Periodontal Surgery Part 2 Flashcards
types of resective surgery
gingivectomy
root resection
types of repair surgery
OFD
MWF
types of regenerative surgery
GTR
grafts
emdogain
what is resective surgery
pocket elimination procedure which establish a morphologically normal attachment but with apical displacement of the dents-gingival complex
causes of gingival overgrowth
inflammatory
drug induced
related to systemic diseases
indications for gingivectomy
gingival enlargement
supra-bony periodontal pocketing
trauma caused by gingival overgrowth
interference with speech/ aesthetics
excellent at home care
wide zone of attached gingivae
contraindications for gingivectomy
narrow attached gingivae
planned osseous contouring
infra-bony periodontal pockets
medical considerations - bleeding disorders
advantages of gingivectomy
simple
good vision
can achieve ideal soft tissue morphology
disadvantages of gingivectomy
limited indications
heal by secondary intention-painful
risk bone exposure
wastes attached gingivae
excessive recession in pd disease
electrosurgery for gingival recontouring
for smaller areas of recontouring
traditionally - electrosurgery
now - lasers
what is surgical crown lengthening
surgical procedure which apically repositions the soft tissue and alveolar bone to expose more tooth structure and increases length of clinical crown
surgical crown lengthening indications
toothwear
poor gingival aesthetics
restoration of subgingival lesions
replacement of crowns with deep margins
management of coronal third fractures
management of infringement of biological width
develop ferrule for pulpless teeth restored with posts
surgical crown lengthening contraindications
poor plaque control
poor compliance
non-functional teeth
periodontal destruction
endodontic compromise
medical history considerations
surgical crown lengthening complications
poor aesthetics due to black triangles
transient mobility of the teeth
root sensitivity
rebound of marginal tissues
root resorption
what is repair surgery
pocket reduction but with replication of the normal attachment
what is repair surgery referred to as
open flap debridement
aim of open flap debridement
access for root surface debridement
assessment of root surface
types of open repair surgery
open flap debridement
modified Widman flap
open flap debridement indications
excellent maintenace
site over 6mm with BOP or suppuration
horizontal bone loss pattern
vertical defect less than 3mm
isolated periodontal pockets remain
contra-indications for open flap debridement
aesthetic region
need for graft/membrane
complex furcation/ bone defects
open flap debridement advantages
healing by primary intention
minimal crystal bone resorption
effective in pockets 6-7mm
open flap debridement disadvantages
can be unpredictable
no new true attachment - healing by long junctional epithelium
risk of recession
interdental craters
what is regenerative surgery
recreations of the complete attachment apparatus of bone/cementum/ functionally orientated periodontal ligament against previously exposed root surface
repair vs regeneration
regeneration - new cementum, new pdl and new alveolar bone
repair - long junctional epithelium, crestal remodelling
aims of regenerative surgery
gain clinical attachment
minimise soft tissue recession
increase bone volume
enhance access for plaque control and maintenance
remove factors associated with disease progression
which cells are useful for regeneration
mesenchymal cells
case selection for regeneration
infra bony defect associated with periodontal pocket over 6mm
class 2 furcation in mandibular molars
single class 2 furcation in maxillary molars
regenerative techniques
guided tissue regeneration
bone graft materials
enamel matrix proteins
combinations
what is guided tissue regeneration
use of mechanical barrier (membrane) to selectively enhance the establishment of PDL and peri-vascular cells in osseous defects to initiate periodontal regeneration
when is guided tissue regeneration used
teeth with periodontal bone loss and infrabony defects
aim of guided tissue regeneration
stop rapid down growth of epithelial cells
create space for pluripotent cells from PDL access root surface
improve local anatomy, function and prognosis of teeth
what do membranes do in guided tissue regeneration
act as a barrier to prevent cells apart from PDL migrating into site
types of bone grafts and sources
Autograft - from same person
Allograft - different person
Xenograft - animal source
Alloplast - synthetic source
name of enamel matrix protein
Emdogain
regeneration advantages
successful in treatment of deep sites of 6mm or greater
healing by primary intention
improvement in volume of supporting tissues of tooth
less recession
regeneration disadvantages
technically challenging
can be unacceptable for patients regarding certain materials used
expensive materials
furcation involved teeth options
NSPT
odontoplasty
open flap debridement
tunnelling procedures
root resection or separation
regenerative procedures
extraction
what is odontoplasty
reduces plaque accumulation by reshaping tooth surface with a bur
when is open flap debridement effective
effective in shallow defects to eliminate pockets
used to access and clean with direct vision
what is root resection
removal of one root of a multi rooted tooth where there is uneven bone loss
when is root separation indicated
carried out infrequently
indicated in extensive furcation involvement where bone loss around both roots is similar
when is tunnel preparation used
mandibular molars with deep degree 2 and 3 lesions
what does the tunnel preparation aim to do
improve ability for oral hygiene measures
what can tunnel preparation increase risk of
root caries
sensitivity
loss of vitality
what is gingival recession
location of the marginal tissue apical to the cement-enamel junction with exposure of the root surface
what must be present in gingival recession
a hard tissue dehiscence
aetiology of recession
traumatic - toothbrushing, partial dentures
traumatic overbite
periodontal disease
poor restorative margins
non-surgical intervention of recession
monitoring and prevention
composite restorations
gingival prosthesis
orthodontics
surgical intervention of recession
frenectomy
grafting surgery
what is frenectomy
removal of local muscle insertion
aims of frenectomy
stabilise tissue
improve access for oral hygiene measures
frenectomy indications
unstable local tissue
blocking access for OH measures
non-recession indications
contraindications for frenectomy
medical/bleeding disorders
scar formation will make further procedures more challenging
aims for surgery
improve/ create band of keratinised attached gingiva
avoid scarring
optimal tissue bled/ colour match
improve access for OH
100% root coverage
pedicle flaps vs free grafts
pedicle flap - local tissue maintaining own blood supply, single site surgery, surgery limited by local anatomy
Grafts - material from distant donor site, two site surgery, large quantity of CT, more technically demanding, no direct blood supply so risk graft can fail
what is a pedicle flap
moving adjacent attached gingiva to cover a region of recession using a split thickness flap
indications of a pedicle flap
narrow defect on single tooth
adjacent teeth with thick phenotype or endulous area
deep vestibule
contraindications of pedicle flap
deep periodontal pocketing
loss of interdental tissue
large root prominences
pedicle flap advantages
one site surgery
good vascularity to pedicle flap
root coverage possible
pedicle flap disadvantages
limited by amount of keratinised adjacent tissue
risk of recession at donor site
risk of dehiscence at donor site
limited to a single tooth
what is a free gingival graft
graft from palate formed by epithelium and small amount of underlying connective tissue is placed into a region with localised recession
aim of free gingival graft
to create a band of keratinised mucosa
remove frenal attachments
prepare site for second procedure to increase root coverage
free gingival graft indications
discomfort during OH measures
ongoing local inflammation
lack of keratinised tissue in region of recession defect
prevention of further recession
insufficient localised keratinised tissue for pedicle flap
free gingival graft contraindications
aesthetic region
aim for complete coverage
donor site tissue poor
medical contraindications
free gingival graft advantages
relatively simple surgery
increase vestibular depth
free gingival graft disadvantages
second surgical site
palatal wound heals by 2ndry intention
unaesthetic
what is connective tissue grafting
surgical procedure where a split thickness flap is raised, released then replaced in a more coronal position
what can connective tissue grafting be combined with
connective tissue graft from palate especially when
limited attached gingival apical to recession
shallow sulcus
buccally placed root
interdental CAL
connective tissue grafting advantages
possible for one site surgery
microsurgical technique - better handling and minimal scarring
excellent colour match
better vascularisation of flap
best root coverage outcomes with CT graft
disadvantages of connective tissue grafting
often benefits from CT graft
technically demanding
what is the general aim of procedures
improve prognosis of tooth retention
to be effective what do all procedures require
non-smoking
optimal OH
optimised non-surgical tx
