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Periodontics 2 > Periodontal Surgery > Flashcards

Periodontal Surgery Flashcards

1
Q

What is the goal of periodontal surgery

A

To control progession of periodotnal destruction and attachment loss

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2
Q

What is periodontal surgery?

A

To intentionally cut soft tissue to control disease or change size and shape of tissues.

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3
Q

What are the indications of periodontal surgery?

A
  • Provide instrumentation access
  • Pockey Depth reduction
  • Correct mucogingival defects
  • Access osseous defects
  • Esthetic imporvement
  • Regeneration of tissue lost to disease
  • Placement of dental implants
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4
Q

Who decides periodontal surgery and how do they evaluate?

A

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.

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5
Q

What are the considerations for periodontal surgery?

A
  • 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
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6
Q

True or False

Surgery will not prevent recurrent periodontal disease and tooth loss

A

True

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7
Q

If a patient chooses no surgery what should occur?

A
  • More requent maintenace
  • More Complex subgingival plaque biofilm control
  • Disease progression possible
  • Acceptance of risk= continued attachment loss and tooth loss
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8
Q

What is a periodontal flap?

A

gain access to underlying structures by separation of tissue from underlying alveolar bone and blood supply.
Aloows for other surgical procedure.

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9
Q

What is a perdontal plastic surgery/ mucogingival surgery?

A

Designed to correct defects in morphology or position of dentogingival junction

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10
Q

What is osseous surgery?

A

Modify bone by either reshaping or removing alveolar bone
relationship of CEJ and alveolar crest changd.

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11
Q

What is replacement or regenerative surgery?

A
  • Operations restores histologically and functionally identical tissue to that which has been lost by disease.
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12
Q

What is implant surgery?

A

placement uncovering and remocal of dental implants

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13
Q

What are some indications for flap surgery and what are its considerations?

A

Indications: Deep pockets, suprabony pockets, infrabony pockets, access to bone.

Considerations:
Thin Narrow gingival= does not allow proper incision
estheritc concerns
caries-prone patients

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14
Q

What are the two types of flap surgery?

A

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.

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15
Q

What are the two types of flap surgery?

A

Based on placement of flap after surgery

  1. Replaced flap (non-displaced)- replaced in position it had been before surgery
  2. Apically positioned (displaced)- positioned apical to original position.
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16
Q

What are the different types of incisions on horizontal and vertical flap.

A
  • 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.
17
Q

What is an access flap/ modified widman flap?

A
  • access to root surfaces for plaque biofilm and calculus removal
  • creates gingiva to root reattachment condition
18
Q

What is open flap ( flap curettage)?

A
  • more extensive access/elevation
  • possible displacement of flap to new location
19
Q

What are the indications and contraindications of access and open flap?

A

indications: esthetically sensitive areas not indicated for flap procedures,
Contraindications: pocket reduction or pocket depths may persist.

20
Q

What is periodontal plastic surgery?

A
  • aimed toward correcting problems with attached gingiva or level of frenum attachment.
  • Improves esthetics and or function
  • can reduce pocket depths
21
Q

What are the different types of periodontal plastic surgery?

A
  • 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
22
Q

What is the indications and contraindications of gingivectomy

A
  • 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.
23
Q

What is electrosurgery advantages and disadvantages?

A

Ad: contours tissue and control hemorrhage, superficial procedures.
Disadvan: unpleasent odoer (burning flesh), heat generated can damage bone and hard and soft tissue.

24
Q

What are the indications and contraindications for periodontal plastic surgery?

A

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.

25
Q

What is the goal of osseous surgery?

A

Eliminate pockets by reshaping/removing bone.

26
Q

What are the two types of osseous surgery?

A

Ostectomy: Removes supporting bone.
Osteoplasty: Reshapes alveolar bone without removal of supporting bone.

Performed together

27
Q

What is the indications and contraindications for osseous surgery?

A

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.

28
Q

What is Replacement and Regeneration Surgery?

A
  • Formation of new alveolar bone, cementum and PDL.
29
Q

What are the different types of periodontal bone grafting?

A
  • 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.
30
Q

What are the indications and contraindications for periodontal bone grafting

A
  • indications: infrabony defects, furcations defect I or II, mandibular molar-b, more walls= more success.
  • Contraindications: less walls
31
Q

Which is the most predicatable method for regenerating periodontal tissues?

A

Guided tissue regeneration

32
Q

What are the different Sutures and Periodontal Dressing

A
  1. 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
  2. Periodontal Dressing: Protects surgical site, secures flap, but does not prevent biofilm formation, will not cotnrol bleeding.
33
Q

Discribe healing after peridontal surgery?

A

● 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

34
Q

What are the postoperative instruction for patients?

A

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

35
Q

What is the role of the Dental Hygienist in all apsects of periodontal surgery?

A

● 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

Periodontics 2 (9 decks)

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