Periodontal Plastic &

Esthetic Surgery

By
Faiz Jehan
Final year Bds
Asan Memorial Dental College and Hospital
Mucogingival surgery
• Introduced by FRIEDMAN
• For corrections involving Attached Gingiva, Shallow
Vestibule, Marginal Gingiva
• In 1996 World Workshop In Clinical periodontics
renamed Mucogingival surgerysurgery as "
PERIODONTAL PLASTIC SURGERY"
Definition
• Periodontal plastic surgery is defined as the surgical
procedures performed to correct or eliminate
anatomic, developmental or traumatic deformities
of the gingiva or alveolar mucosa.
Problems associated with shallow vestibule
• Gingival recession ➡ gingival margin apically➡ reduced
vestibular depth
poor oral hygiene
Not enough space for removable prosthesis
 Problems associated with
Aberrant Frenum
Frenum that encroaches the margin of gingiva

interferes with PLAQUE REMOVAL

Tension from the frenum tends to open the sulcus.
 Esthetic Deformities
Recession ➡ facial gingival margin ➡ Alter Gingival
symmetry
Loss of interdental Papilla ➡ black hole
Gummy smile
Physiological Gingival pigmentation➡ unacceptable
Techniques to deepen the Vestibule
• FREE AUTOGENOUS GRAFTS TECHNIQUE
The classic technique:
Step 1: Prepare the recipient site
Step 2: Obtain the graft from the donor site
Strip technique ➡ Hans et al., two/three strips of 3-
5mm wide gingival donor tissue is obtained.
• Step 3: Transfer and immobilize the graft(gut suture)
Step 4: and Protect the Graft
Aluminum foil and Periodontal dressing
Technique to remove the Frenum
Frenectomy➡
Procedures
 Simple excisional/ classical frenectomy
Miller's technique
V-Y plasty
Frenectomy using Electrocautery
Laser Frenectomy
Frenectomy procedure
Technique to improve esthetics
Root coverage(Gingival Augmentation Coronal to
the Recession)
Papilla reconstruction
Semilunar pedicle
design
Both connective
tissue and bone
grafting into the
interdental area
 Gummy smile➡exicision of soft tissues (3mm of
keratinized marginal tissue left behind)
Correct gingival
asymmetry
Gingivoplasty
Minimally invasive
flap surgery
Gingival
Depigmentation
-Mucosal excision
- Rotary
instruments
- Electrosurgery
- Cryosurgery
- Lasers
Conclusion
• Periodontal plastic surgery as the name indicates
deals with the esthetic correction mostly
• The success of the grafts depends on vascular
supply.
Reference
• Newman And Carranza Third South Asia Edition
• Pictures - google
Thank you