Periodontal Surgery Flashcards
What is the goal of periodontal surgery
To control progession of periodotnal destruction and attachment loss
What is periodontal surgery?
To intentionally cut soft tissue to control disease or change size and shape of tissues.
What are the indications of periodontal surgery?
- Provide instrumentation access
- Pockey Depth reduction
- Correct mucogingival defects
- Access osseous defects
- Esthetic imporvement
- Regeneration of tissue lost to disease
- Placement of dental implants
Who decides periodontal surgery and how do they evaluate?
periodontist decides if surgery needed after NSPT and sufficient healing has occured.
They evaluate:
* pocket depth
* bone level
* tooth value
* biofilm control and caries risk
* health of patient
* expectations informed consent
Limitations: Surgery will not prevent recurrent disease or tooth loss without proper maintenance.
What are the considerations for periodontal surgery?
- Pocket Depth:
1. surgery successful for 5-9 PD
2. 5-6mm wait and see approach (NSPT and maintenance) - Bone level
1. Depends on amount of bone (>50%)
2. Osseous defect
3. Periodontal pockets
4. Ossesous surgery included
5. Biological width (1-2mm of CT) - Tooth Value/ Function
1. Save specific teeth
2. esthetically acceptable - Biofilm Control
1. inadequate selfcare= increase in disease progression
2. poor control= postpone or bdon surgery
3. Increase caries risk = restorations, tooth loss - Patient Health
1.Smoking discourages
2.Specific systemic disease or conditions (Uncontrolled) - AGE
1. any age is acceptable
2. factor in disease progression - expectations
1. esthetics
2. inability to restore to pre-disease - Informed concent
1. diagnosis prognosis, expected results
2. Ramifications of delaying recommended treatment
3. Different treatments
4. Choose no surgery
True or False
Surgery will not prevent recurrent periodontal disease and tooth loss
True
If a patient chooses no surgery what should occur?
- More requent maintenace
- More Complex subgingival plaque biofilm control
- Disease progression possible
- Acceptance of risk= continued attachment loss and tooth loss
What is a periodontal flap?
gain access to underlying structures by separation of tissue from underlying alveolar bone and blood supply.
Aloows for other surgical procedure.
What is a perdontal plastic surgery/ mucogingival surgery?
Designed to correct defects in morphology or position of dentogingival junction
What is osseous surgery?
Modify bone by either reshaping or removing alveolar bone
relationship of CEJ and alveolar crest changd.
What is replacement or regenerative surgery?
- Operations restores histologically and functionally identical tissue to that which has been lost by disease.
What is implant surgery?
placement uncovering and remocal of dental implants
What are some indications for flap surgery and what are its considerations?
Indications: Deep pockets, suprabony pockets, infrabony pockets, access to bone.
Considerations:
Thin Narrow gingival= does not allow proper incision
estheritc concerns
caries-prone patients
What are the two types of flap surgery?
It is based on bone exposure after flap reduction
Full thickness or mucoperiosteal: all soft tissue is reflected to expose bone, blunt dissection; periosteal elvators, allows for ossessous surgery.
Partial thickness or mucossal: involves epithelium and layer of CT, sharp dissection scalpels.
What are the two types of flap surgery?
Based on placement of flap after surgery
- Replaced flap (non-displaced)- replaced in position it had been before surgery
- Apically positioned (displaced)- positioned apical to original position.
What are the different types of incisions on horizontal and vertical flap.
- Horizontal- mesio-distal direction
- two types crevicular or sulcular incision
- interneal bevel incision
*Vertical- apico-occlusal direction, allow elevation without soft tissue damage or stretching.
What is an access flap/ modified widman flap?
- access to root surfaces for plaque biofilm and calculus removal
- creates gingiva to root reattachment condition
What is open flap ( flap curettage)?
- more extensive access/elevation
- possible displacement of flap to new location
What are the indications and contraindications of access and open flap?
indications: esthetically sensitive areas not indicated for flap procedures,
Contraindications: pocket reduction or pocket depths may persist.
What is periodontal plastic surgery?
- aimed toward correcting problems with attached gingiva or level of frenum attachment.
- Improves esthetics and or function
- can reduce pocket depths
What are the different types of periodontal plastic surgery?
- Gingivectomy: Removes gingiva for pocket reduction.
- Gingivoplasty: Reshapes gingiva.
- Free gingival graft: Donor tissue grafted to increase gingival width.
- Lateral pedicle graft: Transposed tissue with blood supply.
- Subgingival connective tissue graft: Connective tissue under flap.
- Crown lengthening: Lengthens clinical crown (functional or esthetic).
- Coronally positioned flap
- Semilunar flap
What is the indications and contraindications of gingivectomy
- Indications: suprabony pockets, gingival enlargement, no osseous defects requiring osseous or regeneration surgery.
- Contraindications: infrabony pockets, pockets reductiion only and insufficient amount of attached tissue.
What is electrosurgery advantages and disadvantages?
Ad: contours tissue and control hemorrhage, superficial procedures.
Disadvan: unpleasent odoer (burning flesh), heat generated can damage bone and hard and soft tissue.
What are the indications and contraindications for periodontal plastic surgery?
Indications:
* recession beyong MGJ=no attached gingiva.
* Poor plaquw biofilm control- recession, inflam calculus formation.
* Significantly reduced width of keratinized gingiva
* control labial or lingual frenum attachment near GM
Contraindications:
* lack of donor tissue
* lack of adequate keratinized tissue at recipient site.
What is the goal of osseous surgery?
Eliminate pockets by reshaping/removing bone.
What are the two types of osseous surgery?
Ostectomy: Removes supporting bone.
Osteoplasty: Reshapes alveolar bone without removal of supporting bone.
Performed together
What is the indications and contraindications for osseous surgery?
Indications: infrabony pockets, incisional periodontal surgery Allows gingival flap adaption
Reversealveolar bony architecture
Contraindications: Defects does not allow for recontouring- too deep or removal will weaken adjacent teeth.
What is Replacement and Regeneration Surgery?
- Formation of new alveolar bone, cementum and PDL.
What are the different types of periodontal bone grafting?
- Autografts: Patient’s bone.
- Allografts: Cadaver bone.
- Xenografts: Bone from another species.
- Alloplasts: Synthetic bone.
- Guided Tissue Regeneration: Barrier membrane to promote selective tissue healing.
What are the indications and contraindications for periodontal bone grafting
- indications: infrabony defects, furcations defect I or II, mandibular molar-b, more walls= more success.
- Contraindications: less walls
Which is the most predicatable method for regenerating periodontal tissues?
Guided tissue regeneration
What are the different Sutures and Periodontal Dressing
- Sutures: Close wounds, secure grafts, and resorbable sutures.
REMOVE IN 7-14 days
> 14 days permit biofilm formation in wound= stitch abcess
location and number placed must be documented - Periodontal Dressing: Protects surgical site, secures flap, but does not prevent biofilm formation, will not cotnrol bleeding.
Discribe healing after peridontal surgery?
● Blood clot forms; protects wound, allows healing
● Sutures maintain tissue position
● 1 – 3 days → epithelial cells migrate
● 5 – 7 days → gingiva covered
● 7 days → blood clot replaced by granulation tissue
● 10 – 12 days → JE reforms
● 2 weeks → collagen formation begins, wound strength approaches pre-surgery
● 3 – 4 weeks → fully epithelialized sulcus attached
● 3 – 4 weeks → connective tissue peaks
● 1 month → osseous healing starts
● 4 – 6 months → calcification increases, complete bone healing and remodeling
Gingivectomy healing longer than flap procedures
o Bone grafting healing longer than osseous procedures
What are the postoperative instruction for patients?
Limited physical activity
● Control bleeding with light finger pressure on gauze
● Soft diet
● Warn about periodontal dressing breaking and swelling
● Avoid smoking → slow wound healing
● Home oral hygiene instructions
● Given list of post-op instructions before dismissal
● Post-op visit scheduled → 7 days
What is the role of the Dental Hygienist in all apsects of periodontal surgery?
● Discuss advantages and disadvantages of surgical treatment
● Asks questions on patient’s behalf
● Help provide answers to concerns
● Provides postoperative care
Suture and dressing removal
Postsurgical biofilm removal
Follow-up wound care instructions
Home care instructions
