Definition and Objectives of Periodontal Plastic Surgery
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].
This is the establishment of a pleasing appearance and form for all periodontal plastic procedures.
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).
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
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 wih tooth extraction (socket preservatton)