“What is periodontal plastic surgery?”
Periodontal Plastic Surgery
Mucogingival surgery, term given by Friedman describe the surgical procedures for correction of relationship between gingiva and oral mucous membrane in reference to three specific problem areas, i.e. attached gingiva, shallow vestibule and frenum interfering with marginal gingiva. So along with advancement of periodontal surgical procedures, scope of nonpocket surgical procedures is increased, now encompassing multitude of areas that were not addressed in the past. Recognizing this, 1996 World workshop in clinical periodontics rename mucogingival surgery as “periodontal plastic surgery”. Periodontal plastic surgery was the term given by Miller in 1993 and is broadened to include the following areas:
- Periodontal prosthetic corrections
- Crown lengthening
- Ridge augmentation
- Esthetic surgical correction
- Coverage of the denuded root surface
- Reconstruction of papillae
- Esthetic surgical correction around implants
- Surgical exposure of unerupted teeth for orthodontics
- Periodontal plastic surgery is defined as “the surgical procedures performed to correct or eliminate anatomic, developmental or traumatic deformities of gingival or alveolar mucosa.” Carranza
- Periodontal plastic surgery includes only the surgical procedures of mucogingival therapy.
“Gum graft surgery cost”
Objectives of Periodontal Plastic Surgery
- Problems associated with attached gingiva
- Problems associated with shallow vestibule
- Problems associated with an aberrant frenum
- Aesthetic surgical therapy
- Tissue Engineering
“Recovery after periodontal plastic surgery”
Indications of Periodontal Plastic Surgery
- Augmentation of edentulous ridge
- Prevention of ridge collapse associated with tooth extraction
- Crown lengthening
- Loss of interdental papilla, which present as esthetic or phonetic defect.
Periodontal Plastic Surgery
Periodontal plastic surgery is defined as the surgical procedures performed to correct or eliminate anatomic, developmental or traumatic deformities of gingival or alveolar mucosa.
Objectives of Periodontal Plastic Surgery
- Problems associated with attached gingiva
- Problems associated with shallow vestibule
- Problems associated with an aberrant frenum
- Aesthetic surgical therapy
- Tissue Engineering
“Best candidates for periodontal plastic surgery”
Problems Associated with Attached Gingiva
Periodontal plastic surgery leads to creation or widening of attached gingiva around teeth and implants. Width of attached gingiva is determined by subtracting depth of sulcus or pocket from distance between crest of gingival margin and mucogingival junction. Main rationale for periodontal plastic surgery on an assumption that minimal width of attached gingiva was required to maintain optimum gingival health. For improving the aesthetics, main objective is coverage of denuded root surface. This coverage also widens the zone of attached gingiva. A wide zone of attached gingiva is needed around teeth which act as abutments for fixed or removable partial dentures. Teeth with subgingival restorations and narrow zones of keratinized gingiva have high gingival scores as compared to teeth with similar restorations and wide zones of attached gingiva. Widening of attached gingiva leads to:
“Periodontal plastic surgery vs traditional gum surgery”
- Enhanced plaque removal around gingival margin.
- Improves aesthetics.
- Reduce inflammation around restored teeth.
Problems Associated with Shallow Vestibule
In this objective of periodontal plastic surgery, creation of some vestibular depth is done when there is lack of vestibular depth. Gingival recession displaces gingival margin apically and reduces vestibular depth. With less vestibular depth oral hygiene procedures are contraindicated. Minimum attached gingiva with adequate vestibular depth does not need surgical correction if proper atraumatic hygiene is practiced from the toothbrush. Less amount of keratinized attached gingiva not having vestibular depth benefit from mucogingival correction. Vestibular depth should be adequate for proper placement of removable prosthesis.
“How to prepare for gum graft surgery”
Problems Associated with Aberrant Frenum
Objective of periodontal plastic surgery is to correct frenal or muscle attachments. If adequate gingiva is present coronal to frenum there is no need to remove it surgically. Frenum which encroaches on margin of gingiva may interfere with plaque removal and tension on this frenum may tend to open the sulcus. In such cases frenum is removed surgically.
Aesthetic Surgical Therapy
Recession of the facial gingival margin causes alteration of proper gingival symmetry and results in an aesthetic problem. The inter – dental papilla is also important to satisfy the aesthetic goals of the patient. A missing papilla creates a space that many call a black hole. Regeneration of the lost or reduced papilla is most difficult goals in aesthetic periodontal plastic surgery.Another area of concern is an excessive amount of gingiva in visible area. This condition is called as a gummy smile, and this can be corrected surgically by crown lengthening. Correction of such anatomic defects has become an important part of periodontal plastic surgery.
“Laser periodontal plastic surgery benefits”
Tissue Engineering
Future of periodontal plastic surgery will encompass the use of tissue-engineered products at the recipient site to reduce donor site morbidity. Results of numerous experimental and clinical studies support the clinician’s use of a minimally invasive approach to periodontal plastic surgery.
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