Perio Surgery Flashcards
What is the goal of periodontal surgery?
to restore health and function to the periodontium AND to improve prognosis
What some indications for periodontal surgical therapy?
accessing root for debridement, eliminating pockets, removing diseased perio tissues, improving esthetics, correcting mucogingival defects, making perio more accessible for better hygiene, create favorable restorative environment, draining perio problems, to improve prognosis of tx, and regeneration of tissues
What is the difference between gingivectomy and gingivoplasty?
-ectomy means to remove, and -plasty means to modify or to mold
What is the goal of a distal wedge procedure?
If the gingiva is level with the occlusal surface of the most posterior molar
(in area of retromolar pad)
What kind of incision is used for a distal wedge?
Full-Thickness Incision
What rate does the gingival epithelium regenerate?
~1mm per day
regenerate from both sides of wound, so overall it grows 2mm per day
What are the main goals of performing a gingivectomy/gingivoplasty?
To recontour soft tissue, lengthen crown, and/or reduce pocket depth
What is the general term for correcting osseous defects/deformities?
Osseous recontouring
Name three regenerative surgical procedures.
Grafted tissue regeneration, ridge augmentation, and sinus lift
What is one possible problem to grafting bone marrow from a patient’s hip?
Morbidity - the patient can feel soreness or pain in that area of hip for a long time (possibly permanent)
To minimize the amount of bone marrow grafted, we use fillers from…?
mostly cows (australian cows), coral, etc.
Why would you place a membrane between the grafted bone material and gingiva?
It prevents epithelial down growth
What is epithelial down growth?
Where the gingival epithelium recedes due to missing underlying connective tissue - CT regenerate waayyyyy slower than epithelium
How long does it typically take connective tissue to regenerate after surgery?
6-8 weeks
Why should a surgical wound be sutured?
to get Primary Intention (wound edges are touching)
When referring to wounds, what is secondary intention?
wound opening where the edges of the wound are NOT in contact with each other - takes much longer to heal
At minimum, how long should it take for the surgical wound in a GTR take to heal?
6-8 weeks (CT must regenerate, and that’s how long it takes for that)
Name five examples of corrective procedures for mucogingival defects.
Apically positioned flaps, frenectomy, free gingival grafts, connective tissue grafts, pedicle flaps
Where is a common source of connective tissue for GTR?
The hard palate of the patient’s mouth
partial thickness flap used
After surgery, what determines the height of the epithelium?
underlying connective tissue (must be present for epithelium to exist)
What determines the type of epithelium in an area?
underlying connective tissue (the CT is what makes keratinized epithelium, keratinized, etc)
Which biotype is less susceptible to tissue loss?
Thick biotype
Name five pre-surgical considerations.
Vital signs, adequate plaque control, medical history, patient consent form, & complete periodontal documents
All incisions should be ______, ________, and _________.
clean, smooth, and definite
indecision results in uneven, ragged incisions
A surgical procedure should be _______, __________, _______, and ____________.
simple, predictable, efficient, and cost effective
Flap design should allow for what? prevent what? maximize what?
Allow for adequate access/visibility. Prevent unnecessary bone exposure. Maximize use/retention of keratinized tissue.
Where is the blade positioned during sulcular/intrasulcular incisions?
Blade is inside sulcus with the tip of blade against the tooth.
Describe what the blade does during an internal bevel/extrasulcular incision?
Blade cuts a wedge of the gingival margin to reduce probing depth
Describe the incision of an external bevel?
Blade cuts straight through the gingiva to [nearly] remove the whole pocket
(blade nearly ⊥ to long axis of tooth)
What is the ideal biological width?
3mm
Which incision should you use to preserve as much tissue as possible?
intrasulcular
What three things make up the biological width?
Instrasulcular depth, junctional epithelium, and width of CT attachment
What is one of the biggest contraindications for NOT using an external bevel technique?
If patient has minimal keratinized attached gingiva
If the patient has minimal keratinized gingival tissue, what incision technique should be used?
Intrasulcular or conservative inverse bevel / extrasulcular incision
Give one example of when you should use an extrasulcular incision?
If you need to remove diseased epithelium and apically position the flap
Give one example of when you should use an external bevel incision?
If you want to remove excess tissue w/o raising a flap
this is the conventional gingivectomy
Describe a full thickness flap.
aka Mucoperiosteal flap because it reflects both mucosal gingiva and periosteum; Allows access to bone; Blunt dissection done with an elevator
Which kind of flap is more technique sensitive?
Partial thickness flap
Which kind of flap leaves periosteum attached to bone for later suturing, and requires sharp dissection with a blade?
Partial thickness flap
An ______ flap is more esthetically pleasing than a _______ flap.
envelope, released
What kind of flap should be made when anatomic limitation are present?
Envelope flap
Envelope flaps are usually ____ thickness.
Full thickness
Do envelope flaps require vertical releasing incisions?
No
What kind of flap utilizes one or two vertical releasing incisions?
Release flap (aka relaxed, pedicle flap)
A released flap extends beyond what anatomical feature?
Mucogingival junction (MGJ)
What areas should be avoided when using a released flap?
papilla, mid-cervical areas, and visible esthetic areas of mouth
What flaps allow to be apically or coronally repositioned?
Released flap
Where should incisions be placed when making a pedicle flap?
line angles (aka released flap)
What is the preferred suture technique?
Interrupted suture because it’s simpler (vs. external mattress suture)
What are two examples of non-resorbable suture materials? And one resorbable material?
non-resorbable: silk, gore-tex
resorbable: chromic gut
What purpose do periodontal dressings serve?
Protecting the tissue, mechanical retention, but NO curative properties.
What are five indications for crown lengthening?
Decayed/fractured teeth impending on bio width, excessive wear of the dentition, clinical crown is inadequate for retention of restoration, gummy smile/uneven gingival margins, or functional reasons like inadequate inter-occlusal space
What are four pre-surgical considerations for crown lengthening?
the esthetics of outcome, if it will compromise support of adjacent teeth, the crown to root ratio, and long-term prognosis of tooth
Can inflammation persist, and/or a pocket form if the biologic width isn’t right?
Yes, as well as “purple gums”
Compared to the coronal aspect of the flap, how should the apical aspect of the released flap be?
apical aspect should be wider than the coronal aspect
Every time you reflect a full-thickness flap, what happens to the bone?
The bone is resorbed up to 1mm every time it’s exposed.
