Periodontology Seminar Discussion AssignmentMonday, 8th of September 2014

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

Presenters:Meta Pradana / 1601 1213 0056Nita Hidayanti / 1601 1213 0075

Gema Paramesti P / 1601 1009 0076

Assignment done by:Ng Yi Hao / 160112142011

FAKULTAS KEDOKTERAN GIGIUNIVERSITAS PADJADJARAN

BANDUNG2014

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 glovesii. Tamponsiii. Nierbekeniv. Glassv. Perforated sterile dukvi. 3cc disposable syringevii. Gracey’s curettes No. 1-2, 3-4, 5-6, 7-8, 11-12, 13-14viii. Scalpel No. 11 ix. Raspatorium x. Bone files xi. Handle scalpel xii. Chirurgis tweezersxiii. Perforated curettexiv. 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 solutioniii. 2% Pehacaineiv. Sewing threadv. Periodontal pack to protect post-incisional tissue, relieve pain and reduce

bleedingvi. 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 β1. 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.

Sources of bone graft materials include: (a) Autograft; derived from the bone in the mouth or the patient's own body. (b) Allograft; derived from the same bone another individual species (c) Xenograft; derived from a different animal species. (d) 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) Incision and opening of flap (c) The removal of soft tissue and granulation tissue by curettage (d) Planing of roots (e) Preparation of the tooth root surface (f) Preparation of the bone defect area (g) Placement of graft material (h) Closure of flap and stitching (i) 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