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Periodontology > Periodontal surgery > Flashcards

Periodontal surgery Flashcards

1
Q

Aims of periodontal surgery

A
  • Gain access to previously inaccessible root surfaces
  • Reduce probing depths
  • Facilitate easier professional management
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2
Q

Evidence for the use of periodontal surgery

A
  • In pockets >6mm, period surgery caused greater increase in clinical attachment level than RSD
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3
Q

Indications for periodontal surgery (5)

A
  • Treatment of residual pockets >5mm and BOP after initial non-surgical tx
  • Access to difficult areas e.g. furcations
  • Gingival enlargement (false pocketing)
  • Mucogingival problems
  • Crown lengthening
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4
Q

Contra-indications for periodontal surgery (7)

A
  • Plaque control >20%
  • Unmotivated patient
  • Poor prognosis teeth
  • Restoratively/endodontically compromised teeth
  • Complex md hx compromising surgery
  • Aesthetic zone
  • Smokers
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5
Q

Pre-surgical tx (before periodontal surgery)

A
  • Good plaque control and motivation
    = Removal of plaque retentive factors or any controllable risk factors e.g. poorly controlled diabetes
  • Non-surgical periodontal tx
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6
Q

Evidence for link between smoking and periodontal surgery

A
  • Smoking reduces benefits
  • Preber and bergstorm - smokers had worse reduction in probing depts and 2x likely to relapse
  • Ah et al - approx 0.5mm less reduction in pocket depths
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7
Q

Why is NSPT required before surgical PT? (4)

A
  • Allows resolution of inflammation thus tissues easier to handle and less likely to bleed
  • Gives better indication of tissue morphology therefore better aesthetics after
  • Pockets may resolve therefore surgery not required
  • Good OH is required before surgery indicated
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8
Q

What are the types of periodontal surgery techniques?

A
  • Gingevectomy
  • Replacement flap
  • Apically positioned flap
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9
Q

Aim of gingivectomy

A

Eliminate false pockets and supra bony defects

Improve aesthetics

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10
Q

Technique of gingivectomy

A
  • Mark pocket depth on tissue and try preserve attached gingiva
  • Bevelled incision coronally and aimed for base of the pocket from buccal to lingual
  • Curette inter proximally to leave exposed bone
  • Instrument root surfaces
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11
Q

Disadvantages of gingivectomy

A
  • No access to furcations or infra bony defects
  • Limited by the width of attached gingiva
  • Poor aesthetics (affects pigmentation)
  • Healing by secondary intention
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12
Q

Aims of replacement flaps

A
  • Reduce pocketing via long JE attachment

- Better aesthetics

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13
Q

How do replacement flaps provide good aesthetics?

A

Maintain the width of attached gingiva and position of the gingival margin

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14
Q

Why are scalloped incisions used in replacement flaps?

A

Allows good proximal closure

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15
Q

When do you use crevicular incisions (in replacement flaps)>

A
  • Healthy sites
  • Thin tissue
    Access is difficult
  • Little attached gingiva
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16
Q

Why are individual incisions done in replacement flaps?

A

Individual incisions prevent straining the gingiva when they are healing (in comparison to continuous incisions)

17
Q

What are inverse bevels in replacement flaps?

A
  • Incise down to crestal bone aiming for the base of the pocket
  • Extend crevicularly around adjacent healthy teeth
  • Or add relieving incisions to allow displacement away from teeth
18
Q

What is important in flap surgery?

A
  • Keep flap moist

- Prevent excess removal of bone

19
Q

Closure in replacement flaps

A
  • Consider if flap requires thinning or bone needs to be reshaped (for aesthetics and adaptation to teeth)
  • Place the flap with the new gingival margin following tooth and bone
  • Use interrupted suture
20
Q

What type of suture used in replacement flaps?

A

Interrupted suture

21
Q

What type of sutures used in apical positioned flaps?

A

Interrupted, continuous or suspensory

22
Q

What happens when the flap is placed more apically?

A

The flap heals with the short JE at the apical extent of attachment loss

23
Q

Replacement vs apical flaps

- Reccession

A

Apically aims for recession to eliminate pockets whereas replacement aims to minimise recession

24
Q

Replacement vs apical flaps

- Extension of the flap

A
  • Replacement flaps are minimal and may not need relieving incisions
  • Apical flaps need incisions and extends beyond the mucogingival margin
25
Q

Why is the apically positioned flap extended beyond mucogingival margin?

A

prevents tethering of the flap

26
Q

What additional procedure may be required in apically positioned flaps?

A

osteoclasts to ensure good adaptation of the flap

27
Q

How to treat osseous lesions and furcation defects

A
  • respective surgery

- Regenerative techniques

28
Q

Contemporary surgical principles

A
  • Minimise flap elevation
  • Minimise trauma to tissues
  • Tension free flap closure
  • Good blood supply to healing tissues
  • Blood clot stability
  • use of microsurgical instruments or monofilament sutures
29
Q

Difficulties with perio surgery of palatal aspect of teeth

A
  • Incisions require exaggerated scallop
30
Q

Indications for root resection

A
  • Localised advanced periodontitis
  • Root caries
  • Root perforation
  • Tooth restorable and functional
31
Q

What are periodontal dressings used for

A
  • Protect wounds
  • Increase comfort
  • Aid location of tissue against bone
  • Hold apically positioned flap in the right place
32
Q

Post surgical maintenance - OH

A
  • Brushing ceased for 1 week (chx mw used)
  • Suture and pack removed 1 week post op and brushing continues
  • IDB after 2 weeks post op
33
Q

When should professional scaling start after surgery

A
  • Professional scaling every 3 weeks util 3 months post op

Periodontology (6 decks)

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