Ch14 Periodontal Surgery Flashcards
What is indicated to control the progression of perio destruction and attachment loss when more conservative nonsurgical treatment are not sufficient
Periodontal surgery
Periodontal surgery involves techniques of what?
Intentionally cut into soft tissues to control disease or change the size and shape of tissues
What are the major benefit and indication for periodontal surgery?
- Gain access to root surfaces for scaling and root planning
- Improves access for patient control of plaque bioflim
Other advantages of surgery include what?
- Improving access to periodontal abscesses
- Exposing root surfaces for restorative dentistry
- Altering the position of the gingival margin to improve pt esthetics
What are the disadvantages and contraindications of Periodontal surgery
- 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
What are the general considerations for Periodontal surgery?
- Probing pocket depth
- Amount of bone loss
- Importance of the tooth to function
- Esthetics
- Pt level of plaque biofilm control
- Pt general health
What are the goals for Periodontal Surgery?
- 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
What is a deepened gingival sulcus with an infected root surface covered by an ulcerated epithelial surface with underlying inflamed connective tissue
Periodontal pocket
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
When is Periodontal surgery is most successful?
Tx periodontal pockets with probing depths of 5-9mm
What is effective in controlling periodontal disease to probing depths of approximately 4mm?
scaling and root planning
What pockets depths are difficult to instrument and often remain infected after the best dental hygiene care?
Pockets deeper than 5mm
Pockets depths greater than 9mm suggest what?
Extreme loss of attachment, which makes the long-tern prognosis for retaining the affected tooth poor.
Probing depths are not always equal to what?
Clinical attachment loss
How are probing depths measured?
From the crest of the gingival margin, to the base of the pocket.
How is attachment loss measured?
From the cementoenamel junction (CEJ) to the base of the pocket
If the gingival margin is on the root surface, as when recession has occurred, then the attachment loss is what?
Greater than the probing depth
If the gingival margin is on the enamel surface of the crown, as in gingival hypertrophy, than the attachment loss is what?
Less than the probing depth
Attachment loss represents what?
Bone destruction
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?
Biologic width
Bone loss caused by perio disease results in what?
Osseous defects
Osseous defects may occur as
- horizontal dimension
- vertical dimension
osseous horizontal dimension occurs when?
The bone resorption is equal on the mesial and distal surfaces of the teeth
osseous vertical dimension occurs when?
The bone resorption is unequal around the teeth
Pockets that are coronal to horizontal bone loss are often called what?
Suprabony pockets
What are the pockets called that extend apically beyond the crest of the bone
Infrabony pockets
May also occur in a variety of configurations that are usually described by the number of bony walls remaining?
Vertical bone loss
When all of the walls of the osseous defect are with the bone housing
Intrabony pocket
The amount of bone remaining around a tooth is an important consideration for what?
In the decision to perform perio surgery
Perio surgery that includes modification of the bone level or shape is called
Osseous surgery
Generally osseous surgery is indicated when?
At least one half of the bone support remains
Third molars can be extracted without altering what?
The pts chewing pattern
Extraction of supererupted teeth (third and second molars) should be considered bec why?
These teeth often negatively affect the prognosis of neighboring teeth
Before surgical therapy is initiated pts should what?
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
Pts who are what? Are not good candidates for periodontal sugery
Poor health
Pts with pockets depths exceeding 5mm and one half their supporting bone loss who are relatively young (younger than 30yrs old) have what?
Aggressive form of periodontal disease and surgery is strongly indicated
Older pts (older than 60yrs of age) with the pockets deoths exceeding 5mm and one half their supporting bone lost have what?
Slowly progressing disease and surgery may be less critical for those pts
What are the 5 basic categories of convenient classification of periodontal surgical procedures
- ) Procedures for pocket reduction or elimination
- ) Procedures for access to root surfaces
- ) procedures for tx of osseous defects
- ) Procedures for correcting mucogingival defects
- ) Procedures for new attachment
What are the goals of pocket reduction surgery?
-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
What are the methods for pocket reduction?
- ) Excisional perio surgery (gingivectomy)
2. ) Incisional perio surgery (flap)
What perio surgery removes the excess tissue from the wall of the periodontal pocket, It is useful for the rapid reduction of gingival pockets?
Excisional perio surgery
What are the most basic excisional surgical reduction termed by?
- ) gingivectomy- excision of the gingiva
2. ) gingivoplasty- surgical reshaping of the gingival tissues
what are the indications for excisional perio surgery?
- Presence of deep perio pocets with thick fibrous tissue is the major indications for gingivectomy
- Fimilial gingival hyperplasia
- Localized crown lengthening for restorative dentistry
