Periodontics › Surgery
Mucogingival Surgery
High-yield revision notes with linked practice questions, written for dental students and candidates preparing for the ADC and other licensing examinations.
High-yield notes
Vestibular depth is measured from the gingival margin to the bottom of the vestibule.
The sulcular brushing technique requires the placement of the toothbrush at the gingival margin, which may not be possible with reduced vestibular depth.
"Gummy smile" may be corrected surgically by crown lengthening.
the mucogingival line in the incisor and canine areas is located approximately 3 mm apical to the crest of the alveolar bone on the radicular surfaces and 5 mm interdentally.
Techniques for gingival augmentation apical to the area of recession include free gingival auto graft, free connective tissue auto graft and the apically positioned flap.
A space between the graft and the underlying tissue is called as dead space
The disadvantage of the free gingival graft is color mismatch.
Periosteal separation technique is a vestibular extension technique where a fenestration is surgically created to create a scar that is firmly bound to the bone.
Subepithelial Connective Tissue Graft was given by Langer and involves the sandwiching of connective tissue from donor site.
Subpedicle (bilaminar) connective tissue graft is a variant of sub-epithelial connective tissue graft.
Creeping reattachment is the postoperative migration of the gingival marginal tissue in the coronal direction along portions of a previously cut root.
The reconstruction of the lost or reduced interdental papilla is the most difficult and unpredictable problem in esthetic periodontal therapy.
Ideally, the width/length ratio of a maxillary central incisor clinical crown should fall between 0.78 and 0.85.
Thus a central incisor with a width of 8.5 mm should have a length between 10 and 11 mm.
Blood supply is the most significant concern in mucogingival surgery
Cigarette smoking is a contraindication for root coverage techniques because the compromised gingival blood supply results in many failures.
Practice questions
Select an option to check your answer. Answers are shown below each question.
The most common cause of gingival recession and the loss of attached gingiva is
- Aabrasive and traumatic tooth brushing habits
- Bdehiscence and fenestration
- Cchronic marginal inflammation
- Dperiodontitis
If the width of attached gingiva to be augmented apical to the recession by free gingival graft is 3 mm, the incision on the recipient site with two vertical incisions from the gingival margin into the alveolar mucosa should extend up to,
- A1.5 mm
- B3 mm
- C4.5 mm
- D6 mm
Ideal thickness of the graft is
- A1.5-2.0 mm
- B1.0-1.5 mm
- C0.5-1.0 mm
- D2.0-2.5 mm
The technique of attaining expansion of the free gingival graft by alternate incisions in opposite sides of the graft is called,
- AClassical technique
- BAccordion technique
- CStrip technique
- Dcombination epithelial-connective tissue strip technique
Revascularization of the graft starts by the
- A5th -6th day
- B2nd or 3rd day
- C1st or 2nd day
- D3rd or 4th day
The fate of the epithelium of the free gingival graft is
- ADevelopment of rete pegs
- BLong junctional epithelium formation
- CDegeneration
- DIncreased keratinization
Not an advantage of the Free Connective Tissue Autografts
- Aoverlying epithelium will be keratinized
- Bhealing is by first intention
- Cless discomfort postoperatively at the donor site
- Dwound is limited to a single area only.
The position best for the apically displaced flap is
- ASlightly coronal to the crest of the bone
- BAt the level of the crest
- CTwo millimeters short of the crest
- DAny of the above position is best suited.
Marginal tissue recession extends to or beyond the mucogingival junction. There is bone and soft tissue loss interdentally or malpositioning of the tooth. According to Miller, which class of recession is it?
- AClass I
- BClass II
- CClass III
- DClass IV
Treatment of choice to cover isolated, denuded root surfaces is
- AFree gingival graft
- BFree connective tissue graft
- CLaterally displaced flap
- DCoronally displaced flap
Not true about semilunar flap
- AIt is a coronally displaced flap
- BIt can be performed on several adjoining teeth.
- Crecommended for the mandibular dentition
- Dindicated where the recession is not more than 3 mm
Untrue about Pouch and Tunnel Technique (Coronally Advanced Tunnel Technique)
- Aesthetic result is excellent
- Bthinning out of the gingival margin after healing
- Cprovides abundant blood supply to the donor tissue
- DThe area is not covered with periodontal dressing.
Tension test is used to check
- AWidth of Attached gingiva
- BVestibular depth
- CFrenal attachment
- DTrauma from occlusion
Not a desired technique for correction of dark triangle
- ARestorative procedure
- BOrthodontic intrusion
- CTissue engineering for papilla reconstruction.
- DFree gingival graft for papilla reconstruction.
Which of the following factor does not cause "Gummy Smile"?
- Avertical maxillary excess
- Bexcessive exposure of the anatomic crown
- Caltered passive eruption
- Dshort upper lip or excessive lip translation
The gingival margin of the lateral incisor is usually about
- AAt the same level as that of the central incisor and the canine
- B1.0 mm coronal to the margins of the adjacent teeth,
- C1.0 mm apical to the margins of the adjacent teeth
- D2.0 mm apical to the margins of the adjacent teeth
0 mm of keratinized marginal tissue
- AThere is no need for osseous surgery, soft tissue excision alone is the treatment of choice.
- BExcision plus an apically positioned flap would be the treatment of choice.
- CSoft tissue excision plus osseous surgery would be the treatment of choice.
- DSoft tissue excision plus osseous surgery plus apically displaced flap would be the treatment of choice.
Which of the following is an example of passive tissue engineering?
- AEnamel matrix derivative (EMD)
- BAutologous fibroblast
- Cguided tissue replacement (GTR)
- DRecombinant human platelet-derived growth factor-BB (rhPDGF-BB)
One of the following is not the criteria for selection of mucogingival techniques
- AAdequate blood supply to the donor tissue.
- BMedical conditions of the patient
- CStability of the grafted tissue to the recipient site
- DAnatomy of the recipient and donor sites
These notes are compiled from standard periodontology texts for study purposes. They are a revision aid, not a substitute for your own reading or current clinical guidelines. If you spot an error, please leave a comment.