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Module 8 > perio surgery > Flashcards

perio surgery Flashcards

1
Q

name 3 types of perio surgery instruments

A

microsurgical instruments
microsurgical scalpel blades
magnification

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2
Q

name 3 flap design dont’s

A

dont cut max bulbosity of root
dont cut diagonal relieving insicions
dont cut vertically through papilla

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3
Q

why are black silk sutures not used anymore

A

baterial colonisation
wicking

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4
Q

what sutures are used now

A

synthetic mono-filament

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5
Q

what should pts be told when sutures are present

A

no brushing in the region
use chlorhexidine mouthwash to reduce plaque formation

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6
Q

why are periodontal dressings not used so much now

A

pts dont like them - aesthetics and function
corners can get bacterial growth underneath

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7
Q

what are the 3 types of perio surgery

A

resective
repair/reattachment
regenerative

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8
Q

what are 2 resective surgeries

A

gingivectomy
root resection

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9
Q

what are 2 repair/reattachment surgeries

A

Open flap debridement (OFD)
modified widman flap (MWF)

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10
Q

what are 3 regenerative surgeries

A

GTR guided tissue regeneration
grafts
emdogain

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11
Q

what is resective surgery

A

pocket elimination procedure which establsihes a morphologically normal attachment but with apical displacement of the dento-gingival complex

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12
Q

what is repair/reattachment surgery

A

pocket reduction surgery but without replication of the normal attachment
healing is by formation of a long juctional epithelim

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13
Q

what flap is used for repair/reattachment

A

partially reflected flap
crevicular incision without relieving incisiosn

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14
Q

describe the open flap debridement procedure

A
  1. pt consent and LA
  2. 1 min chlorhexidine
  3. incision in gingival sulcus
  4. raise full thickness flap, limited to 1mm below alveolar crest
  5. remove granulation tissue
  6. scale tooth surface
  7. suture
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15
Q

what is the modified widman flap

A

resection of soft tissue collar from ginigival margin
incision 0.5-1mm from gingival margin

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16
Q

what are the indications for partially reflected flaps

A

excellent maintenance
site >6mm with BOP or suppuration
horizontal bone loss pattern
vertical defect<3mm
isolated perio pockets remain

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17
Q

what are containdications for partially reflected flaps

A

asesthetic region
need for graft/membrane
complex furcation/bone defects
lack of/limited attached ginigvae (MWF)

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18
Q

what are advantaged of partially reflected flaps

A

healing by primary intention
minimal crestal bone resorption
effective in pockets 6-7mm

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19
Q

what are disadvantages of partially reflected flaps

A

can be unpredictable
no new attachment
risk of recession
interdental craters

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20
Q

what is regeneration

A

recreation of the complete attachment apparatus of bone/cementum/functionally orientated periodontal ligament against previously exposed root surface

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21
Q

what is the difference between repair and regeneration

A

repair causes long junctional epithelium and crestal remodelling
regenerations causes new cementum pdl and alveolar bone

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22
Q

what are the 3 aims of regenerative surgery

A

regenerate defect
remove factors associated with disease progression
enhance access for plaque control and maintenance

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23
Q

what is needed for regeneration?

A

PDL cells
wound stability
space provision
primary intention healing

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24
Q

what cells are available to repopulate the root for healing

A

epithelial cells
gingival connective tissue cells
bone cells
mesenchymal cells from PDL

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25
Q

what to epithelial cells do in healing

A

long junctional epithelium

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26
Q

what to ginigval connective tissue cells do in healing

A

CT attachment or root resoprtion

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27
Q

what to bone cells do in healing

A

root resorption and ankylosis

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28
Q

what to mesenchymal cells do in healing

A

regeneration

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29
Q

what is the case selection criteria for regeneration

A

infrabony defect with pocket >6mm, depth >3mm, <25 degrees, high number of walls
class 2 furcation mandibular molars
single class 2 furcation maxillary molars

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30
Q

what are the 4 regenerative techniques

A

guided tissue regeneration
bone graft materials
enamel matrix proteins (EMD)
combinations (GTR&bone, EMD&bone)

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31
Q

what is guided tissue regeneration

A

use of mechanical barrier (membrane) to selectively enhance the establishment of PDL and peri-vascular cells in osseous defects to initiate periodontal regeneration

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32
Q

what are the 3 aims of GTR

A
  1. stop rapid downgrowth of epithelial cells
  2. create space for pluripotent cells from PDL to access root surface
  3. improve local anatomy, function and prognosis of teeth
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33
Q

what is the function of a membrane

A

act as a barrier to prevent cells apart from PDL migrating into site

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34
Q

what is an autograft

A

from donor site of same person

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35
Q

what is an allograft

A

from a different person but human bone

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36
Q

what is a xenograft

A

from animal source

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37
Q

what is alloplast

A

synthetic material

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38
Q

what does emdogain do

A

mimics the development of tooth supporting apparatus during tooth formation

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39
Q

what is the effect of EMD on epithelial cells

A

decreased cell proliferation and migration

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40
Q

what is the effect of EMD on gingival fibroblasts

A

reduced cell migration

41
Q

what is the effect of EMD on bone

A

increased cell proliferation and migration, support of bone formation but not osteoinductive

42
Q

what is the effect of EMD on PDL fibroblasts

A

increased cell proliferation, migration and attachment

43
Q

what is the effect of EMD on cementoblasts

A

increased in vivo mineralisaton

44
Q

what is the outcome of EMD and GTR

A

no additional benefit compare with each alone

45
Q

what is the outcome of EMD and graft

A

improved outcomes with EMD and xenograft/autogenous bone
no improvement with alloplastic materials

46
Q

what is the outcome of graft and GTR

A

best combination for non-contained defects

47
Q

what is the outcome of EMD, graft and GTR

A

no additonal benefit compared to 2 combined

48
Q

what are the advantaged of regeneration

A
  • successful in tx of deep sites >6mm
  • healing by primary intention
  • improvement in volume of supporting tissues of tooth
  • less recession for pt
49
Q

what are the disadvantages of regeneration

A
  • technically challenging to get a good outcome
  • can be unacceptable for some pts depending on materials used
  • expensive materials
50
Q

what are 3 causes of gingival overgrowth

A

inflammatory
drug-induced
related to systemic conditions

51
Q

what healing is after gingivectomy

A

secondary

52
Q

what are indications for gingivectomy

A

gingival enlargement/overgrowth persists despite non-surgical care
supra-bony periodontal pocketing
excellent at home care
wide zone of attached gingivae

53
Q

what are contraindications for gingivectomy

A

narrow attached gingivae
planned osseous recontouring
infra-bony periodontal pockets
medical contraindications - bleeding disorder

54
Q

what are advantages of gingivectomy

A

simple
good vision
can achieve ideal soft tissue morphology

55
Q

what are disadvantages of gingivectomy

A

limited indications
heal by secondary intention
risk bone exposure
wastes attatched gingivae
excessive recession in PD disease

56
Q

what is surgical crown lengthening

A

surgical procedure which apically repositions the soft tissue and alveolar bone to expose more tooth structure, and increase the length of the clinical crown

57
Q

what is the aim of surgical crown lengthening

A

surgically maintain biologic width whilst apically repositioning the gingival level

58
Q

7 indications for surgical crown lengthening

A
  1. toothwear
  2. poor gingival aesthetics
  3. restoration of subgingival lesions
  4. replacement of crowns with deep margins
  5. management of coronal third fractures
  6. management of infringement of biologic width
  7. develop ferrule for pulpless teeth restored with posts
59
Q

6 contraindications for SCL

A
  1. poor plaque control
  2. poor compliance
  3. non-functional teeth or teeth of poor strategic value
  4. periodontal destruction
  5. endodontic compromise
  6. medical history considerations
60
Q

5 SCL complications

A
  1. poor aesthetics due to black traingles
  2. transient mobility of teeth
  3. root sensitivity
  4. rebound of marginal tissues
  5. root resorption
61
Q

what is odontoplasty

A

reshaping tooth surface

62
Q

what can odontoplasty increase

A

sensitivity and caries

63
Q

when is OFD effective

A

shallow defects to eliminate pockets

64
Q

when is tunneling done

A

mandibular molars with deep degree 2 and 3 furcations

65
Q

what is root resection

A

removal of one root of a multi-rooted tooth where there is uneven bone loss

66
Q

what are the indications for root resection

A

class 2/3 furcation involvement
severe bone loss on 1 or more roots
root fracture/perforation/deep caries
failed endo or inoperable canals

67
Q

what are contraindicaitons for root resection

A

inadequate bone support on remaining roots
unfavourable anatomy - fused root, long root trunk
significant discrepancies in bone height
remaining roots not restorable

68
Q

what is hemisection

A

root resection usually in mandibular molars with portion of crown

69
Q

what is the most predictable way to regenerate furcations

A

GTR with bone graft

70
Q

what is ginigval recession

A

location of the marginal tissue apical to the CEJ with exposure of root surface

71
Q

what are the possible aetiological factors of recession

A

traumatic - toothbrushing, partial dentures, lip/tongue piercing, self-inflicted
traumatic overbite
periodontal disease
poor restorative margins - plaque retention, encroach of biologic width

72
Q

what are the factors related to increased risk of recession

A

high muscle attachment/frenal pull
thin tissue phenotype
alveolar dehiscence
teeth outside alveolar bone after orthodontic treatment (proclination, arch expansion)
lack of keratinised tissue

73
Q

what is the non-surgical management of recession

A

monitoring and prevention
composite restorations
gingival prosthesis
ortho?

74
Q

what is the surgical management of recession

A

frenectomy
pedicle flaps
free gingival grafts
subepithelial connective tissue graft
coronally advanced flap & GTR

75
Q

what are the indications for surgical management of recession

A
  • prevention of continued recession
  • improve ability to perform OH measures
  • aesthetic concern
  • sensitivity/root caries?
76
Q

what are the contraindications for surgical management of recession?

A
  • poorly controlled diabetes
  • bleeding disorders
  • smoking
  • poor OH
  • active perio disease
  • previous failed procedures
  • self-inflicted injuries
77
Q

what are the aims of a frenectomy

A

stabilise tissue
improve access for OH measures

78
Q

what are the indications for frenectomy

A

unstable local tissue
blocking access for OH measures
midline diastema
shallow vestibule for prosthesis

79
Q

what are the contraindications for frenectomy

A

medical/bleeding disorders
scar formation will make further procedures more challenging

80
Q

what are the aims of grafting

A
  • improve/create band of keratinised, attached gingiva
  • avoid scarring
  • optimal tissue blend/colour match
  • improve access for OH
  • 100% root coverage
81
Q

what is pedicle flap

A

local tissue maintaining own blood supply
single site surgery
surgery limited by local anatomy

82
Q

what is a graft

A

material from distant donor site
two site surgery
larger quantity of ct
more technically demanding
no direct blood supply so graft can fail

83
Q

what kind of flap is a pedicle flap

A

split thickness flap

84
Q

what are the indications for a pedicle flap

A

narrow defect on single tooth
adjacent teeth with thick phenotype or edentulous area
deep vestibule

85
Q

what are the contraindications for pedicle flap

A

deep perio pocketing
loss of ID tissue
large root prominences
lack of relevant local anatomy
deep root abrasion

86
Q

what are the advanteges of pedicle flaps

A

one site surgery
good vascularity to pedicle flap
root coverage possible

87
Q

what are the disadvantages of pedicle flaps

A
  • limited by amount of adjacent keratinised, attached gingivae
  • risk of recession at donor site
  • risk of dehiscence at donor site
  • limited to a single tooth
  • not as likely to gain root coverage
88
Q

what is a free gingival graft

A

graft from palate formed of epithelium and small amount of underlying connective tissue is placed into a region with localised recession

89
Q

what are the aims of free gingival graft

A
  • to create a band of keratinised mucose
  • remove frenal attachments
  • prepare site for second procedure to increase root coverage
90
Q

what are the indications for free gingival graft

A
  • discomfort during OH measures
  • ongoing local inflammation
  • lack of keratinised tissue in region of recession defect
  • prevention of further recession
  • insufficient local keratinised tissue pedicle flap
91
Q

what are the contraindications for free gingival grafts

A
  • aesthetic region
  • aim for complete root coverage
  • donor site tissue poor
  • medical containdications
92
Q

what are the advantages of free gingival grafts

A

relatively simple surgery
increases vestibular depth

93
Q

what are the disadvantages free gingival grafts

A

secondary surgical site
palatal wounds heals by 2ndry intention
unaesthetic

94
Q

what is a coronally advanced flap

A

surgical procedure where a split thickness flap is raised, released and then replaced in a more coronal position

95
Q

what are the advantages of coronally advanced flaps

A

possible for 1 site surgery
less technically demanding than tunnelling
can be combined with GTR

96
Q

what are the disadvantages of coronally advanced flap

A

often benefit from CT graft
if used with GTR, higher risk of infection
vertical releasing incisions mean delayed healing

97
Q

what is a modified coronally advanced tunnel with CT graft

A

split thickness flap raised without any releasing incision and maintaining interdental papilla
repositioned coronally with CT graft threaded through tunnel underneath ginigvae

98
Q

what are the advantages of modified coronally advanced tunnel with CT graft

A

microsurgical technique
excellent colour match
better vascularisation of flap
best root coverage

99
Q

what are the disadvantages of modified coronally advanced tunnel with CT graft

A

secondary operative site
technically demanding - thin phenotype, graft harvesting

Module 8 (7 decks)

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