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BDS4 Perio > Periodontal Plastic Surgery > Flashcards

Periodontal Plastic Surgery Flashcards

1
Q

What is access therapy in periodontal treatment?

A

OFD
 Part of step 3
 If certain sites still have deep pockets

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2
Q

What are the advantages of OFD?

A

Better vision, better access to complex pockets (direct access to bone crest)

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3
Q

What are the features of resective periodontal surgery?

A

More historic
- Used before regenerative therapy
- Contributes to bone loss
- Curettage to remove lining of pocket- does not accelerate healing (we want to remove biofilm)

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4
Q

What are the types of resective periodontal therapies that are still used?

A

Furcation resective tx (tunnel prep- easier to keep clean)

Gingivectomy for hyperplasia

CLS- before prosthetic tx (cheaper than implants?)

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5
Q

What is regenerative perio therapy used for?

A
  • Augment using bone substitute with membranes
  • Fix horizontal and vertical infra-bony defects
  • Lose of alveolar bone is difficult due to anatomical structures (issues with implants)
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6
Q

What are the different types of mucogingival therapy in periodontal surgery? (focusses on ST)

A

Gingival augmentation

Root coverage

Gingival preservation at ectopic tooth eruption

Preservation of ridge collapse associated with tooth extraction

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7
Q

What are the ADV/DIS of surgical periodontal treatment?

A

ADV
- Faster outcomes
- Effective

DIS
- Requires good OH (as it is less useful if patient has poor OH- recontamination)

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8
Q

What are the steps in the periodontal treatment plan?

A

Emergency treatment
Disease control
Re-evaluation
Surgery
Reconstruction
Supportive care

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9
Q

How does mucogingival deficiency present?

A

Recession

Black triangles

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10
Q

What is recession?

A

Gingival recession is the displacement of the gingival soft tissue margin apical to the cement-enamel junction which results in exposure of the root surface

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11
Q

What factors are involved in aetiology of recession? pt 1

A
  • Inflammatory process- perio disease
  • PMPR (HPT)- exposes recession, bone is already lost but inflammation is reduced (this may be amenable to reconstructive surgery- but consent patient to this)
  • Vigorous tooth brushing esp in patients with thin biotype (teach correct technique)
  • Hard bristled toothbrush
  • Traumatic incisal relationship- stripping of gingival tissues
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12
Q

What factors are involved in aetiology of recession? pt 2

A
  • Trauma from foreign bodies (piercings)
  • Teeth out if alignment of arch- esp with thin biotype and overlying dehiscence
  • Orthodontic treatment
  • Aberrant frenal attachments- pull on gingival tissues
  • High frenal attachment affecting OH
  • Iatrogenic damage from restorative treatment- subgingival margins that impinges on SCA
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13
Q

What was the old classification for recession?

A

Millers
-> superseded by 2017 classification

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14
Q

What are the types of recession?

A
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15
Q

What types of recession can be surgically fixed?

A

We can only fix class 1 reliably

Class 2 may or may not be amenable to MG surgery (partially treatable)
-> may not be covered up fully

Class 3- not possible

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16
Q

What are the signs and symptoms which occur as result of recession?

A

Dentine hypersensitivity

Cervical caries

Cervical abrasion and erosion

Poor aesthetics- can only be corrected by surgery

Loss of vitality- if recession progresses to apex, may lose tooth

17
Q

What are the treatment options for recession?

A
  1. Monitoring
  2. Use of desensitizing agents, varnishes and dentine bonding agentsto decrease oversensitivness
  3. Composite restoration
  4. Prosthetic crown with pink porcelain in the region of the recession
  5. Removable pink gingival veneers- plaque trap and could worsen disease
  6. Orthodontics- prevention?
  7. Surgery
18
Q

Why are teeth with recession more susceptible to cervical caries?

A

Cementum covering on exposure of root is lost

Cementum and dentine are softer tissue than enamel- not as resistant to caries

-> F supplements can help- Fluorapatite is more resistant than HA/cover with composite

19
Q

What are the issues with covering lesions in cervical area caused by recession with composite?

A

Cervical fillings must be done with precision- no overhangs/very smooth
-> May affect aesthetics/create plaque trap

20
Q

How are cervical abrasion and erosion treated?

A

Abrasion- correct toothbrushing

Erosion- correct diet (acidic drinks)

21
Q

What are the types of gingival graft?

A

1)Free soft tissue graft (gingival and connective)

2)Pedicled gingival graft- vessels maintained

22
Q

What are the types of pedicle gingival graft?

A

Rotational flaps
-> Laterally positioned flap
-> Double papilla flap

Advanced flap
-> Coronally advanced flap
-> Semilunar coronally repositioned flap procedure

23
Q

What is the difference between a full thickness flap and split thickness?

A

Full thickness flap- cutting through to bone

Split thickness (basis of MG surgery flaps)- cut through mucosa but leave some tissue, periosteum over bone
-> never expose bare bone to oral cavity- bacterial infection
-> “Borrowing bit of tissue- but some remains over bone”

24
Q

When is a graft required for mucogingival recession?

A

Progressive recession (esp in thin biotypes)

Root sensitivity

Poor aesthetics

Patient finding it difficult to keep area clean

Orthodontic/prosthetic treatment planned

25
Q

What are the steps in a free gingival graft?

A
  • Remove split thickness flap of tissue from palatal side (from first premolar to second molar- avoids palatal arteries)
  • Suture this into new area
26
Q

What are the ADV of a free gingival graft?

A

Short procedures

Inexpensive

Can be done by GDP

Easy to carry out (if experienced)

Increases keratinized tissue around the teeth, implant or crown

27
Q

What are the DIS of free gingival graft?

A

Not ideal for upper arch if they expose gingiva when they smile (colour is not perfect match)

More susceptible to failure than pedicled flaps (no vessels for 1 week- nutrients only come from adjacent tissue)

Recession may recur

28
Q

What is a connective tissue graft’s benefits?

A

Can be used to modify biotype
-> Prevents future recession

29
Q

How is a connective tissue graft carried out?

A

Same procedure but you take connective tissue from below mucosa, replace and suture
-> uses tunnel technique- semi-lunar flap

30
Q

What are the steps in taking a coronally advanced flap?

A
  • Cut flap- split thickness
  • Move everything coronally and suture over defect

** Add connective tissue graft if you want to thicken biotype

31
Q

What are the features of a laterally repositioned pedicle flap?

A

 Reposition tissue to left or right
 Split thickness flap on one side and rotate over and suture
 Good if you cannot do coronally advanced if not enough keratinised gingivae apically

32
Q

What is a double papilla rotational flap?

A

Similar to laterally repositioned but done on both sides
-> used if not enough tissue for flap on one side

33
Q

Why are even small gains with MG therapy worthwhile?

A

Could be enough to save the tooth

Can prevent extraction- especially if patient only going to lose one tooth as it would affect occlusion
-> or could consider implant (cost?)

BDS4 Perio (2 decks)

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