1. Treatment of Gingival Recession
   1. T/t of gingival Augmentation apical to Recession
      1. 1. Free gingival Autograft (FGG) given by Bjorn Donor site heals by secondary intention
         1. a. Classical technique Palate is the donor site —> 5 mm away from crest of Lingual marginal gingiva
            1. Ideal Thickness = 1-1.5 mm
            2. Case 1 : If the graft is too thick Peripheral areas of the graft gets necrosed
            3. Case 2 : Graft is too Thin Complete graft will get necrosed
            4. Graft Shrinks atleast 25%, so use graft of Bigger size
            5. Maximum shrinkage occur after 1 st week of Sx
         2. b. Varient Technique
            1. Accordian Technique
            2. Various partial Thickness incisions are given on the under surface of graft to increase the surface area of graft
            3. Graft initially gets its Blood supply from the Recipient Bed also called Plasmatic fluid
            4. Initially graft is Pale & Pallor for 2 days
            5. Then blood capillaries start growing with time
            6. Functional integration of graft occurs on 17th day
            7. Strip Technique
            8. To use small strip of graft & suture them separately
         3. Healing of FGG
            1. 0.75 mm graft : 10.5 weeks 1.7 mm graft. : 16 week
      2. 2. Free CT Autograft
         1. Edel Gold standard for augmentation of gingival recession
         2. Advantage : C.T carries a genetic message for the overlying epithelium
         3. Donor site Healing occurs by primary intention
         4. Less donor site morbidity
         5. Better esthetics & color matching in CT graft
      3. 3. Apically Displaced flap
      4. 4. Edlen Mescher flap - Vestibuloplasty
   2. T/t of Gingival Augmentation coronal to Recession
      1. 1. Free Gingival graft given by Miller
         1. FGG is a very imp technique to treat gingival Recession & Vestibular deepening simultaneously
      2. 2. CT Graft - Levine
      3. 3. Pedicel Autograft
         1. Laterally displaced flap given by Grupe & Warren
            1. Used to cover areas of isolated gingival recession & thick biotype of tissue
         2. Coronally displaced flap
            1. Semilunar coronally displaced flap - given by Tornow
            2. Provides 2-3 mm of coverage
            3. Subepithelial CT graft - Langer
2. Frenum surgery
   1. Frenectomy
      1. A frenectomy is the removal of a frenulum, a small fold of tissue that prevents an organ in the body from moving too far.
      2. Sometimes high frenal attachment may lead to midline diastema
   2. Frenotomy
      1. frenotomy is the incision and the relocation of the frenal attachment
3. Vestibuloplasty
   1. Surgical procedure whereby the oral vestibule is deepened by changing the soft tissue attachments
   2. Edlen Mescher flap - Vestibuloplasty
4. Papilla Reconstruction surgery
   1. Indications
      1. 1. If primary cause of periodontal disease is interdental papilla loss 2. If traumatic tooth brushing 3. Mal- positioning of the teeth 4.No contact point between the teeth like in case of midline diastema
      2. Black triangles are seen in between teeth
   2. Non- Surgical
      1. 1. Scaling & Root planing 2. Reinforcement of Oral hygiene procedures & oral health education 3. Correction & Relocation of the contact point
   3. Surgical
      1. 1. Conventional Papilla Preservation flap 2. Modified papilla preservation flap 3. Simplified papilla preservation flap 4. Entire papilla preservation flap 5. Semilunar Coronally Repositioned Flap 6. Whale’s tail technique
5. Mucogingival Surgery (PPS)
   1. Given by Friedman
   2. T/t of Gingival Recession
   3. Vestibuloplasty/ Vestibular deepening
   4. Frenectomy
      1. Complete removal of frenum
   5. Frenotomy
      1. Partial removal of frenum
   6. Interdental Papilla Reconstruction surgery
   7. Gingival Depigmentation
6. Gingival Depigmentation
   1. Important factors : 1. Amalgam Tattoo 2. Pigmented Nevi 3. Oral Melanotic Macules 4. Melanoma 5. Smoker’s Melanosis 6. Heavy Metals 7. Minocycline 8. Hemochromatosis
   2. Techniques Employed for Gingival Depigmentation
      1. Surgical Method: 1. Scalpel Surgical Technique 2. Cryosurgery 3. Electro surgery 4. Lasers: a. Nd:Al : Yttrium - Gamet b. Erbium-YAG Lasers c. Carbon Di-Oxide Lasers
         1. Scalpel Technique knife used : Kirkland Knife
         2. Cryo- Surgical Depigmentation Tetrafluroethane is commonly used in cryosurgery for depigmentation
      2. Methods Aimed at masking Pigmented Gingiva with Grafts from Less Pigmented Areas: 1. Free Gingival Grafts 2. Connective Tissue Grafts 3. Acellular Dermal Matrix Allografts