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TACD MEMBERS NIGHT Tuesday April 12, 2011

TACD MEMBERS NIGHT Tuesday April 12, 2011. Subepithelial Connective Tissue Graft for Root Coverage. AGENDA. Brief history of the technique Etiology and indications for using a subepithelial connective graft (CTG) Advantages and limitations

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TACD MEMBERS NIGHT Tuesday April 12, 2011

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  1. TACD MEMBERS NIGHTTuesday April 12, 2011 Subepithelial Connective Tissue Graft for Root Coverage

  2. AGENDA • Brief history of the technique • Etiology and indications for using a subepithelial connective graft (CTG) • Advantages and limitations • Miller’s classification and procedure predictability • Materials, instruments and surgical technique • Visit with patients who have undergone the procedure • Live demonstration

  3. ETIOLOGY & INDICATIONS ROOT COVERAGE • Corrective or preventive (acts as a fiber barrier) • Increased susceptibility to root caries • Tooth hypersensitivity from exposed dentin • Aesthetic concerns of exposed dentin and/or crown margins RIDGE AUGMENTATION

  4. MILLER’S CLASSIFICATION Type I • No interdental bone loss • Defect is coronal to the mucogingival junction (MGJ) Type II • No interdental bone loss • Defect extends to or beyond MGJ Highly predictable complete root coverage

  5. MILLER’S CLASSIFICATION Type III • Interdental bone loss (mild to moderate) with accompanying loss of papillary height • Defect at or apical to the MGJ Type IV • Severe interdental bone loss with accompanying loss of papilla • Defect at or apical to the MGJ Complete root coverage impossible

  6. ADVANTAGES • Highly predictable • Highly successful due to enhanced blood supply • Aesthetic • Used on single or multiple sites • Good healing potential for palate donor site

  7. LIMITATIONS • Technically demanding • Anatomy may limit volume of available tissue-shallow palatal vault, greater palatine vessels, nasopalatine vessels • Multiple sites may need multiple appointments due to tissue volume limitations • Previous surgeries and scar tissue formation

  8. MATERIALS, INSTRUMENTS AND TECHNIQUE Microsurgical Kit Mirror, probe, cotton pliers, suture pliers, Castroviejo suture forceps, scissors, microsurgery elevators, Orban knife, #15 & 15c blades and round handle, Harris knife, scalers, EDTA or tetracycline, saline, glass slab and gauze Gut 5-0, Polypropylene 6-0 and Vicryl 4-0 sutures • Thorough oral hygiene work up • Review procedure with patient • Pre op meds • Pre-surgical rinse • Local anaesthetic (Citanest 4% plain, Lidocaine 2% 1:100,00/50,000) • Prepare recipient site-floss, root plane and smear layer treatment, pouch/envelope flap preparation(blunt then sharp dissection) • Harvest graft tissue from palate (premolar or retromolar) and close • Place and secure graft (sling suture)

  9. POST-OP • Ice area • Review procedure Post-op Recommendations • Ice on and off every 10 minutes • Limited activity for 24 hours • No brushing or manipulating area for 4-6 weeks • Maintain good oral hygiene and take meds (antibiotic, anti-inflammatory, Peridex) • Call patient • Remove palatal sutures in 1 week and grafted site sutures in 2-3 weeks

  10. QUESTIONS ?

  11. CLIENTS AND NOTES • Lisa: CTG lower anteriors lingual first surgery 2005, second surgery 2006 • Robert: CTG #33 facial Oct. 2010 • Armando: CTG #16 buccal one week ago • Adrian: CTG #23 facial today • Kathy: CTG #33 facial Feb. 2011

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