Connective Tissue Grafts 5q3v7

TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS

UCLA SCHOOL OF DENTISTRY

Presents

Dr. E. Barrie Kenney Professor & Chairman Section of Periodontics

E. Barrie Kenney B.D.Sc., D.D.S., M.S., F.R.A.C.D.S. Tarrson Family Endowed Chair in Periodontics. Professor and Chairman Division of Associated Clinical Specialties UCLA School of Dentistry

Connective Tissue Graft

Treatment of Gingival Recession Esthetic Problem

Yes

No Adequate Keratinized Gingiva Yes

3 Month Evaluation for Progression

Adequate Keratinized Gingiva

Yes

No No Gingival Graft

Gingival Graft for Root Coverage or Gingival Graft and Coronally Repositioned Flap

Recession More than 2 mm.

Yes

No Coronally Repositioned Semi-Lunar Flap

Adequate Adjacent Donor Site Yes Lateral Sliding Flap

No

Adequate Palatal Donor Site Yes

Connective Tissue Graft

No

Coronally Repositioned Flap with Membrane or Emdogain

Treatment of Gingival Recession Esthetic Problem

Yes

No Adequate Keratinized Gingiva Yes

3 Month Evaluation for Progression

Adequate Keratinized Gingiva

Yes

No No Gingival Graft

Gingival Graft for Root Coverage or Gingival Graft and Coronally Repositioned Flap

Recession More than 2 mm.

Yes

No Coronally Repositioned Semi-Lunar Flap

Adequate Adjacent Donor Site Yes Lateral Sliding Flap

No

Adequate Palatal Donor Site Yes

Connective Tissue Graft

No

Coronally Repositioned Flap with Membrane or Emdogain

Smoking and Root Coverage with Connective Tissue Grafts Smoking may affect root coverage outcome. A prospective clinical trial in humans. Martins A.G. et al J. Periodontol. 2004 75:586

• 18 Recessions in 15 Patients • 7 smokers, 8 non-smokers • Clinical evaluation at 30, 60, 90 and 120 days post surgery

Percent Root Coverage Attachment Level Gain

Non Smokers

Smokers

74.73

58.84

2.54

2.00

Root Resorption assosiated with a subepithelial connective tissue graft:Clinical and histologic report of a case. Int. J. Periodont. Rest. Dent. 2003, 4:391

Carnio J,Camargo P.M, Kenney E.B.

• 2 year post surgery • Clinically successful • Patient changed to full denture • Conventional surgery • 50% citric acid for 3 minutes

Connective Tissue Graft Plus Emdogain Histological evaluation of 4 cases with root coverage following a connective tissue graft combined with an Enamel Matrix Derivative Preparation Carnio J, Camargo, P.M., Kenney, E.B., Scheak, R.K. J. Periodontol. 2002 73:1534

• 4 upper teeth with Miller class II or III recession • Connective tissue graft plus Emdogain • Root treated with EDTA for 2 minutes • 2 sectioned at 6 months, 2 at 1 year • Light microscopy • Notch placed above bone crest

Gingival Recession • All teeth obtained root coverage • Connective tissue adjacent to root • 1 case of new cementum after 6 months • No significant new bone formation • No long junctional epithelium

Original

6 months

4

0

6

2

1 year

5

1

6

3

6 MONTH

6 MONTH

1 YEAR

AlloDerm • Processed human skin

• Basement membrane side white, rough and dull

• Developed in 1994 for burns

• Collagen elastin and ground substance

• Cells removed

• No epithelium

• Antiviral treatment

• Vessels intact

• Freeze-dried

• All donors

• Dermal side red, shiny

Negative for HIV, hepatitis B & C, syphilis

A short-term and long-term comparison of root coverage with an acellular dermal matrix and a subepithelial graft Harris RJ, J Periodont 2004, 75:734

• 25 patients • Evaluated at 12 to 13 weeks and 48 to 49 months • Non-random assignment

Percentage

AlloDerm Connective Tissue Graft

of

Root

12 - 13 weeks 93.4 96.6

Coverage 48 – 49 months 65.8 97.0

UCLA SCHOOL OF DENTISTRY