Periodontal Surgery Part 1 Flashcards
where does periodontal surgery fit?
step 3 - managing non-responding sites
what does step 1 do?
builds foundations
- provides preventive and health promotion tools to patient
what does step 1 evaluate
Improvement in OH
plaque levels
bleeding
meeting targets in self care plan
what is step 2
sub gingival instrumentation
what does step 2 evaluate
whether the patient is stable of unstable
what is a stable patient
no periodontal pockets over 4mm with BOP
no remaining deep sites over 6mm
what is an unstable patient
BOP in pockets over 3mm
deep sites remain over 6mm
what is periodontal surgery
collection of surgical interventions involving the supporting tissues of teeth
3 types of periodontal surgery
respective
reparative
regenerative
indications for periodontal surgery
pocket reduction
improvement in gingival contour
improvement of access to OH measures
access to inaccessible non responding sites
regain lost clinical attachment
when is surgical intervention recommended
residual deep sites over 6mm
infra bony defects over 3mm
furcation involvement (class III)
general considerations for surgery
patients wishes and expectations and cooperation
MH, SH
non-surgical periodontal therapy not successful at this site
OH compliance
local factors around tooth (acmes, mobility, infra bony defect)
long term prognosis of tooth
operator experience and resources
systemic considerations for surgery - absolute contraindications
bleeding conditions (INR>3-3.5, low platelets)
recent MI or stroke (<6 months)
recent valvular prosthesis placement or transplant (<6-12 months)
significant immunosuppression
active cancer therapy
IV bisphosphonate treamtment
systemic considerations for surgery - relative contraindications
patient wound healing potential
social history - smoking
smoking and periodontal surgery impact
smoking impairs wound healing - less attachment gain and PD reduction after surgery in smokers
local considerations for surgery
oral hygiene
soft tissue considerations
hard tissue considerations
local anatomical structure
access for surgery
case selection at DDH
NSPT and RSD under LA carried out at maximum potential
minimal supra/su gingival calculus deposits present
compliance with smoking cessation
good plaque control by PFS >80%
present of PPD >6mm and BOP and/no suppuration
no/minimal mobility
pre-operative radiograph showing bony morphology
consent
pain
bleeding
swelling
brusing
post-op infection
recession
scarring
transient mobility of teeth
dentinal sensitivity
failure of procedure
use of biomaterials
basic principles of periodontal microsurgery
microsurgical instruments
microsurgical scalpel blades
magnification
minimal wound
gentle handling of soft and hard tissues
retention of pre-operative soft tissue architecture
flap design principles
keep flaps as minimal as possible
every design is unique
careful handling of tissues
measure interdental pailla to determine handling
most periodontal surgeries avoid vertical relieving incisions
if receiving incisions required, start at 90 degrees to gingival margin and vertical direction
haemostasis
expect minimal blood loss during surgery
local application of LA containing adrenaline can help reduce bleeding
most surgeries have primary closure
sutures
synthetic mono-filament suture
- resorbable or non-resorbable
- non -wicking
- low bacterial colonisation
- can be difficult to tie as ‘springey’
while sutures present no bruising in the region and use chlorohexidine mouthwash to reduce plaque formation
concerns regarding periodontal dressings
difficult handling and placement
patients don’t like it - aesthetics and function
bacterial growth underneath
when are periodontal dressings used
cover raw wound edges in gingivectomy
control healing after gingivectomy
stabilise free gingival graft
post-op instructions
take regular analgesia
use ice packs for first 12 hours to reduce swelling
avoid surgical site when brushing until sutures remvoed
suture removal at 5-7 days
no probing or instrumentation of site for 3 months minimum
effectiveness of periodontal surgery
reduction in overall PPD
elimination of deep pockets
reduced disease progression
effectiveness of pocket reduction is dependant on what
depth of initial site
