Periodontal Surgery Flashcards
Name 3 categories of periodontal surgery?
Resective
Regenrative
Plastic
Name the 6 types of Resective Perio Surgery?
Gingivectomy
* Open flap
debridement
* Modified Widman
flap
* Apically
repositioned flap
* Furcation plasty
* Root separation +
resection
+/- ossesous
recontouring
Name the 4 types of Regenrative Perio Surgery?
Guided tissue
regeneration +/-
bone substitute
* Biologic root surface
modification
* Other grafting
biomaterials
* Combined therapies
Name the 7 types of Plastic Perio surgery?
Free tissue grafts
* Connective tissue
grafts
* Xenografts
* Allografts
* Coronally
positioned flaps
* Tunnel techniques
* Crown lengthening
surgery
Name the 3 indications and purpose of periodontal surgery?
The management of residual sites of
deep periodontal pockets.
* Crown lengthening.
* Management of gingival excess.
* Management of gingival recession.
What are the tx options fort non-responding periodontal pocketing?
No treatment
* Palliative care
* Continuous non-surgical therapy and
maintenance +/- adjunctive agents
- Surgical regeneration
- Surgical debridgement
Name the short term and long term risks of periodontal surgery?
Short:
- Bleeding
- Infection
- Swelling
- Pain
- Sensitivity
Long:
- Mobility
- Recession
- Futher LoA
- Failure
- Black traingles
Name the 6 oral contraindications to periodontal surgery?
Poor plaque control
* Poor compliance with non-surgical therapy
* Unrestorable teeth
* Grade III mobility
* Unrestored caries
* Untreated endodontic pathology
Name the 8 medical contradindications to periodontal surgery?
Poorly controlled diabetes
* Uncontrolled hypertension
* Immunocompromised patients (e.g. leukaemia)
* Immunosuppressive drugs (e.g. cyclosporin)
* Chemotherapy
* Radiotherapy
* High risk of MRONJ
* Increased bleeding risk - INR ≥ 4
- Multiple antiplatelet drugs
- NOAC
Decision making balance between non-surgical and surgiucal approach?
Non-surgical:
- Pockets < 6mm
- Systemic conditions with
adverse effect on healing
- Limited plaque control
- Limited motivation
- Other uncontrolled dental
disease
- Limited ability to understand
and/or tolerate surgery
Surgical:
- Pockets ≥ 6mm
- Systemic health
- Excellent plaque control
- Excellent motivation
- No other dental disease
- Good ability to understand
and/or tolerate surgery
Primary goals of surgical perio treatment?
To create accessibility for optimal root
surface instrumentation.
* To establish a gingival morphology that
facilitates efficient oral hygiene as
performed by the patient.
Secondary goals for surgical perio treatment?
Decrease pocket depth to enable
stability an maintenance
* Reduce BoP and disease activity
* Improve tooth longevity
What are the 5 general principles of periodontal surgery?
Flap must have a broad base to enable sufficient blood supply
* Flap length: width should not exceed 2:1
* Flap big enough to provide access to the roots with bony defects
* Mucoperiosteal flaps should be used, except when grafting
* Minimal tension when suturing
Name the 8 principl;es of MIST flap design?
Performed under magnification using microsurgery equipment
* Minimal incisions
* Continuous incisions avoided
* Vertical incisions avoided
* Extensive reflections avoided
* Flap reflection by sharp dissection
* Use of regenerative materials & EMD where possible
* Flaps secured using vertical matress sutures
What are the idnciations and contrainditcaitons for MIST?
Indications:
- isolated defects
Contra:
- Generalised horizontal defects
- Multiple interconnected defects
Name the 5 advantages of MIST?
Reduced post-operative healing time
* Reduced post-operative morbidity
* Enhanced aesthetic outcomes
* Reduced post-operative recession
* Improved papilla height & contour
Name the 5 disadvantages of MIST?
Technique sensitive
* Reduced access
* Magnification & microinstruments required
* Not a universal technique, apply only when appropriate
* May require longer operating time
What factors lead to failure of surgical tretament of perio surgery?
Poor technique
* Failure to remove granulation tissue/tissue tags
* Residual calculus
* Reverse architecture
* Improper flap placement
- Inadequate maintenance
Name the 4 prerequisites of Guide bone and itssue regenration?
P - Primary closure &
undisturbed healing
A - Angiogenesis to provide
blood supply & undifferentiated
mesenchymal cells
S - Space for bone infill
S - Stability of wound
Name the 6 different bone graft materials?
- Autografts – same individual – harvested from donor site
- Isografts – genetically identical
- Allografts - same species
- Alloplasts - synthetic
- Xenografts - different species
- Bioactives – e.g. enamel proteins, PRGF often combined with
other material that provide scaffold
Principles of suturing for perio surgery?
Least reactive suturing
material
* Minimal amount of suturing
material below the graft
* Suture close to tissues
* Suture removed as soon as
possible
Interrupted suture – most commonly
used suture in periodontal surgery
Modified vertical mattress sutures
ideal for interdental tissue closure
Factors influencing perio surgery outocme?
Surgery successful for group who received professional cleaning
every 2 weeks and were able to maintain good oral hygiene
Post-surgical care advice for perio surgery?
Over the next week eat only soft food that requires little chewing, do not
use the teeth in the surgical site for chewing
* No vigorous movement of fluids
* Use of HSMW after food (+/- chlorhexidine)
* Do not brush the teeth that had surgery for 48 hrs, brush other teeth as
normal twice daily during this period
* Reduce physical activity for 48 hrs
* Refrain from smoking as tobacco smoke will irritate the wound and delay
healing
* Pain relief, immediately, paracetamol/ibuprofen
* Swelling to be expected, should resolve in 4-5 days
