Documente Academic
Documente Profesional
Documente Cultură
Soft Tissue
Grafting
Surgery
Objectives
To understand some of the different
types of grafts used in Periodontal
Plastic Surgery (Mucogingival Surgery)
To understand the indications for the
different types of mucogingival
surgeries
To show some examples of one of the
most common grafting procedures, the
FGG and CTG.
To understand when a condition would
not benefit from Mucogingival Surgery
Definitions
Attached Gingiva The portion of
the gingiva that is firm, dense, stippled
and tightly bound to the underlying
periosteum, tooth, and bone.
Free Gingiva That part of the
gingiva that surrounds the tooth and is
not directly attached to the tooth.
Definitions
Mucogingival Junction the area of
union of the gingiva and alveolar
mucosa
Alveolar Mucosa Loosely attached
mucosa covering the basal part of the
alveolar process and continuing into the
vestibular fornix and the floor of the
mouth
Definitions
Mucogingival Defect a departure
from the normal dimension and
morphology of the relationship
between the gingiva and the alveolar
mucosa
Definitions
Free Gingival Graft (FGG) - A soft
tissue graft that is completely
detached from one site and
transferred to a remote site. No
connection with the donor site is
maintained
Subepithelial Connective Tissue
Graft (CTG) - A detached connective
tissue graft that is placed beneath a
partial thickness flap. This variation of
the free gingival graft provides the
tissue graft with a nutrient supply on
vestibuloplasties
1948 First Gingivoplasties
1956 Grupe and Warren publish
Laterally Positioned Flap
1963 Bjorn publishes the Free
Gingival Graft
1982 P.D. Miller introduces the FGG
for root coverage. Fernandez does first
CT graft
1989 AAP renames Mucogingival
Surgery to Periodontal Plastic Surgery
Root Coverage
Coronally positioned flap
Semilunar flap
Laterally positioned flap
Double papilla flap
Free Gingival Graft
Connective Tissue Graft
Guided Tissue Regeneration using
Disadvantages
Pre-op
Recipient
Site
Courtesy of Barry R. Wohl, DDS
Long-term follow-up
Courtesy of Barry R.
Wohl, DDS
Receding Gums
Miller Classification of
Class I. Recession
Recession
that has not extended
to MGJ. No bone loss
Class II. Recession to
or beyond the MGJ.
No bone loss
Class III. Recession
to or beyond MGJ.
Bone loss. Papilla
recession
Class IV. Recession
beyond MGJ. Bone
Precipitating Factors:
Inflammation related to plaque
Restorations adjacent to thin tissue
Occlusal Trauma including orthodontic
treatment
After
Connective
Tissue Graft
Pre-op
Occlusal
Trauma
Postop
3 years post-op
Does it HURT?
The common perception is that
Connective Tissue Grafting is VERY
PAINFUL!!
This is often the patients
perception
This perception is usually the result
of hearsay from friends and
relatives
The origins probably go back to the
days of the Free Gingival Grafts
FEAR
Does it HURT?
Reality
In 20 years of performing CT grafts, very
few patients ever complain about
significant pain afterwards
Most are pleasantly surprised at how
little pain they had
Very little post-op bleeding, swelling or
bruising
Of course, everyones pain threshold is
different
Conclusions
Mucogingival defects are very
common across all age groups and
both genders
Mucogingival defects can be either
congenital or acquired with both
predisposing and precipitating factors
Periodontal Plastic Surgery can be
used to correct mucogingival defects
via a variety of methods and
techniques
Indications for Periodontal Plastic
Thank You!
Questions?