Periodontal Aesthetics

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Periodontal Aesthetics
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Soft tissue aesthetics

• Recession
• Crown fractures/Crown lengthening

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BONE GRAFT
CTG?
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Recession

• Localised
• Generalised

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Gingival Recession
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Classification of Recession

• Millers Classification (1985)

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New causes of recession
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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)

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Gingival Biotype

• Two gingival biotypes have been described by
  Olsson Lindhe (1991)
• Thick, flattened biotype (type 1)
• Thin, scalloped biotype (type 2 )

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Gingival Biotype I
TYPE 1
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Gingival Biotype II
TYPE 2
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Relationship of anatomy and inflammation leading
to recession
Keratinised tissue
Bacteria
Anatomical influences
Inflammation
Fenestrations
Position of tooth
Trauma
Dehiscences
Frenal attachment
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Gingival recession

• Indications for surgical correction include
• increases in recession
• Persistent inflammation
• dentinal hypersensitivity
• aesthetic concerns of the patient
• Early Caries
• Age

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Can a clean site be maintained?
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Mucogingival surgery

• Pedicle grafts
• Rotational flap Lateral sliding flap, double
  papilla flap, oblique rotated flap.
• Advanced flap Coronally repositioned flap,
  semilunar coronally repositioned flap.

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Mucogingival surgery

• Free soft tissue grafts
• Epithelialised graft
• Subepithelial connective tissue graft

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Healing phases
HOURS
DAYS
3 MTHS
6 MTHS
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Lateral Sliding Flap
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LSF
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Lateral Sliding Flap
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Coronally Repositioned Flap
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Coronally Repositioned Flap
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Free Gingival Graft
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Sub-epithelial CT graft
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Sub-epithelial CT Graft
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Frenectomy
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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

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Crown Lengthening
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Crown Lengthening
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Crown Lengthening