Periodontal Surgery

Question 1

In terms of bone loss and attachment when should we extract a tooth?

Answer 1

• Class 3 or bone loss over 75%
• Inadequate attachment
• Loss of over 70% bone height (vertical)
• Bone loss to the apex

Question 2

What defect is this?

Answer 2

Four-wall osseous defect

Question 3

What defect is this?

Answer 3

Two-wall osseous defect

Question 4

What defect is this?

Answer 4

Three-wall osseous defect

Question 5

Which type of ossesous defects have the highest regenerative surgery potential?

Answer 5

Three and Two wall osseous defects

Question 6

Describe a mouth that is periodontally stable

Answer 6

Question 7

What factors can influencing tissue healing?

Answer 7

• OH
• Smoking
• Selection of case & choice of tooth
• Initial pocket depth
• Gingival tissue biotype – Thin (worse) or Thick (best)
• Gingival recession (worse)
• Exposure of membrane/Infection

Question 8

What defect is this?

Answer 8

One-wall ossesous defect

Question 9

What are the different furcation subclasses?

Answer 9

SUBCLASS A - Vertical bone resorption of 3mm or less (measured from the furcation fornix)

SUBCLASS B - Vertical bone resorption of 4-6mm

SUBCLASS C - Vertical bone resorption of 7mm or more

Question 10

Define furcation lesion

Answer 10

Pathological resorption of bone in the anatomical area of a multi-rooted tooth where roots diverge

Question 11

What are the different furcation classes?

Answer 11

CLASS 1 - Horizontal loss of periodontal support (less than 3mm entry)

CLASS 2 - Horizontal loss of periodontal support (over 3mm but WITHOUT coming out other side)

CLASS 3 - Horizontal loss of periodontal support WITH Naber’s probe passing entirely “through & through”

Question 12

Why may non-surgical periodontal therapy fail?

Answer 12

• Large PPD (>6mm) - harder to access and debride
• Large surface area - harder to debride
• Difficult access
• Presence of stubborn calculus
• Anatomical features which complicate NSPT
• Restorative features which complicate NSPT - subgingival margins of fixed prostheses
• Patient factors - failure to implement OHI, smoker, diabetic

Question 13

What are the advantages of periodontal surgical over NSPT?

Answer 13

• Better access to deep pockets
• Better visualisation and enhanced cleaning of anatomical features
• Potential for regeneration of attachment apparatus
• Enables the elimination or reduction of periodontal pockets
• Improved access for patient OH
• Can alter the position of the gingival margin to correct mucogingival defects (e.g recession) or to increase root exposure for restorative purposes (crown lengthening)