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Perio II > EXAM 1 Perio Surgery > Flashcards

EXAM 1 Perio Surgery Flashcards

1
Q

what is periodontal surgery?

A

any surgical procedure used to treat periodontal disease or to modify the morphology of the periodontium

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2
Q

what is the goal of periodontal surgery?

A

to restore health and function to the periodontium and to improve prognosis

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3
Q

what are the 10 indications for periodontal surgical therapy?

A
  1. access for root debridement
  2. elimination of pockets by removal and/or recontouring of soft or osseous tissue
  3. removal of diseased periodontal tissues creating a favorable environment for new attachment
  4. correction of mucogingival deficiencies or defects
  5. establishment of tissue contours that facilitate oral hygiene maintenance
  6. establishment of esthetics by reducing gingival enlargement or by augmenting tissue deficiencies
  7. creation of favorable restorative environment
  8. establishment of drainage or emergent periodontal problems
  9. determining and improving treatment prognosis
  10. regernative procedures
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4
Q

describe the two surgical procedures for the correction of soft tissue defects

A
  • distal wedge
    • correction of overgrowth of tissue, usually distal to molars
    • tissue in the shape of a wedge is removed, and remaining tissue is sutured
  • gingivectomy/gingivoplasty
    • performed to recontour soft tissue
    • need to make sure there is a sufficient zone of keratinized tissue
    • ex. remove gingival overgrowth
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5
Q

describe the procedure for the correction of osseous defects/deformities

A
  • osseous recontouring
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6
Q

describe regenerative procedures

A
  • GTR - guided tissue regeneration
  • ridge augmentation procedures
  • sinus lift
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7
Q

what are some examples of correction of mucogingival defects?

A
  • apically positioned flaps
  • frenectomy
  • free gingival grafts
  • connective tissue grafts
  • pedicle flaps
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8
Q

describe presurgical considerations

A
  • complete medical history
  • vital signs should always be recorded
  • adequate plaque control
    • otherwise, no surgery
  • surgical consent form should be completed in all cases
  • periodontal documentations should be complete
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9
Q

what is a mucogingival defect?

A
  • loss of significant amount of keratinized tissue
  • most often on the facial surfaces
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10
Q

Surgical considerations:

select the surgical ___ carefully.

A
  • procedure
  • should be simple, predictable, efficient, and cost effective
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11
Q

surgical considerations:

incisions should be ___, ___, and ___. indecision usually results in what?

A
  • clean, smooth, and definite
  • indecision usually results in an uneven, ragged incision.
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12
Q

surgical considerations:

where possible, ___ procedures are preferred to those of ___

A
  • primary intention
  • secondary intention
    • there are some exceptions
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13
Q

surgical considerations:

base of the flap should be ___

A

wide enough

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14
Q

surgical considerations:

___ should be removed to allow for rapid healing

A

tissue tags

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15
Q

surgical considerations:

adequate ___ stabilization is necessary

A

flap

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16
Q

surgical considerations:

all flaps should be designed for maximum ___ and ___ of ___ gingival tissue

A

utilization and retention of keratinized gingival tissue

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17
Q

surgical considerations:

flap design should allow for adequate ___ and ___, and should prevent unecessary ___ exposure.

A
  • access and visibility
  • bone
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18
Q

if you want to preserve as much tissue as possible, what type of incision should be utilized?

A

intrasulcular incision

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19
Q

what are the normal clinical characteristics (average width) of the attached gingiva?

A
  • maxillary average width
    • incisors - 3.5 to 4.4mm
    • premolars - 1.9mm
  • mandibular average width
    • incisors - 3.3 to 3.9mm
    • premolars: 1.8mm
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20
Q

what is the average biological width?

A

1:1:1 - average overall biological width is 3mm

  • intrasulcular width (sulcus) - 1mm
  • junctional epithelium (epithelial attachment) - 1mm
  • connective tissue attachment (supracrestal connective tissue attachment) - 1mm
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21
Q

if there is minimal keratinized attached gingiva, what type of incision should be used?

A
  • intrasulcular incision or a conservative inverse bevel/ extrasulcular incision
  • no external bevel/ gingivectomy should be done
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22
Q

if a procedure would involve the need to remove diseased epithelium and apically positioning the flap, what type of incision should be used?

A

extrasulcular incision

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23
Q

if the goal is to remove excess tissue without raising a flap, what type of incision should be used?

A

external bevel incision (conventional gingivectomy)

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24
Q

what are the two types of flaps?

A

full thickness and partial thickness flaps

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25
Q

a full thickness flap is also known as a ___ flap

A

mucoperiosteal

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26
Q

full thickness flaps include the ___

A

periosteium

27
Q

full thickness flaps involve ___ dissection with an ___, and allow access to ___

A
  • blunt
  • elevator
  • bone
28
Q

which flap type is less technique sensitive?

A

full thickness flap

29
Q

___ thickness flaps may have crestal resorption up to 1mm

A

full

30
Q

partial thickness flaps are also known as ___

A

split thickness flaps

31
Q

in partial thickness flaps, does the periosteum remain attached to bone?

A

periosteum

32
Q

which flap type involves sharp dissection with a blade?

A

partial thickness flaps

33
Q

which flap type is more technique sensitive?

A

partial thickness flaps

34
Q

in partial thickness flaps, the flap can be sutured to the ___

A

periosteum

35
Q

which flap type does not allow full access to the bone?

A

partial thickness flap

36
Q

which type of flap has no vertical releasing incisions?

A

envelope flap

37
Q

the envelope flap is esthetically more ___ than the released flap

A

predictable

38
Q

which flap type is used also when anatomic limitations are present?

A

envelope flap

39
Q

which flap type is helpful when primary closure is necessary?

A

envelope flap

40
Q

are envelope flaps usually full thickness or partial thickness? what determines this?

A
  • full thickness
  • determined by the inclusion of the periosteum
41
Q

the released flap is also called what?

A

relaxed or pedicle flap

42
Q

released flaps have one or two ___

A

vertical releasing incisions

43
Q

which flap type offers flexibility in terms of access?

A

released flap

44
Q

released flaps may reposition ___ or ___ easily

A

apically or coronally

45
Q

which flap type can create an esthetic nightmare if the verticals are placed in the wrong place?

A

released flap

46
Q

released flaps extend beyond the ___

A

MGJ

47
Q

released flaps are placed at ___

A

line angles

48
Q

what two areas should be avoided in released flap types?

A

papilla and mid-cervical areas

49
Q

what type of flap is this?

A

full thickness flap

50
Q

what type of flap is this?

A

partial thickness flap

51
Q

what type of flap is this?

A

envelope flap

52
Q

what type of flap is this?

A

released flap

53
Q

what are the 4 indications for crown lengthening?

A
  • teeth that have decayed or fractured below the gingival margin with impingement of the biologic width
  • excessive wear of the dentition. the clinical crown is inadequate for the retention of a cast restoration
    • bulimic patient, chemical erosion
  • an unesthetic gingival margin. gummy smile or uneven gingival margins
  • functional reasons - teeth with inadequate inter-occlusal space
54
Q

what are the 4 pre-surgical considerations for crown lengthening?

A
  • esthetics
  • compromise the support on the adjacent teeth?
  • pre-op crown:root ratio
  • long term prognosis of the tooth
55
Q

what are the consequences of impinged biologic width?

A
  • persistent inflammation; low grade
  • purple gums
  • potential for eventual pocket formation
56
Q

describe the sequencing for crown lengthening

A
  1. determine restorability of the tooth
    1. perio and prosthetic treatment plan
  2. if possible, have all restorative variables completed
  3. crown lengthening surgery completed
  4. allow 6-12 weeks for healing
57
Q

describe periodontal dressings

A
  • placed on top of surgical site after treatment (looks like silly putty)
  • no curative properties
  • may be useful in protecting the tissues
  • comfort for the patient
58
Q

what is zinc oxide-eugenol?

A
  • a type of periodontal dressing
  • liquid and powder mixture
  • high potential for alelrgic reactions
59
Q

what is nonegenol (coe-pak)?

A
  • type of periodontal dressing
  • most common
  • supplied in 2 tubes
    • 1 tube contains zinc oxide, an oil (for plasticity), gum (cohesiveness), and bithionol (a fungicide)
    • other tube contains fatty acids with a resin and a bacteriostatic agent
60
Q

what are cyanoacrylates used for?

A

periodontal dressings

61
Q

what are methacrylate gels used for?

A

periodontal dressings

62
Q

describe non resorbable suture materials

A
  • silk sutures
  • nylon: monofilament
  • ePTFE gore-tex
  • polyester: braided
63
Q

describe resorbable suture materials

A
  • surgical: gut
  • plain gut: monofilament (30d)
  • chromic gut: monofilament (45 to 60 d)
64
Q

describe synthetic suture materials

A
  • polyglycolic: braided (16 to 20 d)
  • vicryl
  • dexon
  • polyglycaprone (90 to 120 d)
  • monocryl
  • polyglyconate: monofilament

Perio II (5 decks)

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