Periodontal surgery Flashcards
What is root surface debridement? (2)
Removal of deposits (plaque, calculus) and a thin layer of cementum bound endotoxin from root surface. Smooth surface
Limitations of RSD (6)
Progressive and aggressive breakdown.
Persistent acute episodes (eg. periodontal
abscess).
Deep complex bone defects – difficulties
with adequate debridement.
Severe hyperplasia or tissue deformity.
Pathology e.g. epulides.
BLIND!
Aims of periodontal surgery (8)
Gain access to root surface for effective debridement
Visualisation of bone defects
Improvement in tissue contour
Reduction in pocketing (probeable pocket depth)
Removal of chronically inflamed tissue
Encourage regeneration of lost periodontal support
Removal of hyperplastic gingival tissue
Crown lengthening
Indications for gingivectomy (3)
Hyperplasia
False pockets
Adequate attached gingiva
Indications for replaced flap surgery (1)
Deep persistent bleeding (supparating) pockets
Indications for apically repositioned flap surgery (3)
Pocket elimination
Crown lengthening
Unseccessful gingivally encroaching restorations
Considerations before surgery
USWORN
Has non-surgical therapy been undertaken and reviewed at an appropriate interval?
Is patient suitable - medically, emotionally
Do the understand procedure (consent, limitations, complications, aesthetic effect)?
Does pathology warrant surgery?
Is OH adequate?
Has restorative strategy been considered?
Surgical techniques (4)
Excisional e.g. gingivectomy
Flap - replacement (reattachment) e.g. replacement flap (original and modified Widman flaps)
Flap - repositional e.g. lateral, apical, coronal
Mucogingival procedures e.g. grafts
Stages of gingivectomy (6)
LA Pocket depth markings Incisions Removal of excised tissue Scaling -removal of granulation / tissue tags -haemostasis -periodontal dressing Dressing
Stages of flap procedures (7)
LA Incisions (use of relieving incisions) Raise flap Currettage RSD Irrigation Sutures (pack for ARF)
Goldman technique
Create a bleeding point by incision
External bevel incision
Base of incision where bleeding point is
Why do we access - flap procedures (7)
Root surface debridement and granulation tissue removal. Root surface treatment and application of therapeutic agents if appropriate. Odontoplasty Root division/amputation Osteoplasty Ostectomy Placement of GTR / graft materials
External bevel vs internal bevel vs crevicular incision (3)
Flap management (3)
Raising flaps
Relieving incisions
Replacement of flap
Methods of currettage (*)
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