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Perio > Perio Surgery > Flashcards

Perio Surgery Flashcards

0
Q

What did the long term data show for surgical vs non surgical?

A

Heitz and mayfield 2002

No difference between CAL and PPD. Between surgical or non surgical

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1
Q

Which paper looked at the effect of non surgical vs surgical treatment and when it is effective?

A

Heitz and mayfield 2002

Pockets 1-3mm there was more CAL with RSD than surgery so just need scale and OHI

Pockets 4-6mm: less CAL with surgery than RSD, PPD reduced more with RSD than with surgery so need OH and RSD consider topical abs

Pockets more than 6mm: more CAL gained with surgery than RSDand PPD reduced with surgery: OH and open flab debridement and RSD

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2
Q

How do you manage furcation?

A 
Insufficient data of effectiveness 
Options are: 
Flap and debride
Apically repositioned flap
Tunnel prep
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3
Q

How do you manage patients with chronic perio?

A 
Full mouth assessment 
RSD >3mm 
Re assess in 2/3 months
If poor response repeat RSD
Consider surgery or Antimicrobials
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4
Q

What are aims of surgery?

A

Gain access to root surface
Increase visualisation for effective debridement
Remove excess tissue or re contour tissues to establish better gingival morphology
Reference or replace lost periodontal tissues

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5
Q

What are the indications for perio surgery?

A 
Deep pockets
Adverse pocket morphology
Bone defects
Furcations
Muco gingival problems
Aesthetics
Short clinical crown height
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6
Q

What are the pre surgical requirements?

A 
MH
Consent
Corsodyl MW
Analgesics 
No smoking
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7
Q

What are thr post op requirements?

A

POI
Corsodyl
Nonsmoking
Analgesics and review in 1/52

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8
Q

What are the options for flaps design?

A

Full flap with 2 relieving incisons
Trianglukar flap with 1 incisions
Modified flap with no relieving incison

Full thickness
Partial thickness: mucoperositum attached to bone

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9
Q

How do you perform a gingivectomy?

A

Measure also pocket deoth with a probe and mark them with blood points
Incise using beveled incison using no12 blackes knife to maintain gingival contour
Curettage tisseue and dress for one week
MaintainOH

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10
Q

Wings is a gingivectomy indicated?

A

Drug induced hyperplasia

Genetic gingival hyperplasia

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11
Q

What is a gingivoplassty?

A

Surgical re contouring or remodelling of the tissues

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12
Q

What is the purpose of combing a ginvectomy with a gingivoplassty?

A

People that have deep pockets and these are then reduced and then re contoured to provide a better contour

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13
Q

What type of flap do you do for deep pockets?

A

Modified widman flap

Deep pockets
Adverse morphology
Failure of access with RSD

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14
Q

How do you do a modified widmand flap?

A

Intracreviscular incision
Retract tissues
Curete

Elimate pocket epithelium and granulation tissue and then suture and maintain OH and obtain long junctions epithelial

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15
Q

What are advantages of modified widman?

A

No extensive sacrifice of non inflamed tissue
No apical displacement of tissues
Close adaptation of tissue with root surface
Less exposed root surface for sensitivity and aesthetics
Minimum trauma to CT and alveolar bone

16
Q

What are the muco gingival suergey options?

A

Frenectomy
Laterally repositions flap
Free epithelial graft

17
Q

What is a Frenectomy?

A

Fraenal reduction

18
Q

How do you manage recession?

A

This is displacement of soft tissues apical to CEJwith exposed root surface mainly seen in adults

Conservative: prevent further damage
Gingival augmentation: if sensitive/ aesthetics

19
Q

Where is recession common?

A

High standard of OH: buccal edge shape defects

Also poor OH and perio disease

20
Q

How can recession be classified?

A

Local or general
Local more likely trauma
General more likedl perio

21
Q

What is the aetiology behind recession?

A 
Mechanical brushing
Localised plaque induced 
Prominently position teeth
Destructive perio
Loss of perio support
Ortho 
Development
22
Q

In ortho, what will determine if recession will develop?

A

Thickness of tissue rather than quality

23
Q

What is pseudo recession?

A

The margin is apical compared to adjacent teeth but CEJ not involved

24
Q

How do you treat recession?

A

Healthy gingiva : do nothing
Inflamed with more tha 2mm attctched gingiva: OH
No attctched gingiva +/- discomfort when Brishing or ortho will cause dehiscence and dentine hypersensitivity then gingival augmentation

25
Q

Which gingival augmention procedures are there?

A

Grafting: free flap from palate
Flap: coronally reposition

26
Q

What is a tunnel preparation?

A

This is done for grade 2 and grade 3 Furcations on mandibular teeth and creates a wide separation angle to allow interdental Brishing

Raise flap
Remove granulation tissue plus or minus bone
Apically reposition flap

27
Q

When is crown lengthening surgery indicated?

A

Subginginval caries
Subginginval Cusp fracture
Poor mechanicals retention: usually do multiple teeth
Gummy smile

28
Q

How do you perform crown lengthening?

A

Flap: incisions apical to gingival margin (wedge shaped) raise the flap (mucosa thickness)
Bone removal and apically reposition flap

Suture

29
Q

What are the options for gingival augmentation?

A

Vestibular gingival extension

Grafts which can be free or pedicled

30
Q

How do you do a free gingival graft?

A 
RSD root surface
Reduce convexity 
Add demineralising agent 
Prepare recipient bed 3/4mm lateral to defect 
Horizontal incison at ACJ
Place graft and dressing
31
Q

What do grafting producers mainly aim to do?

A

Increase the width of keratinised gingiva and prevent furthe rrecession from occurring

32
Q

What are the three options for grafts to cover recession defects?

A

Free gingival graft
Pedicle sliding graft
Sub epithelial connective tissue graft

Perio (6 decks)

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