Introduction to PeriodontalSurgery

Question 1

Goal of peridontal sugery

Answer 1

restore health and function to the periodontium and improve prognosis

Question 2

Full thickness flap

Answer 2

1. aka Mucoperiosteal flap
2. includes the periosteum
3. Blunt dissection w/ an elevator
4. Allow access to bone
5. less tech sensitive than partial flap
6. May have crestal resorption up to 1 mm

Question 3

Partial Thickness Flap

Answer 3

1. aka as Split thickness flap
2. periosteum remains attached to bone
3. Sharp dissection with blade
4. technique sensitive
5. can suture to periosteum
6. does not allow full access to bone

Question 4

Envelope flap

Answer 4

1. no vert releasing incisions
2. esthetically more predictable than released flap
3. used also when anatomic limitations are present
4. helpful when primary closure is necessary
5. usually “full thickness” (includes periosteum)

Question 5

released flap (relaxed, pedicle)

Answer 5

1. have 1 or 2 vertical releasing incisions
2. offers flexibility in terms of access
3. May reposition apically or coronally easily
   4 can create esthetic nightmare if verts are placed wrong
4. extend beyond line angles
5. place at line angles
6. avoid papilla and midcerivical areas

Question 6

Biological width- average

Answer 6

3mm

Question 7

Biological width sulcus

Answer 7

.5-.8 mm

Question 8

Biological width juctional epithelium

Answer 8

.5-1.35 mm

Question 9

Biological width connective tissue fibers

Answer 9

1-1.8 mm

Question 10

indications for crown lengthening?

Answer 10

1. decayed or fractured below ging. margin with impingement of biologic width
2. excessive wear of dentition. Clinic crown inadequate for retention of cast restoration
3. unesthetic gingival margin(gummy smile or uneven gingival margin)
4. functional reasons; teeth with inadequate inter-occlusal space

Question 11

Pre-surgical considerations

Answer 11

1. esthetics
2. compromise the support on the adjacent teeth
3. pre-op crown:root
4. long term prognosis of the tooth

Question 12

consequences of impinged biologic width

Answer 12

• persistent inflammation. low grade
• purple gums
• potential for eventual pocket formation

Question 13

sequencing

Answer 13

1. determine restorability of tooth (perio and prosth tret plan
2. if possible, have all restorative variables completed
3. crown lengthening surgery completed
4. allow 6-12 weeks for healing