Periodontology Seminar Discussion Assignment

Monday, 8th of September 2014

Supervisor : Yanti Rusjanti, drg., M.kes., Sp.Perio (K)

Presenters:
Meta Pradana / 1601 1213 0056
Nita Hidayanti / 1601 1213 0075
Gema Paramesti P / 1601 1009 0076
Assignment done by:
Ng Yi Hao / 160112142011

FAKULTAS KEDOKTERAN GIGI

UNIVERSITAS PADJADJARAN
BANDUNG
2014

1. Classification of gingival recession according to Miller:

According to Miller (1985), gingival recession is classified into 4 types, namely:
(a) Type 1 Class I:
Marginal recession does not extend to the mucogingival junction, there is no loss
of bone in the interdental area, type of recession can be wide or narrow.

(b) Type 2 Class II:

Marginal recession extends to or apical junction, there is no loss of bone and
wound tissue in the interdental area, type of recession can be broad or narrow.
(c) Type 3 Class III:
Marginal recession extends to or mucogingival junction, there is loss of
interdental bone or soft tissue or tooth malposition.
(d) 4 Type Class IV:
Recession extends to or into the mucogingival junction, loss of bone and soft
tissue intrdental severe or severe malposition.
2. What tools and materials are prepared for periodontal surgery?
(a) Basic instruments: Mouth mirror, explorer, tweezers, probes
(b) Surgical instruments:
i.
Rubber gloves
ii.
Tampons
iii.
Nierbeken
iv.
Glass
v.
Perforated sterile duk
vi.
3cc disposable syringe
vii.
Graceys curettes No. 1-2, 3-4, 5-6, 7-8, 11-12, 13-14
viii. Scalpel No. 11
ix.
Raspatorium
x.
Bone files
xi.
Handle scalpel
xii.
Chirurgis tweezers
xiii. Perforated curette
xiv.Microscaler
xv.
Needle and needle holder
xvi. Water syringe
xvii. Glass cement slab and spatula
xviii. Lower anterior extraction forcep
(c) Materials:
i. 10% Betadine solution
ii. Physiological NaCl solution
iii. 2% Pehacaine
iv. Sewing thread
v. Periodontal pack to protect post-incisional tissue, relieve pain and reduce
bleeding
vi. Distilled water for irrigation
3. What is PRF?
PRF or platelet-rich fibrin according Choukroun, et al. is the generation of platelet
concentrates containing 2 platelets and growth factors (growth factors) in the form of
fibrin membranes prepared from the patient's own blood and is free of anticoagulants
or other artificial biochemical mdifikasi (Chandran and Sivadas, 2013). Developed by

Choukroun PRF, et al. in 2001 in France, it contains 97% platelet and 50% leukocyte
(Malathi et al., 2013). The PRF contains a dense fibrin network with leukocytes,
cytokines, growth factors and glycoproteins such as transforming growth factor 1.
Platelet-derived growth factor, vascular endothelial growth factor and
thrombospondin-1 glycoprotein like PRF leukocytes play a role in the release of
growth factors, immune regulation, anti-infective activity, and matrix remodeling
during wound healing.
Platelets (thrombocytes) are a key element in wound healing, therefore wound
healing after periodontal treatment can be accelerated by using PRF (Chandran and
Sivadas, 2013). Wound healing process starts from the formation of blood clots and
tissue injury in the event of post-surgical periodontal cause platelet incorporation
supported by the formation of thrombin and fibrin.
PRF can improve the healing of both soft tissue and hard tissue in periodontal
treatment, therefore PRF is a powerful healing biomaterials with high regenerative
capacity and can be used in a variety of procedures such as periodontal defects in the
form of intrabony defects, furcation treatment, removal of sinus and useful as media
in vitro studies in tissue engineering.
PRF was obtained from the patient's own blood by means of blood sampling on
the antecubital vein. The blood was then placed into a sterile 10ml tubes without
anticoagulant and was then centrifuged using centrifuge machine.

4. What is a gingival mask?

Gingival mask or also called "artificial gum" is a removable appliance used to
replace the gingival tissues associated with loss of soft tissue and bone around the
teeth or dental implants. Gingival mask is used to replace the loss of gingival tissue
which can be caused by trauma, periodontal surgery, or recession, or when other
methods to restore the gingival tissue is not possible or fails. Indications of this
include the use of artificial gums:
(a) to cover the artificial crown margins were visible, implant components and the
exposed root surface, and to reduce the length of the clinical crown,
(b) to cover the black triangles between teeth where gingival recession has occurred,
(c) patients with a high lip lines and gummy smile that had been treated with
osseointegrated dental implants,
(d) patients with visible tooth root surface with a temperature-sensitive complaints.
Contraindications: Periodontal health is poor or unstable, poor oral health, high
caries activity, allergies silicon and heavy smokers.

Method of attachment of gingival mask on the gums is similar to that of "contact

lens". Humidity and its contact with the lip prosthesis can hold this artificial gingival
prosthesis in place. Gingival mask is made of a light cured acrylic.

5. What surgical treatments can be done for gum recession?

(a) Lateral pedicle graft
(b) Coronal positioned flap
(c) Free gingival graft
(d) Sub epithelial connective tissue autograft
(e) Guided tissue regeneration (GTR)
(f) Semilunar coronally repositioned flap

6. Describe the bone-grafting procedure in periodontal surgery.

Bone graft (bone grafting) - This procedure is performed when periodontitis has
destroyed the bone surrounding the tooth root. Grafted bone will be derived from a
small fragment of the patient's own bone or synthetic bone or bone from a donor.
Graft but that of bone graft material itself is the best material. Bone can help prevent
tooth loss. It can also lead to new bone growth naturally. A bone graft can be
performed as long as there are opportunities in tissue regeneration. The functions of
bone graft material itself include:
(a) Osteoconduction: Graft material acts as a foundation that will help the formation
of bone.
(b) Osteoinduction: Graft material stimulates or induces new bone formation.
(c) Osteogenesis: The cells of graft material produces new bone.

(a)
(b)
(c)
(d)

Sources of bone graft materials include:

Autograft; derived from the bone in the mouth or the patient's own body.
Allograft; derived from the same bone another individual species
Xenograft; derived from a different animal species.
Alloplastic graft; a synthetic material such as tricalcium phosphate or
hydroxyapatite.

Indications:
(a) Vertical/angular 3-walled bone defect.
(b) Vertical/angular 2-walled bone defect bone defect; provided the defect is not too
wide.
Bone-grafting procedure:
(a) Anesthesia

(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)

Incision and opening of flap

The removal of soft tissue and granulation tissue by curettage
Planing of roots
Preparation of the tooth root surface
Preparation of the bone defect area
Placement of graft material
Closure of flap and stitching
Installation of periodontal dressings

Bone-grafting illustration: (Top left) bone graft material is placed in the bone defect and prepared
root surface area. (Top right) flap is closed and stitched. (Bottom) bone graft material has been
fused with the healthy tissue of the alveolar bone