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Однажды твоя жизнь будет оценена не по тому сколько денег ты заработал и сколько у тебя машин. А по тому как ты повлиял на чью-то жизнь...


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Chirurgia OMF

Practical Periodontal Plastic Surgery


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Mucogingival therapy is a general term describing nonsurgical
and surgical treatment procedures for the correction
of defects in morphology, position, and/or amount of soft
tissue and underlying bony support around teeth and dental
implants. The term mucogingival surgery was introduced
in the literature by Friedman in 1957 and was
defined as “surgical procedures for the correction of relationship
between the gingiva and the oral mucous membrane
with reference to problems associated with attached
gingiva, shallow vestibules, and a frenum attachment that
interfere with the marginal gingiva.” Frequently, however,
the term mucogingival surgery described all surgical procedures
that involved both the gingiva and the alveolar
mucosa.
Consequently, not only were techniques designed (a) to
enhance the width of the gingiva and (b) to correct particular
soft tissue defects regarded as mucogingival procedures,
but included in this group of periodontal treatment
modalities were (c) certain pocket-elimination approaches.
According to the latest version of the American Academy of
Periodontology’s Glossary of Periodontal Terms (1992),
mucogingival surgery is defined as “plastic surgical procedures
designed to correct defects in the morphology, position
and/or amount of gingiva surrounding the teeth.” Miller
(1993) proposed that the term periodontal plastic surgery
is more appropriate because mucogingival surgery has
moved beyond the traditional treatment of problems associated
with the amount of gingiva and recession-type defects
to include correction of ridge form and soft tissue aesthetics.
Consequently, periodontal plastic surgery is defined as
“surgical procedures performed to prevent or correct
anatomic, developmental, traumatic, or plaque diseaseinduced
defects of the gingiva, alveolar mucosa, or bone”
(American Academy of Periodontology 1996, p. 702).

Periodontal plastic surgery procedures are performed to
prevent or correct anatomical, developmental, traumatic,
or plaque disease–induced defects of the gingiva, alveolar
mucosa, and bone [American Academy of Periodontology
(AAP) 1996].
THERAPEUTIC SUCCESS
This is the establishment of a pleasing appearance and
form for all periodontal plastic procedures.
INDICATIONS
Gingival augmentation
This is used to stop marginal tissue recession or to correct
an alveolar bone dehiscence resulting from natural or
orthodontically induced tooth movement. It facilitates
plaque control around teeth or dental implants, or is used
in conjunction with the placement of fixed partial dentures
(Nevins 1986; Jemt et al. 1994).
Root coverage
The migration of the gingival margin below the cementoenamel
junction with exposure of the root surface is
called gingival recession, which can affect all teeth surfaces,
although it is most commonly found at the buccal
surfaces. Gingival recession has been associated with
tooth-brushing trauma, periodontal disease, tooth malposition,
alveolar bone dehiscence, high muscle attachment,
frenum pull, and iatrogenic dentistry (Wennstrom
1996). Gingival recessions can be classified in four categories
based on the expected success rate for root coverage
(Miller 1985):
• Class I: A recession not extending beyond the mucogingival
line; normal interdental bone. Complete root coverage
is expected.
• Class II: A recession extending beyond the mucogingival
line; normal interdental bone. Complete root coverage
is expected.
• Class III: A recession to or beyond the mucogingival line.
There is a loss of interdental bone, with level coronal to
gingival recession. Partial root coverage is expected.
• Class IV: A recession extending beyond the mucogingival
line. There is a loss of interdental bone apical to the
level of tissue recession. No root coverage is expected.
Root-coverage procedures are aimed at improving aesthetics,
reducing root sensitivity, and managing root caries
and abrasions.
Augmentation of the edentulous ridge
This is a correction of ridge deformities following tooth loss
or developmental defects (Allen et al. 1985; Hawkins et al.
1991). It is used in preparation for the placement of a fixed
partial denture or implant-supported prosthesis when aesthetics
and function could be otherwise compromised.
Ridge deformities can be grouped into three classes
(Seibert 1993):
• Class I: A horizontal loss of tissue with normal, vertical
ridge height
• Class II: Vertical loss of ridge height with normal, horizontal
ridge width
• Class III: Combination of horizontal and vertical tissue loss
Aberrant frenulum
This is used to help close a diastema in conjunction with
orthodontic therapy. It is used in treating gingival tissue
recession aggravated by a frenum pull (Edwards 1977).
Prevention of ridge collapse associated
with tooth extraction (socket preservation)
The maintenance of socket space with a bone graft after
extraction will help reduce the chances of alveolar ridge
resorption and facilitate future implant placement.
Crown Lengthening
This is used when there is not enough dental tissue available
or to improve aesthetics (Bragger et al. 1992; Garber
& Salama 1996).
Exposure of nonerupted teeth
The procedure is aimed at uncovering the clinical crown of
a tooth that is impacted and enable its correct positioning
on the arch through orthodontic movement.
Loss of interdental papilla
No technique can predictably restore a lost interdental
papilla. The best way to restore a papilla is not to lose it in
the first place.

 

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