soft tissue grafts techniques
DESCRIPTION
Fundamentals of Soft Tissue Grafting Principles for Dental Cliniciansby Dr. Jin Y. KimBoard-Certified PeriodontistLecturer, UCLA School of DentistryTRANSCRIPT
Periodontal Plastic Surgery:Fundamentals of
Soft Tissue Grafting Techniques
Jin Y. Kim, DDS, MPH, MS Diplomate, American Board of Periodontology
Lecturer, UCLA Periodontics
Periodontal Plastic Surgery:Fundamentals of
Soft Tissue Grafting Techniques
Jin Y. Kim, DDS, MPH, MS Diplomate, American Board of Periodontology
Lecturer, UCLA Periodontics
Copyright 2009 © Jin Y. Kim, DDS, MPH, MS www.DrJinKim.comwww.DrJinKim.com
Periodontal Plastic SurgeryPeriodontal Plastic Surgery
• Augmentation of the dimensions of gingival tissue
• Frenectomy
• Root coverage procedures
• Reconstruction of the alveolar ridge
• Surgical crown lengthening for function and esthetics
• Surgical exposure of unerupted teeth
• Augmentation of the dimensions of gingival tissue
• Frenectomy
• Root coverage procedures
• Reconstruction of the alveolar ridge
• Surgical crown lengthening for function and esthetics
• Surgical exposure of unerupted teeth
Copyright 2009 © Jin Y. Kim, DDS, MPH, MS www.DrJinKim.comwww.DrJinKim.com
Root Coverage ProceduresRoot Coverage Procedures
• Indications:– root sensitivity– esthetics– protect root surface from caries/abrasions– improved hygiene
• Indications:– root sensitivity– esthetics– protect root surface from caries/abrasions– improved hygiene
Copyright 2009 © Jin Y. Kim, DDS, MPH, MS www.DrJinKim.comwww.DrJinKim.com
Root Coverage ProceduresRoot Coverage Procedures
• pedicle soft tissue grafts– rotational flaps– advanced flaps
• free soft tissue grafts– epithelized soft tissue graft– subepithelialized connective tissue graft
• combination graft– one-stage procedures– two-stage procedures
• pedicle soft tissue grafts– rotational flaps– advanced flaps
• free soft tissue grafts– epithelized soft tissue graft– subepithelialized connective tissue graft
• combination graft– one-stage procedures– two-stage procedures
Copyright 2009 © Jin Y. Kim, DDS, MPH, MS www.DrJinKim.comwww.DrJinKim.com
Marginal Tissue RecessionMarginal Tissue Recession
• Class I– recession not extending to MGJ– no loss of interdental bone or soft tissue
• Class II– recession extends to, or beyond MGJ– no loss of interdental bone or soft tissue
• Class I– recession not extending to MGJ– no loss of interdental bone or soft tissue
• Class II– recession extends to, or beyond MGJ– no loss of interdental bone or soft tissue
Miller P.D. Int J Periodont Rest Dent 1985;2:8
II
IIII
IIIIII
IVIV
Copyright 2009 © Jin Y. Kim, DDS, MPH, MS www.DrJinKim.comwww.DrJinKim.com
Marginal Tissue RecessionMarginal Tissue Recession
• Class III– recession extends to, or beyond MGJ– loss of interdental bone or soft tissue
apical to CEJ, but coronal to apical extent of marginal tissue recession
• Class IV – recession extends to, or beyond MGJ– loss of interdental bone or soft tissue
apical to the extent of marginal tissue recession
• Class III– recession extends to, or beyond MGJ– loss of interdental bone or soft tissue
apical to CEJ, but coronal to apical extent of marginal tissue recession
• Class IV – recession extends to, or beyond MGJ– loss of interdental bone or soft tissue
apical to the extent of marginal tissue recession
Miller P.D. Int J Periodont Rest Dent 1985;2:8
II
IIII
IIIIII
IVIV
Copyright 2009 © Jin Y. Kim, DDS, MPH, MS www.DrJinKim.comwww.DrJinKim.com
Ridge Deficiency (Seibert)Ridge Deficiency (Seibert)
• Class I– buccolingual loss of tissue with normal ridge
height in a apicocoronal dimension
• Class II– apicocoronal loss of tissue with normal ridge
width in a buccolingual dimension
• Class III– combined buccolingual and apicocoronal loss of
tissue resulting in loss of normal height and width
• Class I– buccolingual loss of tissue with normal ridge
height in a apicocoronal dimension
• Class II– apicocoronal loss of tissue with normal ridge
width in a buccolingual dimension
• Class III– combined buccolingual and apicocoronal loss of
tissue resulting in loss of normal height and width
Seibert J.S. Compend Cont Educ Dent 1983;4:437
Copyright 2009 © Jin Y. Kim, DDS, MPH, MS www.DrJinKim.comwww.DrJinKim.com
Ridge Deficiency (Allen)Ridge Deficiency (Allen)
• Type A– apicocoronal loss of ridge contour
• Type B– buccolingual loss of ridge contour
• Type C– combined buccolingual and apicocoronal
loss of ridge contour
• Type A– apicocoronal loss of ridge contour
• Type B– buccolingual loss of ridge contour
• Type C– combined buccolingual and apicocoronal
loss of ridge contourAllen P. et al J Periodontol 1985;4:195
Type
Copyright 2009 © Jin Y. Kim, DDS, MPH, MS www.DrJinKim.comwww.DrJinKim.com
Ridge Deficiency (Allen)Ridge Deficiency (Allen)
• Mild– less than 3 mm
• Moderate– 3 to 6 mm
• Severe– greater than 6 mm
• Mild– less than 3 mm
• Moderate– 3 to 6 mm
• Severe– greater than 6 mm
Allen P. et al J Periodontol 1985;4:195
Severity
Copyright 2009 © Jin Y. Kim, DDS, MPH, MS www.DrJinKim.comwww.DrJinKim.com
Cosmetic Root CoverageCosmetic Root Coverage
• classification 1968, 1985• coronally positioned flap 1976, 1986• free gingival grafts 1982, 1985• subepithelial C.T. graft 1985, 1986• envelope flap 1985• semilunal flap 1986• GTR (G-TAM) 1991, 1992
• classification 1968, 1985• coronally positioned flap 1976, 1986• free gingival grafts 1982, 1985• subepithelial C.T. graft 1985, 1986• envelope flap 1985• semilunal flap 1986• GTR (G-TAM) 1991, 1992
Historical Perspective
Copyright 2009 © Jin Y. Kim, DDS, MPH, MS www.DrJinKim.comwww.DrJinKim.com
Ridge AugmentationRidge Augmentation
• classification 1983• roll technique 1979• onlay grafting 1979, 1983• subepithelial C.T. graft 1979, 1982• pouch procedure 1980, 1981• modified or improved technique 1985• socket preservation 1989• GTR 1988
• classification 1983• roll technique 1979• onlay grafting 1979, 1983• subepithelial C.T. graft 1979, 1982• pouch procedure 1980, 1981• modified or improved technique 1985• socket preservation 1989• GTR 1988
Historical Perspective
Copyright 2009 © Jin Y. Kim, DDS, MPH, MS www.DrJinKim.comwww.DrJinKim.com
Graft ThicknessGraft Thickness
Thickness Primary(mm) contraction Immobilization Viability .
0.5-0.75 slight essential best “take”
0.75-1.25 moderate absolutely less assuredessential
1.25-1.75 greatest absolutely least assuredessential
Sullivan H.C., & Atkins J.H. Periodontics 1966;6:121
Copyright 2009 © Jin Y. Kim, DDS, MPH, MS www.DrJinKim.comwww.DrJinKim.com
Palatal TissuePalatal Tissue