Perio

Question 1

Indications of Modified Widman Flap (MWF)

Answer 1

1. Moderate periodontitis.
2. Deeper interdental defects.
3. Intrabony pockets and craters.
4. Pocket with furcation involvement (grade II).
5. May be used with bone graft techniques.

Question 2

Contraindications of Modified Widman Flap (MWF)

Answer 2

1. Very narrow attached gingiva.
2. In case where osseous recontouring of extremely deep defect is required.
3. Cases with irregular pattern of bone loss.
4. If the case requires resective procedure to eradicate the pocket.

Question 3

Technique of Modified Widman Flap (MWF)

Answer 3

1. Initial incision parallel to the long axis of the teeth.
2. Minimum reflection of the flap.
3. Crevicular incision around the neck of the teeth.
4. Horizontal supra-crestal incision.
5. The flap is designed to ensure full coverage of alveolar bone including the interdental septum (primary closure by preservation of the interdental papilla).

Question 4

Indications of Apically Displaced Flap

Answer 4

1. Suprabony and infrabony pocket.
2. Diseased roots which are located subgingivally.
3. Crown lengthening procedure.
4. The need to increase keratinized tissue.
5. Need to enhance cleansibility.
6. Furcation involvement.

Question 5

Contraindications of Apically Displaced Flap

Answer 5

1. Compromised cosmetics.
2. Anatomical preclusions.
3. Poor crown/root ratio.
4. Esthetic considerations.
5. Presence of excessive mobility.
6. Inadequate gingiva.
7. Advanced attachment loss.
8. Patients at risk for root caries (high caries susceptibility) since excessive root surfaces are often exposed.

Question 6

Technique of Apically Displaced Flap

Answer 6

1. Internal bevel incision.
2. Vertical releasing incisions extending into the alveolar mucosa
3. Crevicular incisions
4. Initial elevation of the flap
5. Interdental incisions
6. Reflection either as full thickness or partial thickness are made
7. Granulation tissue is removed and the roots a scaled and planned.
8. Osseous recontouring is made if necessary.
9. The flap is displaced apically and sutured.

Question 7

Indications of Undisplaced Flap (Internal Bevel Gingivectomy)

Answer 7

1. Suprabony pockets.
2. Moderate gingival enlargement.
3. Wound closure enhancement.

Question 8

Contraindications of Undisplaced Flap (Internal Bevel Gingivectomy)

Answer 8

1. Infrabony defects.
2. Pocket in presence of minimal gingiva.
3. Severely inflamed tissue.
4. When esthetics would be compromised.
5. Need to gain access to bone.
6. Anatomical preclusions.

Question 9

Technique of Undisplaced Flap (Internal Bevel Gingivectomy)

Answer 9

1. Bleeding points.
2. Initial internal bevel incision.
3. Second or crevicular incision.
4. Flap reflection.
5. Interdental incision.
6. The pocket wall is removed.
7. All tissue tags and granulation tissue is removed
8. Scaling and root planning
   Suture and pack the area

Question 10

Types of flaps used in Regenerative Surgery

Answer 10

1. Coronally positioned flap.
2. Papillary preservation technique.
3. The conventional flap with only crevicular incision.

Question 11

Technique of conventional flap with only crevicular incision

Answer 11

1. Sulcular incisions to bone.
2. Reflect a full thickness flap.
3. Granulation tissues are removed.
4. Root planing.
5. Chemical conditioning of the root surface.
6. Intramarrow penetration.
7. Graft placement
8. Wound closure
9. Suturing
10. Pack the area

Question 12

Indications of osseous resection

Answer 12

1. Shallow intrabony defect around a tooth with sufficient periodontal support.
2. Existence of non-supporting bone that could affect a periodontal pocket or that hinders close adaptation of flap.(thick alveolar bone margin exostosis, interdental craters, residual osseous defects remaining after regenerative procedures)
3. Irregularity of bone morphology related to hemisection and root resection.
4. Crown lengthening procedures
5. One walled infrabony defect
6. Class I or II furcation involvement.

Question 13

Contraindications of osseous resection

Answer 13

1. Periodontal pocket of more than 8mm depth.
2. Three walled infrabony defects suitable for new attachment procedures.
   (treatment by regenerative procedures)
3. Deep craters
4. Bottom of the osseous defect extends apically against multiple-root trunk.

Question 14

Factors to Consider Prior to Performing Osseous resective surgery

Answer 14

1. Length and shape of the roots.
2. Location and dimension of the defects
3. Width of supporting bone
4. Root prominence
5. Relationship of the intraosseous defects to adjacent teeth and other anatomic structures, e.g., palatal exostosis

Question 15

Non-graft associated techniques indications

Answer 15

• Three wall defects

- Periodontal abscesses

Question 16

indications of ENAC

Answer 16

1. Suprabony pocket in the presence of normal gingival form and width

Question 17

Contraindications of ENAC

Answer 17

1. Inadequate keratinized gingiva.
2. Hyperplastic tissue.
3. Osseous defects.
4. Malposed teeth.
5. Furcations.

Question 18

Indications of sub gingival curettage

Answer 18

1. Elimination of Suprabony pockets located in accessible areas and having inflamed edematous pocket walls.
2. Reattachment attempts in moderately deep infrabony pockets located in accessible areas.
3. It can be done as a non-definitive procedure:
   a. To reduce inflammation prior to pocket elimination by other methods. (ex: gingivectomy)
   b. In cases where aggressive surgical techniques (e.g. flaps) are contraindicated owing to age, systemic problems.
4. Maintaining areas of recurrent inflammation and pocket depth.

Question 19

Contraindications of sub gingival curettage

Answer 19

1. If the pocket walls are firm and fibrous.
   (will need surgical excision of the fibrous tissue)
2. Inaccessibility and technical difficulties (e.g., complex pockets, furcation involvement)
3. Lesion beyond M.g. junction.

Question 20

How gingival curettage works:

Answer 20

1. Shrinkage

2. Reattachment (new attachment)

Question 21

Indications of gingivoplasty

Answer 21

1. Deformities in the gingiva created by gingival and periodontal disease.
2. Gingival clefts and craters.
3. Shelf like interdental papilla. (ex: ANUG)

Question 22

Indications of gingevectomy

Answer 22

1. supra bony pocket (fibrotic wall)
2. gingival enlargement
3. crown lengthening
4. supra bony periodontal abscess

Question 23

contraindications of ginfgevectomy

Answer 23

1. osseous surgery (infra bony pocket, location of pocket apical to the MGJ)