1. Periodontal Aesthetics

2. Soft tissue aesthetics Recession Crown fractures/Crown lengthening

3. CTG? BONE GRAFT

4. Recession Localised Generalised

5. Gingival Recession

6. Classification of Recession Class I Class III Class IV Class II Millers Classification (1985)

7. New causes of recession

8. 1-19% of children have one or more recession lesions (Ruf 1998 ortho) 50 % of people 18 to 64 years of age have one or more sites with recession 88 % of people 65 years of age and older have one or more sites with recession (Kassab 2003) Prevalence of recession lesions

9. Gingival Biotype Two gingival biotypes have been described by Olsson & Lindhe (1991) Thick, flattened biotype (type 1) Thin, scalloped biotype (type 2 )

10. Gingival Biotype I TYPE 1

11. Gingival Biotype II TYPE 2

12. Anatomical influences Inflammation Keratinised tissue Position of tooth Fenestrations Dehiscences Trauma Bacteria Frenal attachment Relationship of anatomy and inflammation leading to recession

13. Gingival recession  Indications for surgical correction include:  increases in recession  Persistent inflammation  dentinal hypersensitivity  aesthetic concerns of the patient  Early Caries  Age

14. Can a clean site be maintained?

15.  Pedicle grafts:  Rotational flap: Lateral sliding flap, double papilla flap, oblique rotated flap.  Advanced flap: Coronally repositioned flap, semilunar coronally repositioned flap. Mucogingival surgery

16.  Free soft tissue grafts:  Epithelialised graft  Subepithelial connective tissue graft Mucogingival surgery

17. Healing phases HOURS DAYS 3 MTHS 6 MTHS

18. Lateral Sliding Flap

19. LSF Day 1 week 3 19 months

20. Lateral Sliding Flap

21. Coronally Repositioned Flap

26. Free Gingival Graft

27. Sub-epithelial CT graft

28. Sub-epithelial CT Graft

29. Frenectomy

30. Crown Lengthening Soft tissue resection – indicated when bone level is at correct height to ensure biologic width is accommodated Soft and hard tissue resection - indicated when bone level is not at the correct height to ensure biologic width is accommodated

31. Crown Lengthening