Perio Post Surgical Management

Question 1

General post op advice for perio surgery?

Answer 1

 Give general advice, preferably written, on what to expect – some pain, swelling etc.

 Oral hygiene advice:
Clean adjacent teeth gently.
Avoid surgery area.
No interdental cleaning.
Chlorhexidine mouthwash 0.2% (flap)
Clean rest of mouth as usual
Return in one week

Question 2

What to do 1 week post perio surgery?

Answer 2

Removal of pack or sutures
Rubber cup polish
Cleaning advice:
- Gentle brushing, soft brush, gums will bleed
- Interdental cleaning gently
- Continue MW (another week - beware staining, mucosal irritation, parotid problems, altered taste)
- Treat any sensitivity - sensitive toothpaste or varnish

See again at 1 month and 3 months

Question 3

Primary intentions of flap surgery?

Answer 3

Fibrin and clot between tooth and flap
Organisation and replacement by granulation tissue
Epithelium grows down from gingival margin
Long junctional forms - takes about 6 weeks
Deep of any vertical bone defect fills in - alveolar crest resorbs
Over time the healed tissue shrinks and more crown is exposed
Changes are maximal at 3 months but occur up to 6 months

Question 4

Secondary intentions after gingivectomy?

Answer 4

Initial fibrin cover over wound under pack
Growth of epithelium from retained islets in wound and margins of area
Initial epithelialisation takes up to 2 weeks - it may be necessary to repack after 1 week
Following healing the gingiva regrows to a certain extent and the gingival level moves coronally
Changes occur up to 6 months

Question 5

Signs of success post flap surgery?

Answer 5

Decrease in inflammation
Less BOP
Decrease in pocket depth
Increase in attachment
Eliminate pus
No increase in mobility
Improvement of tissue contour
Stabilisation of bone levels

Question 6

Review appts post surgery?

Answer 6

One week
4-6 weeks OH support
3 months (Do NOT probe before this)
6 months (may need to wait before probing with some regenerative techniques)

Question 7

Perio flap outcome expectations?

Answer 7

Shallow non bleeding pocket with clinical attachment gain and bone gain

Question 8

Advantages of flap surgery?

Answer 8

Pocket elimination

Question 9

Complications of flap surgery?

Answer 9

During

• Pain
• Excessive bleeding
• Apex exposed
• Damage to flap

After

• Pain
• 2ndry haemorrhage
• Sensitivity
• Infection
• Swelling

Long term

• Recession
• Dentine sensitivity
• Poor aesthetics

Question 10

Why does the treatment outcome vary?

Answer 10

Surgical procedure:
- Technique, operator skills

Pt factors:

• OH
• Smoking and infection control
• General condition

Defect-characteristics:
- Defect angle and width amount of loss of attachment and bone

Question 11

Disadvantages of flap surgery?

Answer 11

More plaque accumulation on dentine surfaces - recurrence of disease
Resection can give rise to tissue damage on neighbouring teeth