridge augmentation- Usually for Class I type of defects


3. Roll technique- Used for soft tissue ridge augmentation- Class I defects


4. Ridge augmentation - improved technique

- Allen et al (1985)


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.


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.


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)


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


7. Frenectomy


8. Electrosurgery for Gingival Retraction


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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