Periodontal plastic surgery

1. Periodontal
Plastic Surgery
Dr Jaffar Raza Syed
Lecturer: Periodontology
KMU-IDS Kohat

2. Objectives:
The objectives of periodontal plastic surgery is to deal with
the problems associated with
Attached gingiva
Shallow vestibule
Aberrant frenum
Papilla
Resorbed alveolar ridge

3. Selection Criteria:
Surgical site free of plaque, calculus and inflammation
Adequate blood supply to the donor tissue
Anatomy of the recipient site
Anatomy of the donor site
Stability of the grafted tissue to the recipient site
Minimal trauma to the surgical site

4. TECHNIQUES FOR INCREASING ATTACHED GINGIVA

5. Epithelial or Free Gingival Graft
Step I: Inject anesthesia
Step II: Prepare the recipient site
Step III: Obtain the graft from the donor site
Step IV: Transfer and immobilize the graft
Step V: Protect the donor site
Step VI: Postoperative instructions
Step VII: Suture removal

6. Post Operative Healing
Phase I: Plasmatic circulation (0–3 days):

7. Phase II: Vascularization (2–11 days):

8. Phase III: Organic union (11–42 days): Tissue maturation phase:

10. Root Coverage Gingival Recession

11. Classification of Soft-tissue Procedures used for Root Coverage

12. Subepithelial Connective Tissue Graft
indicated for larger and multiple defects with good vestibular depth and gingival
thickness to allow a split thickness flap to be elevated. Adjacent to the denuded
root surface, the donor connective tissue is sandwiched between the split flap

14. Laterally Positioned Pedicle Flap:

15. Laterally Positioned Pedicle Flap:

16. Laterally Positioned Pedicle Flap:

17. Double Papilla Flap Procedures:

18. Double Papilla Flap Procedures:

19. Coronally Displaced Flap
create a split-thickness flap in the area apical to the denuded root and position it
coronally to cover the root
Indication
Cover denuded root surface with adequate width of keratinized gingiva.
Procedure
Step I: Incisions: Internal bevel incision/ vertical incisions are given
beyond the mucogingival junction
Step II: Flap reflection: Partial-thickness flap is raised
Step III: Scaling and planing
Step IV: Suturing

20. Semilunar Coronally Displaced Flap:
provides 2–3 mm of root coverage which is successful for the maxilla.
It is not recommended for mandibular teeth

21. Frenectomy
Indications
Gingival or papillary frenal attachment
High-frenum attachment
To facilitate orthodontic treatment
Gingival recession
When lingual frenum interferes with speech
Instruments
Mosquito forceps or hemostat.
Surgical handle Bard–Parker No. 3 with detachable and replaceable surgical blades
No. 15 or 11

22. TECHNIQUES TO VESTIBULAR EXTENSION
3 basic procedures for extending the gingiva into the vestibule:
1. Gingival extension using periosteal fenestration.
2. Vestibuloplasty using modified Edlan–Mejchar procedure.
3. Gingival extension with a free epithelial graft.

23. Gingival extension using periosteal fenestration

24. Vestibuloplasty using modified Edlan–Mejchar procedure

25. TECHNIQUES FOR PAPILLA RECONSTRUCTION
Classification of Papillary Height Nordland and Tarnow (1998)

26. Procedure
The various methods to create interdental papilla are

27. TECHNIQUES FOR ALVEOLAR RIDGE AUGMENTATION
Classification Seibert (1983)
Modification of Classification

28. Procedure
The various approaches are as follows:
Pedicle graft procedure
Roll flap procedure
Free graft procedures
Pouch graft procedure
Interpositional graft procedure
Onlay graft procedure.