Periodontal surgery Flashcards
What is the definition of periodontal surgery?
Surgical manipulation of periodontal soft tissues, root, and bone Primary
What is the goal of periodontal surgery?
To create an oral environment conducive to maintaining dentition in health, comfort, and function
What are the surgical objectives?
Provide access to debride roots and bone
Modify osseous architecture
Repair/regenerate the periodontium
Pocket reduction
Establish acceptable soft tissue contours
What are some surgical options for periodontitis treatment?
Flap & osseous surgery: Resect pockets
Flap debridement: Try for new attachment to roots
Regeneration (Guided Tissue Regeneration - GTR): Grow new bone, periodontal ligament, cementum
Extraction: Replace with implants, fixed partial denture (FPD), removable partial denture (RPD)
What are the indications for flap and osseous surgery?
Good oral hygiene
bleeding on probing
moderate probing depths and attachment levels
mild to moderate bone loss
recontouring that does not expose furcations or compromise support
What is the technique used in flap and osseous surgery?
Reflect periodontal flaps, scale and root plane teeth
recontour bone to eliminate osseous craters
replace flaps apically to eliminate pocket depth
What are the goals of flap and osseous surgery?
Root debridement, restore ideal osseous and gingival contours, and eliminate or reduce pockets.
What are the indications for open flap debridement?
Good oral hygiene, bleeding on probing, severe probing depths and attachment loss, and when recontouring would expose furcations or compromise support.
What are the goals of open flap debridement?
Debride roots and osseous defects, improve osseous contours, reduce pockets, and gain clinical attachment.
What are the indications for guided tissue regeneration (GTR)?
Good oral hygiene, bleeding on probing, localized vertical osseous defects, and Grade 2 furcation defects.
What are the goals of guided tissue regeneration?
Debride roots and osseous defects, and regenerate the periodontium (cementum, bone, periodontal ligament).
What are the indications for extraction in periodontal therapy?
Severe periodontitis and hopeless prognosis.
What are the key steps in socket preservation after extraction?
Atraumatic extraction, freeze-dried bone graft, and primary closure with a resorbable collagen membrane.
What are the indications for crown lengthening?
Encroachment of the supracrestal attachment (biologic width), gingival inflammation, and bone loss.
What are the advantages of an epithelialized free soft tissue autograft (free gingival graft)?
Increases keratinized gingiva and provides better root coverage.
What are the advantages of a subepithelial connective tissue graft?
Better tissue color match, dual blood supply, less pain at donor site, and predictable root coverage.
When is an allograft (Alloderm) indicated?
For multiple areas of recession and inadequate donor tissue.
What are the advantages of using an allograft (Alloderm)?
No donor site is needed and suturing is easier.
