Eval Surgical Outcomes & Complications-Gillone

Question 1

Conventional therapies in Perio

Answer 1

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

Question 2

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

Answer 2

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

Question 3

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

Answer 3

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

Question 4

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

Answer 4

• SRP
• Modified Widman Flap→most
• Osseous Surgery→ least

Question 5

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

Answer 5

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

Question 6

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

Answer 6

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

Question 7

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

Answer 7

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

Question 8

Surgical vs Non-surgical Perio therapy: Results for:

1-3 mm PD

4-6 mm PD

>7mm PD

Answer 8

• 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

Question 9

Surgical vs Non-surgical Perio therapy: Longitudinal study results

Answer 9

• 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

Question 10

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

1-3 mm pockets

4-6 mm pockets

>7mm pockets

Answer 10

• 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

Question 11

What therapies are used for PD reduction?

Answer 11

• Gingivectomy
• Resective Osseous surgery
• Open Flap Debridement

Question 12

What is the Healing Timeline for PD reduction therapies?

Answer 12

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

Question 13

What therapies are used for Periodontal Regeneration?

Answer 13

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

Question 14

What is the Healing timeline for Periodontal Regeneration therapies?

Answer 14

Guided tissue regeneration, Biological Material

Question 15

Mucogingival Periodontal Plastic Surgery

Answer 15

• 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

Question 16

Post Surgical Complications

Answer 16

• Bleeding
• Infection
• Inflammation
• hypersensitivity
• Adverse Tissue Changes

Question 17

Complication: Bleeding

Answer 17

• 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

Question 18

Hemostatic Agents

Answer 18

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

Question 19

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

Answer 19

• Systemic Disorders:
  
  • Platelet deficiencies
  • coagulation defects
  • HTN
• Medications

Question 20

Inflammation=Post-op Swelling

Answer 20

• 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

Question 21

Hypersensitivity=Post-op Pain

Answer 21

• 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

Question 22

Adverse Tissue Damage= Post-op pain

Answer 22

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