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week 87 > Eval Surgical Outcomes & Complications-Gillone > Flashcards

Eval Surgical Outcomes & Complications-Gillone Flashcards

1
Q

Conventional therapies in Perio

A
  • SRP (non surgical)
  • Modified Widman Flap
  • Osseous Surgery
  • Subgingival curretage
  • Open Flap Debridement
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2
Q

If 1-3 mm Pocket: What treatments resulted in clinical attachment gain (CAL)?

A
  • None:
  • Attachment Loss
    • SRP→least
    • Modified Widman Flap
    • Osseous Surgery→Most
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3
Q

If 4-6mm Pocket: What treatments resulted in clinical attachment gain (CAL)?

A
  • SRP→MOST attachment gain
  • Modified Widman Flap
  • Osseous Surgery→least
  • Open Flap Debridement
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4
Q

If >7mm Pocket: What treatments resulted in clinical attachment gain (CAL)?

A
  • SRP
  • Modified Widman Flap→most
  • Osseous Surgery→ least
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5
Q

If 1-3 mm Pocket: What treatments resulted in reduced pocket depth?

A
  • MIXED
  • Increase: Got worse
    • SRP
    • Modified Widman Flap
  • Decrease
    • Osseous Surgery
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6
Q

If 4-6 mm Pocket: What treatments resulted in reduced pocket depth?

A
  • Decreased:
    • SRP
    • Modified Widman Flap→Best results
    • Osseous surgery
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7
Q

If >7mm Pocket: What treatments resulted in reduced pocket depth?

A
  • Decreased PD:
    • SRP→ worse
    • Modified Widman Flap
    • Osseous Surgery→ Best
    • Open Flap Debridement→ Good but less stable in long term
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8
Q

Surgical vs Non-surgical Perio therapy: Results for:

1-3 mm PD

4-6 mm PD

>7mm PD

A
  • 1-3mm PD
    • Most PD reduction: OS
      • no difference after 5 years
    • Less CAL loss: SRP
  • 4-6 mm PD
    • Most PD reduction: MWF
    • Most CAL gain: SRP
  • >7mm PD:
    • Most PD reduction: OS
      • OFD- good but not long term
    • Most CAL Gain: MWF
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9
Q

Surgical vs Non-surgical Perio therapy: Longitudinal study results

A
  • OS
    • reduce PD in deeper pockets
    • stable/maintain shallow PD
    • apically positioined tissue
  • OFD
    • initially reduced pockets
    • after 5 yrs, returned to presurgery level
  • To prevent soft tissue rebound
    • positive bone architecture
    • eliminate interproximal craters
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10
Q

Surgical vs Non-surgical Perio therapy: Literature Conclusions for:

1-3 mm pockets

4-6 mm pockets

>7mm pockets

A
  • 1-3 mm pockets:
    • Surgical Therapy had significantly more CAL Loss vs non
  • 4-6 mm pockets:
    • MWF had significantly more CAL loss vs non-surgical
  • > 7mm:
    • OS had significantly higher PD reduction than SRP
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11
Q

What therapies are used for PD reduction?

A
  • Gingivectomy
  • Resective Osseous surgery
  • Open Flap Debridement
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12
Q

What is the Healing Timeline for PD reduction therapies?

A
  • gingivectomy, respective osseous surgery, Open flap debridement
  • 2 months Healthing before re-eval
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13
Q

What therapies are used for Periodontal Regeneration?

A
  • Guided Tissue Regeneration
  • Biological Material
  • 6months-1 year Healing before re-eval
    • Do not probe area for 6 months
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14
Q

What is the Healing timeline for Periodontal Regeneration therapies?

A

Guided tissue regeneration, Biological Material

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15
Q

Mucogingival Periodontal Plastic Surgery

A
  • Avoid probing surgical area for 6 months
  • wait 6 months-1 year to assess outcome
  • Free Gingival Graft (FGG)
    • expect up to 1mm of creeping attachment in 1 year
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16
Q

Post Surgical Complications

A
  • Bleeding
  • Infection
  • Inflammation
  • hypersensitivity
  • Adverse Tissue Changes
17
Q

Complication: Bleeding

A
  • Lots of bleeding during incisions & flap reflection
  • How to control:
    • remove granulation tissue
    • wet gauze and pressure
    • Local w/EPI (Vasoconstrictor)
    • Aspiration
  • If vessel is cut=Xs Hemorrhage
    • Blind suture to tie off artery
  • slow constant blood flow:
    • hemostatic agents→ achieve hemostasis
18
Q

Hemostatic Agents

A
  • Absorbable
    • collagen sponge
    • gelatin sponge
  • Bone Wax
  • Oxidized
    • cellulose
    • regenerated cellulose
  • Thrombin
  • Tranexamic acid
    • 1300 mg TID for 5 days
19
Q

What can cause excessive bleeding? (Not including laceration of a vessel)

A
  • Systemic Disorders:
    • Platelet deficiencies
    • coagulation defects
    • HTN
  • Medications
20
Q

Inflammation=Post-op Swelling

A
  • Routine care:
    • Apply moist hot rag intermittently
    • Anti-inflammatory meds:
      • ibuprofen
      • ASA=aspirin
      • diclofenac
  • W/in 2 days
    • Peak Swelling
    • pt reports soft painless swelling of surgical area
    • Temperature & enlarged lymph nodes-sometimes
      • local inflammatory rxn
  • Day 4:
    • swelling subsides
  • Day 5+
    • swelling persists, increases or increased pain→Antibiotic; think infection
21
Q

Hypersensitivity=Post-op Pain

A
  • Minor Pain & discomfort if standard precautions used
    • minimal or no pain: 50%
    • severe pain: 5%
    • 20% of pts w/pain took 5+ doses of analgesics
  • Mucogingival Procedures have more discomfort than plastic surgery and osseous surgery
    • 6x plastic surgery
    • 3.5x OS
  • Tx:
    • Ibuprofen 800mg loading dose
    • 1 tab every 8 hrs for 2 days
22
Q

Adverse Tissue Damage= Post-op pain

A
  • Be careful of exposed & Dry bone
    • severe pain
    • inflammation

week 87 (7 decks)

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