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Periodontal Aesthetics

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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Periodontal Aesthetics

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  1. Periodontal Aesthetics

  2. Soft tissue aesthetics • Recession • Crown fractures/Crown lengthening

  3. BONE GRAFT CTG?

  4. Recession • Localised • Generalised

  5. Gingival Recession

  6. Class II Class I Class IV Class III Classification of Recession • Millers Classification (1985)

  7. New causes of recession

  8. 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)

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

  10. TYPE 1 Gingival Biotype I

  11. TYPE 2 Gingival Biotype II

  12. Relationship of anatomy and inflammation leading to recession Keratinised tissue Bacteria Anatomical influences Inflammation Fenestrations Position of tooth Trauma Dehiscences Frenal attachment

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

  14. Can a clean site be maintained?

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

  16. Mucogingival surgery • Free soft tissue grafts: • Epithelialised graft • Subepithelial connective tissue graft

  17. Healing phases HOURS DAYS 3 MTHS 6 MTHS

  18. Lateral Sliding Flap

  19. week 3 19 months Day 1 LSF

  20. Lateral Sliding Flap

  21. Coronally Repositioned Flap

  22. Coronally Repositioned Flap

  23. Free Gingival Graft

  24. Sub-epithelial CT graft

  25. Sub-epithelial CT Graft

  26. Frenectomy

  27. 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

  28. Crown Lengthening

  29. Crown Lengthening

  30. Crown Lengthening

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