Periodontal Plastic Surgery

 
Today, the term "periodontal plastic surgery" is understoond as "surgical procedures aimed to prevent or eliminate congenital anatomical and (or) acquired gum defects, alveolar mucosa and bone" (American Academy of Periodontology, 1996).
 
The success of any plastic surgery is to achieve a favorable appearance and the natural shape of a particular anatomical structure of the patient's mouth. In this section, I describe the main types of defects encountered and remedies. 
 
To improve the accuracy and quality of surgery in periodontal surgery an operating microscope or binoculars with additional lighting are used, small tools and a thin suture material. 
 
So what are the surgical techniques that we use to fix various defects in the oral cavity:
 
1. Using of free gingival graft. This method is highly efficient and flexible. From the palate, where the thickest gum is with a scalpel a gingival graft of the required size is excised and fixed to the site with suture material to the defect area. The method is needed to eliminate recessions (baring of roots of teeth), to increase the amount of lost gum in extracted teeth area (preparation for prosthetics), etc.
 
 
2. Subepithelial tissue connecting graft - this technique is considered to be the "gold standard" for the elimination of gingival recession in periodontal plastic surgery,
 
and used to remove visualization of implant or abutment edge, increasing the zone of keratinized attached gingiva and alveolar ridge increasing. 
 
The method consists in the excision of tissue from the palate lying under the top layer of the gums and fixation of the graft in the area of soft tissue defects.
 
3. Transplants on the pedicle. This method of periodontal plastic surgery is used to increase the insufficient amount of soft tissue, remove gingival recession.
 
Gum is split into two parts, above- or underlying soft tissue is shifted to the area of the defect, without cutting it off completely, leaving the pedicle.
 
4. Removal of frenulum of the upper lip or tongue. It is recommended with a short frenulum attaching, conducting of orthodontic treatment and to create conditions for a satisfactory self-care. During this procedure the frenulum is excised and then the wound edges are stitched.
 
5. Lengthening of the clinical crown is used to remove excess gum imaging (for aesthetic reasons), with caries of the root, short clinical crowns. 
 
In spite of the absolute individuality of each patient, the beauty of a smile has several components and is subject to certain general laws. Smile components are teeth (from premolar to premolar), periodontal (gum contour) and the lips.
 
With a beautiful smile75-100% of the upper incisors and gingival papillae are exposed. Gum margin in the area of central incisors and canines is located on one level, and in the lateral incisors is 2mm lower. The line on incisorial edge is parallel to the lower lip.
 
Lengthening clinical crowns through gingivectomy (removal of the gums) allows creating a unique beautiful smile.
 
6. Vestibuloplastic by Kazanjian. Used on the lateral parts of the jaws prior to or in association with implants to increase the zone of keratinized attached gingiva.
 
Close fastened movable mucosa may affect the health of crowns and lifetime of the implants. Thanks to this technique, we displace the movable portion of the mucous away from implants.
 
7. Methods of the second surgical stage of implantation (the disclosure of implants). During the second surgical stage of implantation they provide access to the implant, check the degree of integration (healing), set to form gums or a temporary crown. In addition, at this stage the gums surrounding the implant can be improved with the help of the following methods:
1. Apikally displaced flap.
2. Tissue connecting transplantation.
 
3. Roll technique.
 
4. Free gingival graft.
5. Restoration of gingival papillae.
 
Recommendations: Any microsurgical intervention in periodontal plastic surgery shows slight swelling and weak pain in the first 3 days. Operated tissues are healed in a few weeks, and the aesthetic result may be received only in one year. In this regard, I recommend home treatment in the first 2 days, refuse solid food for a month, 3 weeks do not use a toothbrush, and after this period apply a brush for the postoperative period with very soft bristles. Fulfill all the recommendations of the physician.