11.15 PD surgery

Question 1

what are the different surgical options for the txt of periodontitis?

Answer 1

1) Flap and osseous surgery (resect pockets to eliminate)
2) Flap debridement, try for new attachment to roots
3) Regeneration (GTR), grow new bone, PDL, cementum
4) Extraction, replace with implants, FPD, RPD

Question 2

If patient presents at EIT with:
-good oral hygiene
-bop
-moderate probing depths and ALs
-mild to moderate bone loss,
what surgery would be indicated?

Answer 2

• Flap and Osseous surgery (or pocket elimination surgery)

* recontouring of bone would NOT expose furcations or result in compromised support

Question 3

procedure of flap and osseous surgery

Answer 3

• reflection of pd flaps
• scale and root plane teeth
• recontour bone to eliminate osseous craters
• replace flaps apically to eliminate pocket depth

Question 4

goals of flap and osseous surgery

Answer 4

• root debridement
• resotre ideal osseous and gingival concours
• eliminate or reduce pockets

Question 5

if patient presents at EIT with:
-good oral hygiene
-bop
-severe probing depths and ALs
what surgery would be indicated

Answer 5

• Flap curettage

- recontouring of bone WOULD expose furcations or result in compromised support

Question 6

flap curettage (or debridement) definition

Answer 6

reflection of soft tissue flap to aid in the debridement of contaminated root surfaces and/or osseous defects

Question 7

goals of flap curettage

Answer 7

• debride roots and osseous defects
• improve osseous contours
• reduce pockets
• gain clinical attachment

Question 8

if a patient presents at EIT with:
-good oral hygiene
-bop
-localized vertical osseous defects
-grade 2 furcation defects
what surgery would be indicated?

Answer 8

Regeneration (GTR)

-“think of containers”

Question 9

regeneration goals:

Answer 9

• debride roots and osseous defects

- regenerate periodontium (cementum, bone, pdl)

Question 10

if a patient presents at EIT with:

• severe periodontitis
• hopeless prognosis
  then. ..

Answer 10

extract!

-socket preservation for future implant is possible

Question 11

what are the different surgical procedures to treat gingival recession?

Answer 11

1) epithelialized Free soft Tissue autograft (free gingival graft)
2) subepithelial connective tissue graft
3) Allograft (alloderm)

Question 12

what are the advantages of an epithelialized free soft tissue autograft (free gingival graft)?

Answer 12

• increases keratinized gingiva

- provides better root coverage

Question 13

advantages of subepithelial connective tissue graft

Answer 13

-better tissue color match
-dual blood supply
-less painful at donor site
-predictable root coverage
(just takes CT from palate)

Question 14

what are the indications and advantages for an allograft (alloderm)?

Answer 14

• multiple areas of recession
• inadequate donor tissue
• no donor site needed,
• easier suturing

Question 15

does an allograft add keratinized tissue?

Answer 15

no, just makes the tissue thicker, NOT adding keratinized tissue