Ch14 Periodontal Surgery

Question 1

What is indicated to control the progression of perio destruction and attachment loss when more conservative nonsurgical treatment are not sufficient

Answer 1

Periodontal surgery

Question 2

Periodontal surgery involves techniques of what?

Answer 2

Intentionally cut into soft tissues to control disease or change the size and shape of tissues

Question 3

What are the major benefit and indication for periodontal surgery?

Answer 3

• Gain access to root surfaces for scaling and root planning
• Improves access for patient control of plaque bioflim

Question 4

Other advantages of surgery include what?

Answer 4

• Improving access to periodontal abscesses
• Exposing root surfaces for restorative dentistry
• Altering the position of the gingival margin to improve pt esthetics

Question 5

What are the disadvantages and contraindications of Periodontal surgery

Answer 5

• Health status or age of the pt
• Specific limitations for each of the periodontal surgical procedures
• Pts perspective, the disavdvantages of surgery are usually limited to time, cost, aesthetics, and discomfort

Question 6

What are the general considerations for Periodontal surgery?

Answer 6

• Probing pocket depth
• Amount of bone loss
• Importance of the tooth to function
• Esthetics
• Pt level of plaque biofilm control
• Pt general health

Question 7

What are the goals for Periodontal Surgery?

Answer 7

• Pocket reduction
• Drainage of periodontal abscesses
• Correction of mucogingival defects
• Aesthetic improvement
• Provision of access for restorative dental procedures
• Regeneration of tissue lost bec of disease
• Placement of dental implants

Question 8

What is a deepened gingival sulcus with an infected root surface covered by an ulcerated epithelial surface with underlying inflamed connective tissue

Answer 8

Periodontal pocket

Question 9

What is coronals bound by the gingival margin on one side by the root surface, on the other side by the epithelial surface and at the base by the junctional epithelium

Answer 9

Pocket

Question 10

When is Periodontal surgery is most successful?

Answer 10

Tx periodontal pockets with probing depths of 5-9mm

Question 11

What is effective in controlling periodontal disease to probing depths of approximately 4mm?

Answer 11

scaling and root planning

Question 12

What pockets depths are difficult to instrument and often remain infected after the best dental hygiene care?

Answer 12

Pockets deeper than 5mm

Question 13

Pockets depths greater than 9mm suggest what?

Answer 13

Extreme loss of attachment, which makes the long-tern prognosis for retaining the affected tooth poor.

Question 14

Probing depths are not always equal to what?

Answer 14

Clinical attachment loss

Question 15

How are probing depths measured?

Answer 15

From the crest of the gingival margin, to the base of the pocket.

Question 16

How is attachment loss measured?

Answer 16

From the cementoenamel junction (CEJ) to the base of the pocket

Question 17

If the gingival margin is on the root surface, as when recession has occurred, then the attachment loss is what?

Answer 17

Greater than the probing depth

Question 18

If the gingival margin is on the enamel surface of the crown, as in gingival hypertrophy, than the attachment loss is what?

Answer 18

Less than the probing depth

Question 19

Attachment loss represents what?

Answer 19

Bone destruction

Question 20

The base of the pero pocket is not at the level of the crest of the alveolar bone, usually 1-2mm of connective tissue attachment covered by epithelium between the probing depth and the alveolar bone, this area is termed by what?

Answer 20

Biologic width

Question 21

Bone loss caused by perio disease results in what?

Answer 21

Osseous defects

Question 22

Osseous defects may occur as

Answer 22

• horizontal dimension

- vertical dimension

Question 23

osseous horizontal dimension occurs when?

Answer 23

The bone resorption is equal on the mesial and distal surfaces of the teeth

Question 24

osseous vertical dimension occurs when?

Answer 24

The bone resorption is unequal around the teeth

Question 25

Pockets that are coronal to horizontal bone loss are often called what?

Answer 25

Suprabony pockets

Question 26

What are the pockets called that extend apically beyond the crest of the bone

Answer 26

Infrabony pockets

Question 27

May also occur in a variety of configurations that are usually described by the number of bony walls remaining?

Answer 27

Vertical bone loss

Question 28

When all of the walls of the osseous defect are with the bone housing

Answer 28

Intrabony pocket

Question 29

The amount of bone remaining around a tooth is an important consideration for what?

Answer 29

In the decision to perform perio surgery

Question 30

Perio surgery that includes modification of the bone level or shape is called

Answer 30

Osseous surgery

Question 31

Generally osseous surgery is indicated when?

Answer 31

At least one half of the bone support remains

Question 32

Third molars can be extracted without altering what?

Answer 32

The pts chewing pattern

Question 33

Extraction of supererupted teeth (third and second molars) should be considered bec why?

Answer 33

These teeth often negatively affect the prognosis of neighboring teeth

Question 34

Before surgical therapy is initiated pts should what?

Answer 34

Establish the nest possible supraginival plaque biofilm control bec progression of perio disease may increase after perio surgery if plaque biofilm is not adequately controlled

Question 35

Pts who are what? Are not good candidates for periodontal sugery

Answer 35

Poor health

Question 36

Pts with pockets depths exceeding 5mm and one half their supporting bone loss who are relatively young (younger than 30yrs old) have what?

Answer 36

Aggressive form of periodontal disease and surgery is strongly indicated

Question 37

Older pts (older than 60yrs of age) with the pockets deoths exceeding 5mm and one half their supporting bone lost have what?

Answer 37

Slowly progressing disease and surgery may be less critical for those pts

Question 38

What are the 5 basic categories of convenient classification of periodontal surgical procedures

Answer 38

1. ) Procedures for pocket reduction or elimination
2. ) Procedures for access to root surfaces
3. ) procedures for tx of osseous defects
4. ) Procedures for correcting mucogingival defects
5. ) Procedures for new attachment

Question 39

What are the goals of pocket reduction surgery?

Answer 39

-To reduce perio pocket depths by removing soft tissues to a level at which plaque biofilm control and maintenance procedures are effective, usually not exceeding 3-4mm in depth

Question 40

What are the methods for pocket reduction?

Answer 40

1. ) Excisional perio surgery (gingivectomy)

2. ) Incisional perio surgery (flap)

Question 41

What perio surgery removes the excess tissue from the wall of the periodontal pocket, It is useful for the rapid reduction of gingival pockets?

Answer 41

Excisional perio surgery

Question 42

What are the most basic excisional surgical reduction termed by?

Answer 42

1. ) gingivectomy- excision of the gingiva

2. ) gingivoplasty- surgical reshaping of the gingival tissues

Question 43

what are the indications for excisional perio surgery?

Answer 43

• Presence of deep perio pocets with thick fibrous tissue is the major indications for gingivectomy
• Fimilial gingival hyperplasia
• Localized crown lengthening for restorative dentistry