Goals and Objectives-Indications for Surgery Flashcards
Goals of Non-Surgical
Therapy
(5)
- Removal of plaque and calculus
- Microflora alteration
- Endotoxin removal
- “Smooth” surface
- Tissue shrinkage
Depth of
pocket: 1-3 mm
Scaling and
Root Planing:
Open Flap
Debridement:
86% calculus-
free
86% calculus-
free
Depth of
pocket: 4-6 mm
Scaling and
Root Planing:
Open Flap
Debridement:
43%
76%
Depth of
pocket: >6mm
Scaling and
Root Planing:
Open Flap
Debridement:
32%
50%
The CEJ: Biofilm and Calculus Trap
–% chance of leaving residual calculus or
biofilm in pockets > 5 mm.
85
Disadvantages of Non-Surgical
Therapy
(4)
- Depth of pockets-determines efficiency
- Loss of connective tissue by scaling
and root planing in healthy sites - Thin versus thick tissue
- Instrumentation of furcations
- Instrumentation of furcations
(2)
- Size of instruments
- Size of furcation entrances
Endpoint of Scaling and Root
Planing
Eliminate inflammation, bleeding on
probing, suppuration, disease
progression
Endpoint of Scaling and Root
Planing
Final goal of a
functional,
comfortable, healthy dentition
with stable probing attachment
levels
Indications for Surgery
* Root and Defect Access
(4)
- Plaque and calculus removal (non-
surgical more difficult to accomplish
in deeper pockets) - Difficulty for furcation instrumentation
without surgical access - Granulation tissue removal
- Access to osseous defects
Indications for Surgery
The ‘gold’ standard
- Regeneration
- Regeneration
Definition:
Reconstitution of a lost or missing
part
- Regeneration
In Periodontics
(3)
- new periodontal ligament
- new cementum
- new bone
Indications for Surgery
* Regeneration
(4)
- Autografts
- Allografts
- Alloplasts/Xenografts
- Guided Tissue Regeneration
- Guided Tissue Regeneration
membranes (2)
- Non-resorbable vs resorbable
membranes
Guided Tissue
Regeneration: GTR
Membrane will provide
epithelial exclusion
Indications for Surgery
* Pocket Elimination
(3)
- Osseous contouring with placement
of the flap margin at the alveolar
crest - Creation of shallow sulci
- Ease of maintenance by therapist
and patient
Indications for Surgery
* Removal of bacteria
* Bacterial penetration seen in —
* Formerly known as —
* 2017 classified as —***
* Causative bacterial pathogen of —
Aggressive Periodontitis
LJP/GJP
Periodontitis
A.a
Indications for Surgery
* Mucogingival Surgery / Periodontal
Plastic Surgery
* Regain —
* Remove —
*
* Restore —
*
periodontium
frena
Root coverage or increase keratinized
tissue
gingival topography
Pre-prosthetics and pre-orthodontics
Indications for Surgery
* Retreatment of Case
(3)
- Non-surgical therapy has failed
- Surgical therapy has failed
- New techniques or materials are
available
Indications for Surgery
* Pre-prosthetic Surgery
(5)
- Crown lengthening
- Ridge augmentation
- Palatal recontouring
- Gingivectomy/Gingivoplasty
- Ridge or Tuberosity Reduction
Indications for Surgery
* Drug-Induced Gingival Overgrowth
(3)
- Dilantin®
- Cyclosporin
- Calcium Channel Blockers
(Nifedipine)
Indications for Surgery
* Abscess Debridement
(4)
- Undiagnosed periodontitis
- Maintenance patients
- Recurrent abscesses
- Undiagnosed diabetes
- Non-surgically treated areas have a greater
percentage of defects that convert from
non-diseased to diseased sites than
surgically treated sites.
- All studies show that results in —
rooted teeth are better for both non-surgical
and surgical modalities than —.
single
molars
- Non-surgically treated areas have a —
percentage of defects that convert from
non-diseased to diseased sites than
surgically treated sites. - All studies show that results in single
rooted teeth are — for both non-surgical
and surgical modalities than molars.
greater
better
Implants
NOT indicated until
periodontal disease has been
controlled and all other dental needs are addressed
in a comprehensive treatment plan (think what you
should do in predoc clinic for implant consult/
planning).
