DENT 267: LO4 LS1&LS2- Plan Perio Therapy for Mucogingival Deformities

normal mucogingival conditions

-the absence of diseased state

-absence of gingivitis, periodontitis, and gingival recession

-perio health can be maintained despite lack of keratinized tissue as well as presence of frena, shallow vestibular depth

periodontal biotypes

-AKA gingival biotype, periodontal morphotype, phenotype

-describes the individual differences in gingival anatomy and morphology

3 categories of periodontal biotypes

-thin scalloped biotype

-thick flat biotype

-thick scalloped biotype

thin scalloped biotype

-slender triangular-shaped tooth crowns

-subtle cervical convexity (scalloping)

-interprox contacts close to incisal edge

-narrow zone of keratinized tissue

-clear, thin delicate gingiva

-thin alveolar bone

thick flat biotype

-square-shaped tooth crowns

-pronounced tissue scalloping

-large interprox contact areas more apical

-thick, fibrotic gingiva

-thick alveolar bone

thick scalloped biotype

slender tooth crowns

-pronounced gingival scalloping

-thick fibrotic gingiva

-narrow zone of keratinized tissue

mucogingival deformities

-significant alteration of morphology, size and interrelationships b/w gingiva and alveolar mucosa that may involve underlying bone

-affects a large number of patients

what is the most common mucogingival deformity

-gingival recession

gingival recession

-most common mucogingival deformity

-apical displacement of gingival margin w/ respect of the CEJ

-associated w/ attachment loss with root exposure

risk factors for gingival recession

-thin periodontal biotype

-absence of attached gingiva

-reduced thickness of alveolar bone due to abnormal tooth position in the arch

how much keratinized tissue and attached gingiva are desirable to maintain health?

-2mm keratinized tissue

-1mm attached gingiva

Miller Classification System for recession of GM

-most common

-based on level of GM with respect to MGJ and underlying bone

-sometimes difficult to identify exact location of apical extent of recession defect w/ respect to MGJ

-difficult to differentiate b/w class I and II

-not clear in defining amount of interprox soft/hard tissue loss b/w class III and IV

-reliability has never been tested

Miller Classification System for recession of GM: Class I

-marginal recession but does not extend to MGJ

-no loss of bone or soft tissue in the inter-dental area

-100% root coverage can be anticipated

Miller Classification System for recession of GM: Class II

-marginal recession that extends to or beyond MGJ

-no loss of bone or soft tissue in interdental area

-100% root coverage can be anticipated

Miller Classification System for recession of GM: Class III

-marginal recession that extends to or beyond MGJ

-bone and soft tissue loss in interdental area

-may have tooth malpositioning that prevents coverage of certain roots

Miller Classification System for recession of GM: Class IV

-marginal recession that extends to or beyond MGJ

-bone and soft tissue loss very severe in interdental area

-may have tooth malpositioning so severe that prevents coverage of many roots

Cairo Classification System for Recession of GM

-new system proposed based on CAL measurements (more objective measurements to classify extent and severity than Miller System) at buccal and interprox sites

Cairo Classification System Recession Types (RT)

-RT1

-RT2

-RT3

Cairo Classification System Recession Types: RT1

-gingival recession w/ no loss of interprox attachment

-most likely associated w/ traumatic toothbrushing

Cairo Classification System Recession Types: RT2

-gingival recession w/ loss of interprox attachment

-most likely associated w/ periodontitis-associated horizontal bone loss

Cairo Classification System Recession Types: RT3

-same as RT2 (gingival recession w/ loss of interprox attachment) but with interproximal loss greater than buccal loss and infrabody defects

mucogingival deformities and conditions around teeth

-periodontal biotype

-gingival/soft tissue recession

-lack of keratinizd gingiva

-decreased vestibular depth

-aberrant frenum/muscle position

-gingival excess

-abnormal color

Stillman's cleft

-type of gingival recession

-narrow, triangular or apostrophe shaped

-exposes cementum

Stillman's cleft: clinical characteristics

-apical position

-inflamed or healthy

-localized or generalized

-more common w/ increase in age

-clients with good OH can have

causes of gum recession

-genetics

-brushing aggressively

-mouth injury or trauma

-perio disease

-braces and dental restos

-poor OH

-teeth grinding or clenching

-high frenal attachment

etiology of recession

-inflammation

-uneven gingival margins

-impact of cervical restos: sites with minimal or no attached gingiva associated w/ intrasulcular resorations are more prone to recession and inflammation

-over vigorously brushing

-excessive occlusal force

-tension of a frenum/high frenal attachment

-inadequate zone of attached gingiva

-habits

-ortho

-following perio surgery

-use of abrasive prophylaxis paste

-dentoalveolar ablation

-piercings

-root to bone angle and attrition

mucogingival involvement (MGI)

-when a perio pocket extends to or beyond the MGJ, the probe may pass through the pocket directly into the alvolar mucosa

minimally attached gingiva

-limited amount of attached gingiva, which is the portion of gum tissue firmly bound to the tooth and underlying bone surrounding the teeth

MAG vs MGI

-MAG:

prognosis of recession

-favourable if no MGI, if recession is not over extensive and if risk factors are corrected

-surgery may be needed: pedicle graft, free gingival graft