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Periodontal Aesthetics. Soft tissue aesthetics. Recession Crown fractures/Crown lengthening. BONE GRAFT. CTG?. Recession. Localised Generalised. Gingival Recession. Class II. Class I. Class IV. Class III. Classification of Recession. Millers Classification (1985).
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Soft tissue aesthetics • Recession • Crown fractures/Crown lengthening
BONE GRAFT CTG?
Recession • Localised • Generalised
Class II Class I Class IV Class III Classification of Recession • Millers Classification (1985)
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 Anatomical influences Inflammation Fenestrations Position of tooth Trauma Dehiscences Frenal attachment
Gingival recession • Indications for surgical correction include: • increases in recession • Persistent inflammation • dentinal hypersensitivity • aesthetic concerns of the patient • Early Caries • Age
Mucogingival surgery • Pedicle grafts: • Rotational flap: Lateral sliding flap, double papilla flap, oblique rotated flap. • Advanced flap: Coronally repositioned flap, semilunar coronally repositioned flap.
Mucogingival surgery • Free soft tissue grafts: • Epithelialised graft • Subepithelial connective tissue graft
Healing phases HOURS DAYS 3 MTHS 6 MTHS
week 3 19 months Day 1 LSF
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