General Principles

Question 1

Limitations of Non-Surgical Periodontal Therapy – SPR

Answer 1

Poor access to deep PD pocket in post teeth due to grooves,
concavities & furcation areas
Pocket distal to terminal molar; Thick tissue
Pocket deeper than 5mm; Less effective
Bacteria in periodontal tissues (cementum, alveolar bone and dentine)

Question 2

Emergency equipment;
 Common emergency-

Answer 2

syncope
 Operator, assistant and office personal should be trained to handle all
emergencies
 Drugs and equipments should be available

Question 3

Tissue management

Answer 3

 Operate gently, carefully & Ovoid roughness
 Use sharp instruments, dull instruments cause unnecessary trauma
Observe the patient at all time

Question 4

Referring Patients for Specialist Treatment

Answer 4

Pocket depth (5 mm) Standard guideline
for referral
Systemic health problems and
Dental
implant
Short roots more seriously jeopardized by 5 mm
 Hypermobility,
Furcations/Restorative

Question 5

Surgical Periodontal Therapy is used

Answer 5

To increase accessibility to the root surface to;
 remove irritant from tooth surface
 treat furcation involvement, root resection/ hemisection
 treat infrabony pockets in distal area of last molar complicated by
mucogingival problems
 improve the prognosis of the teeth
To eliminate or reduce pocket & pathological changes in PD pocket in
teeth where complete removal of root irritant is not clinically possible, area with
irregular bony contour, deep crater & bony defects
To reshape soft and hard tissue to attain
a harmonious topography and correct morphological defect that may favor plaque accumulation and pocket recurrence or impair esthetic

Question 6

Hemostasis; To control bleeding

Answer 6

To provide clear view of root surface for
thorough removal of deposit and root
planing
Permit an accurate appraisal of the extent
& pattern of soft tissue and bone
involvement
Prevent seepage of blood into the floor of
mouth and oropharynx
Bleeding may disappear/reduce after
removing granulation tissue

Question 7

Thrombin

Answer 7

Applied topically to bleeding surface
Allergic reaction can occur in patients with known sensitivity to
bovine materials
Must not be injected into tissues or vasculature, can cause severe (and possibly fatal) clotting

Question 8

Absorbable
Gelatin sponge
(gelfoam)

Answer 8

Cut into various sizes and applied to bleeding surface.
May form nidus for infection or abscess
Should not be over packed into extraction site or wound—may
interfere with healing

Question 9

Oxidized
cellulose
(Oxycel)

Answer 9

applied to wound dry as opposed to Moistened
May cause foreign body reaction
Extremely friable and difficult to
place; should not be used
adjacent to bone—impairs bone
regeneration; should not be used
as a surface dressing, inhibits
epithelialization

Question 10

Oxidized
regenerated
cellulose
(Surgicel
Absorbable
Hemostat)

Answer 10

Cut to various shapes and
positioned over bleeding sites
Encapsulation, cyst formation, and foreign-body reaction possible
Should not be placed in deep wounds—may physically interfere with wound.
Thick or excessive amounts should not be used

Question 11

Periodontal Dressing

Answer 11

Periodontal dressings have no curative properties but assist healing
by protecting the tissue rather than providing “healing factors.” or
antibacterial properties
• The dressing facilitates healing by preventing surface trauma
during mastication
• Protects the patient from pain induced by contact of the wound
with food or with the tongue during mastication

Question 12

Zinc oxide - Eugenol packs (Not in use);

Answer 12

Zinc oxide - Eugenol packs (Not in use);
• Accelerators (Zinc acetate), give better working time
• Binder & filler (Asbestos); induce lung disease
• Tannic acid; liver damage
• Eugenol; may induce allergic reaction (reddening of the area & burning
pain in some patients

Question 13

Most commonly used periodontal dressing

Answer 13

Non- Eugenol (Coe-Pak) is commonly used

Question 14

Retention of pack;

Answer 14

Mechanically by
interlocking in interdental spaces and joining
the lingual & facial portion of the pack

Question 15

Instructions to patient

Answer 15

should take two Paracetamol (Tylenol) tablets every 6 hours for
the first 24 hours. Take the same medication if you have discomfort. Do
not take aspirin, this may increase bleeding
Do not brush over the dressing.
first 3 hours after the operation, avoid hot foods to permit the
dressing to harden and mouth rinsing. Avoid hot liquids during the first 24
hours.
Do not smoke.
Use chlorhexidine (Peridex, PerioGard) oral rinses after brushing; a
prescription for this rinse has been given to you
During the first day, apply ice intermittently to your face over the operated
area. It is also beneficial to suck on ice chips intermittently during the first
24 hours

Question 16

The swelling generally begins

Answer 16

The swelling generally begins 1 to 2 days after the
operation and subsides gradually after 3 or 4 days

Question 17

If there is bleeding

Answer 17

there under pressure for
20 minutes. Do not remove it during this period to examine it
If the bleeding does not stop at the end of 20 minutes, please contact the
office. Do not try to stop bleeding by rinsing the area with water