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247 Periodontics > Chapter 29 > Flashcards

Chapter 29 Flashcards

1
Q

What are the indications for periodontal surgery?

A
  • To improve access for improved periodontal instrumentation
  • To reduce pocket depth
  • Provide access to perio osseous defects
  • Resect or remove tissue
  • Regenerate periodontium lost due to disease
  • Graft bone or bone-stimulating materials
  • Improve appearance of the periodontium
  • Enhance prosthetic dentistry
  • Place dental implants
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2
Q

Possible contraindications for dental surgery

A
  • Uncontrolled diabetes/hypertension
  • Recent cardiovascular event
  • Bleeding disorders
  • Kidney dialysis
  • Radiation to the jaw
  • Total non-compliance with self-care
  • Pts at high risk for caries
  • Pts w/ unrealistic expectations of surgical outcomes
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3
Q

What ar ethe possible outcomes of periodontal surgery?

A
  • Healing by long junctional epithelium: LJE attaches to the tooth along the root surface
  • Healing by tissue shrinkage: Recession of gingiva apically
  • Healing by regeneration: New bone, CT and cementum
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4
Q

Terminology associated with wound healing

A
  • Repair
  • Reattachment
  • New attachment
  • Regeneration
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5
Q

Terminology associated with degree of wound closure

A

Primary intention
Secondary intention
Tertiary intention

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6
Q

What is repair?

A

Healing of a wound by formation of tissues that do not fully restore the original architecture or original function of the body part
- Scar tissue
- Healing by LJE
- No regeneration of new perio tissues

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7
Q

What is reattachment?

A

Healing of a periodontal wound by reunion of the connective tissue and roots where they were separated by a surgical incision or injury but not disease

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8
Q

What is new attachment?

A
  • The union of a pathologically exposed root w/ connective tissue or epithelium
  • Only in area damaged by disease
  • Newly attached epithelium and CT
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9
Q

What is regeneration?

A
  • Complete restoration
  • Formation of: new cementum, functional PDL and AB
  • Possible but not predictable
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10
Q

What is primary intention?

A

Close approximation of margins

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11
Q

What is secondary intention?

A

Margins not in close contact:
- granulation tissue followed by epithelial migration over wound

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12
Q

What is tertiary intention?

A

Left open to clear potential infection

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13
Q

How are periodontal flaps classified?

A
  • Based on AB exposure
  • Based on location of flap margin
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14
Q

What are the two classifications of periodontal flaps based on AB exposure?

A

Full-thickness flap
Partial-thickness flap

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15
Q

What are the classifications of periodontal flaps based on location of flap margin?

A

Nondisplaced flap (replaced in original position)
Displaced flap:
- Apical
- Coronal
- Lateral

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16
Q

What are the types of incisions?

A
  • Horizontal: crevicular (sulcular) and internal (inverse) bevel
  • Vertical: vertical releasing incisions
17
Q

Types of periodontal surgery

A
  1. Flap for access (modified Widman flap)
  2. Open flap debridement
  3. Osseous resective surgery
  4. Apically positioned flap w/ osseous surgery
  5. Bone replacement grafts
  6. Guided tissue regeneration
  7. Perio plastic surgery
  8. Frenectomy
  9. Crown lengthening
  10. Gingivectomy/gingivoplasty
  11. Laterally positioned flap
  12. Coronally positioned flap
  13. Semilunar coronally positioned flap
  14. Free soft tissue autograft
  15. Subepithelial CT graft
  16. Implant surgery
  17. Perio microsurgery
  18. Laser surgery
18
Q

What type of incision would be made for a flap for access (modified widman) for an open flap debridement and what would this be done for?

A
  • Inverse bevel incision to remove pocket epithelium
  • Full thickness flap
  • Access to root surface (modified widman)
  • Access to root surfaces and bone crest (open flap)
  • Purpose is to clean the root surfaces, remove granulation tissue and place a healthy CT surface against the clean root surface
19
Q

What type of incision would be made for an apically positioned flap w/ osseous surgery and what would this be needed for?

A

Inverse bevel incision to remove pocket epithelium
- Full thickness flap
- Bone defects are reduced or removed, bone recontoured
- Tissue is apically positioned, and particularly w/ apically positioned flap may expose significant root surface
- Ostectomy: removal of supporting bone around teeth
- Osteoplasty: Recountouring of non-supporting bone

20
Q

What is osteogenesis?

A

Formation of new bone by viable, living cells contained in the graft material

21
Q

WHat is osteoinduction?

A

Molecules contained in the graft material (bone morphogenic poteins (BMPs) have the ability to attract osteoblasts to the site to form new bone

22
Q

What is osteoconduction?

A

The graft acts as a scaffold for host bone-forming cells outside the graft to migrate, attach and grow on

23
Q

What are the 4 types of bone replacement grafts?

A
  1. AUTOGRAFTS
  2. ALLOGRAFTS
  3. XENOGRAFTS
  4. ALLOPLASTS
24
Q

What are autografts?

A
  • From the patient themselves
  • Intraoral, hip, chin, skull
25
Q

What are allografts?

A
  • From another human
  • Cadaverous or living
  • Freeze dried
  • Calcified/decalcified
26
Q

What are xenografts?

A
  • From another species (bovine)
  • Freeze died
  • Calcified/decalcified
27
Q

What are alloplasts?

A
  • Synthetic bone-like material
  • Plaste of paris
  • Bioactive glass
  • Calcium phosphate
28
Q

Where are the only cells that have potential to induce periodontal regeneration found?

A
  • PDL
  • Have the ability to regrow lost ecmentum, lost PDL and lost AB
29
Q

How does guided tissue regeneration work?

A
  • Uses a membane to exclude epithelium and allow slower growing cells from the PDL to repopulate the defect
  • Without a barrier, epithelial cells would grow faster along the oot surface, blocking access to the root for slower growing CT and cells of the PDL

247 Periodontics (19 decks)

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