Periodontal surgery

Question 1

Periodontal Surgery

Answer 1

Periodontal surgery is a plastic (reshaping) surgical procedure designed to restore and regenerate normal form and function to lost and damaged periodontal structures which support the teeth (the gum tissue, periodontal ligament and bone).

Question 2

Objectives for periodontal surgery

Answer 2

• To eliminate pockets
  1. Root surface is made accessible for root planing
  2. After healing – (self-performed tooth cleaning)
• To preserve the periodontium by facilitating plaque removal and plaque control
  Achieved by:
  1. Creating accessibility for proper professional scaling and root planing.
  2. Establishing a gingival morphology which facilitates the patient’s self performed plaque control.
  3. Regeneration of periodontal attachment lost due to destructive disease

**4 main points: **
* Eliminate periodontal pockets
* Eliminate inflammation and bleeding
* Minimise tooth loss
* Prevent recurrence of disease

Question 3

Indications for surgical treatment

Answer 3

1. Impaired access for scaling and root planing
2. Impaired access for self performed plaque control, due to:

• Pronounced gingival hyperplasia and/or gross gingival abberations → (gingivectomy and gingivoplasty)
• Presence of restorations with defective marginal fit or adverse contour → (crown-lengthening procedures)
• Deep periodontal pockets → (pocket elimination procedures)

3. Access for osseous surgery and/or regenerative techniques

Question 4

Gingivectomy

Answer 4

Surgical removal of excess gingival tissue due to supra-alveolar pockets or gingival hyperplasia
Only performed if there is enough attached keratinized gingiva.

Question 5

Gingivoplasty:

Answer 5

Gingivoplasty is a type of gingival surgery used to reshape gingival tissue around teeth.

Question 6

Advantages of flap operations include

Answer 6

Existing keratinized gingiva is preserved.

Marginal alveolar bone is exposed whereby the morphology of bony defects can be identified and proper treatment rendered.

Furcation areas are exposed, the degree of involvement and the “tooth-bone” relationship can be identified.

Flap can be repositioned at its original position/level or shifted apically, thereby making it possible to adjust the gingival margin to local conditions.

Post-operative period less unpleasant compared to gingivectomy.

Question 7

Osteoplasty and Ostectomy

Answer 7

Osteoplasty – is the shaping of bone without removal of any supporting bone

Ostectomy – the removal of supporting bone. Usually performed by burs under irrigation. Bone chisels, files and rongeurs can also be used