Indications for Surgery

Question 1

What is the cutoff for A1c at school?

Answer 1

8

Question 2

Where is the majority of of residual calculus located on the tooth?

Answer 2

At CEJ and line angles

Question 3

Endpoint of _______:
Eliminate inflammation, bleeding on
probing, suppuration, disease
progression
Final goal of a functional,
comfortable, healthy dentition
with stable probing attachment
levels.

Answer 3

SRP

Question 4

*: The ‘gold’ standard
Definition: Reconstitution of a lost or missing
part

• In Periodontics
• new periodontal ligament
• new cementum
• new bone

Answer 4

Regeneration*

Question 5

In perio, what is regeneration?

Answer 5

New cementum
New PDL
New bone

Question 6

• Osseous contouring with placement
of the flap margin at the alveolar
crest
• Creation of shallow sulci
• Ease of maintenance by therapist
and patient

Answer 6

Pocket Elimination

Question 7

Is surgical or non surgical therapy more likely to have defects after treatment?

Answer 7

Non surgical is worse

Question 8

Are single rooted or multirooted teeth more likely to get a better result from surgery?

Answer 8

Single rooted

Question 9

Reproduction or
reconstitution of a lost or injured part. New
alveolar bone ,cementum, and
periodontal ligament are formed restoring
new architecture and function of the
attachment apparatus. (Example of a bone
replacement grafting procedure.)

Answer 9

Regeneration:

Question 10

The union of
connective tissue with a root surface
that has been deprived of its original
attachment apparatus. i.e. Reunion of
connective tissue with a root surface which
has been pathologically exposed. (Example
of a connective tissue graft to cover an
area of root recession).

Answer 10

New Attachment

Question 11

The reunion of connective
tissue with a root surface on which viable
periodontal ligament tissue is present.
(Example is where biologic width (now
termed supracrestal tissue attachment)
existed before a flap was reflected and
when the flap is replaced, reattachment
occurs with the intact connective tissue
fibers.)

Answer 11

Reattachment:

Question 12

The healing of a wound that does
not fully restore the architecture or
function of the part. (The primary example
is healing by a long junctional epithelium.
This is the body’s protective healing to
prevent ankylosis and root resorption.)

Answer 12

Repair:

Question 13

_____ flap: all soft tissue
including the periosteum is reflected
exposing the underlying bone. (Most
commonly used flap, and also called a
mucoperiosteal flap.)

Answer 13

Full thickness flap:

Question 14

________ flap: epithelium
and some connective tissue is reflected,
leaving periosteum and some connective
tissue overlying the bone.

Answer 14

Partial (split) thickness flap:

Question 15

Removal of the
connective and epithelial
attachment circumferentially
with a curette

Answer 15

Curettage:

Question 16

Removal
of the connective
and epithelial
attachment
circumferentially
with a scalpel

Answer 16

ENAP:

Question 17

The excision of the soft
tissue wall of the periodontal pocket. The
incision forms an external bevel or surface
that is exposed to the oral cavity.

Answer 17

Gingivectomy:

Question 18

Gingival deformities are
reshaped and reduced to create a normal
and functional form. The incision creates an
external bevel.

Answer 18

Gingivoplasty:

Question 19

_______ Indications
 Elimination of suprabony pockets which
can’t be adequately debrided without tissue
removal.
 Elimination of suprabony pockets if the
pocket wall is fibrous and firm and therefore
will not shrink after non-surgical therapy.
 Access for restorative with suprabony
pockets.
 These three indications are usually
corrected by flap surgery for access.
 Elimination of gingival enlargements (most
common indication for gingivectomy).**
 Elimination of asymmetrical or unesthetic
gingival topography (gingivectomy and/or
gingivoplasty).
 Exposure of unerupted teeth when
adequate keratinized tissue is present.

Answer 19

Gingivectomy indications

Question 20

What is most common indication for gingivectomy?

Answer 20

Elimination of gingival enlargements

Question 21

________ Contraindications
 Access is needed to infrabony defects.
 Base of pocket is apical to MG junction, or
when keratinized tissue is inadequate so
that a gingivectomy would remove all of the
keratinized tissue.
 Severely inflamed tissue (needs scaling
and root planing)
 Esthetics (anterior maxilla)
 Anatomical preclusion (lack of keratinized
tissue)

Answer 21

Gingivectomy contraindications

Question 22

 Advantages
 Relatively simple and fast.
 Disadvantages
 Limited applicability (suprabony defects)
 Longer healing period (4-5 weeks)
 More post-operative discomfort
 Less effective than flap surgery (no
access to osseous defects)

Answer 22

Gingivectomy

Question 23

 Surgical debridement of the root surface
and removal of granulation tissue from
osseous defects following reflection of a
mucoperiosteal flap.
 Modifications:
 Modified Widman
 Curtain procedure (maxillary anteriors)

Answer 23

Open Flap Debridement

Question 24

______ Indications
 Advanced disease where access is needed
to root surfaces and osseous defects.
 Where regeneration may be possible.
 To preserve tissue for esthetics.
 As an exploratory procedure or as part of
the non-surgical phase of treatment for
fibrous tissue.
 Less post-operative discomfort.

Answer 24

Open Flap indications

Question 25

______ Contraindications
 Patient is unable to tolerate a surgical
procedure.
 Increased tissue recession may result in
esthetic compromise.
 Potential of root caries and root sensitivity
due to greater root exposure post-
surgically.

Answer 25

Open Flap contraindications

Answer 26

Social contract