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Periodontology module 7 > Periodontal Surgery Part 2 > Flashcards

Periodontal Surgery Part 2 Flashcards

1
Q

types of resective surgery

A

gingivectomy
root resection

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2
Q

types of repair surgery

A

OFD
MWF

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3
Q

types of regenerative surgery

A

GTR
grafts
emdogain

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4
Q

what is resective surgery

A

pocket elimination procedure which establish a morphologically normal attachment but with apical displacement of the dents-gingival complex

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5
Q

causes of gingival overgrowth

A

inflammatory
drug induced
related to systemic diseases

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6
Q

indications for gingivectomy

A

gingival enlargement
supra-bony periodontal pocketing
trauma caused by gingival overgrowth
interference with speech/ aesthetics
excellent at home care
wide zone of attached gingivae

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7
Q

contraindications for gingivectomy

A

narrow attached gingivae
planned osseous contouring
infra-bony periodontal pockets
medical considerations - bleeding disorders

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8
Q

advantages of gingivectomy

A

simple
good vision
can achieve ideal soft tissue morphology

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9
Q

disadvantages of gingivectomy

A

limited indications
heal by secondary intention-painful
risk bone exposure
wastes attached gingivae
excessive recession in pd disease

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10
Q

electrosurgery for gingival recontouring

A

for smaller areas of recontouring
traditionally - electrosurgery
now - lasers

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11
Q

what is surgical crown lengthening

A

surgical procedure which apically repositions the soft tissue and alveolar bone to expose more tooth structure and increases length of clinical crown

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12
Q

surgical crown lengthening indications

A

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

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13
Q

surgical crown lengthening contraindications

A

poor plaque control
poor compliance
non-functional teeth
periodontal destruction
endodontic compromise
medical history considerations

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14
Q

surgical crown lengthening complications

A

poor aesthetics due to black triangles
transient mobility of the teeth
root sensitivity
rebound of marginal tissues
root resorption

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15
Q

what is repair surgery

A

pocket reduction but with replication of the normal attachment

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16
Q

what is repair surgery referred to as

A

open flap debridement

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17
Q

aim of open flap debridement

A

access for root surface debridement
assessment of root surface

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18
Q

types of open repair surgery

A

open flap debridement
modified Widman flap

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19
Q

open flap debridement indications

A

excellent maintenace
site over 6mm with BOP or suppuration
horizontal bone loss pattern
vertical defect less than 3mm
isolated periodontal pockets remain

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20
Q

contra-indications for open flap debridement

A

aesthetic region
need for graft/membrane
complex furcation/ bone defects

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21
Q

open flap debridement advantages

A

healing by primary intention
minimal crystal bone resorption
effective in pockets 6-7mm

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22
Q

open flap debridement disadvantages

A

can be unpredictable
no new true attachment - healing by long junctional epithelium
risk of recession
interdental craters

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23
Q

what is regenerative surgery

A

recreations of the complete attachment apparatus of bone/cementum/ functionally orientated periodontal ligament against previously exposed root surface

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24
Q

repair vs regeneration

A

regeneration - new cementum, new pdl and new alveolar bone
repair - long junctional epithelium, crestal remodelling

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25
Q

aims of regenerative surgery

A

gain clinical attachment
minimise soft tissue recession
increase bone volume
enhance access for plaque control and maintenance
remove factors associated with disease progression

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26
Q

which cells are useful for regeneration

A

mesenchymal cells

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27
Q

case selection for regeneration

A

infra bony defect associated with periodontal pocket over 6mm
class 2 furcation in mandibular molars
single class 2 furcation in maxillary molars

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28
Q

regenerative techniques

A

guided tissue regeneration
bone graft materials
enamel matrix proteins
combinations

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29
Q

what is guided tissue regeneration

A

use of mechanical barrier (membrane) to selectively enhance the establishment of PDL and peri-vascular cells in osseous defects to initiate periodontal regeneration

30
Q

when is guided tissue regeneration used

A

teeth with periodontal bone loss and infrabony defects

31
Q

aim of guided tissue regeneration

A

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

32
Q

what do membranes do in guided tissue regeneration

A

act as a barrier to prevent cells apart from PDL migrating into site

33
Q

types of bone grafts and sources

A

Autograft - from same person
Allograft - different person
Xenograft - animal source
Alloplast - synthetic source

34
Q

name of enamel matrix protein

A

Emdogain

35
Q

regeneration advantages

A

successful in treatment of deep sites of 6mm or greater
healing by primary intention
improvement in volume of supporting tissues of tooth
less recession

36
Q

regeneration disadvantages

A

technically challenging
can be unacceptable for patients regarding certain materials used
expensive materials

37
Q

furcation involved teeth options

A

NSPT
odontoplasty
open flap debridement
tunnelling procedures
root resection or separation
regenerative procedures
extraction

38
Q

what is odontoplasty

A

reduces plaque accumulation by reshaping tooth surface with a bur

39
Q

when is open flap debridement effective

A

effective in shallow defects to eliminate pockets
used to access and clean with direct vision

40
Q

what is root resection

A

removal of one root of a multi rooted tooth where there is uneven bone loss

41
Q

when is root separation indicated

A

carried out infrequently
indicated in extensive furcation involvement where bone loss around both roots is similar

42
Q

when is tunnel preparation used

A

mandibular molars with deep degree 2 and 3 lesions

43
Q

what does the tunnel preparation aim to do

A

improve ability for oral hygiene measures

44
Q

what can tunnel preparation increase risk of

A

root caries
sensitivity
loss of vitality

45
Q

what is gingival recession

A

location of the marginal tissue apical to the cement-enamel junction with exposure of the root surface

46
Q

what must be present in gingival recession

A

a hard tissue dehiscence

47
Q

aetiology of recession

A

traumatic - toothbrushing, partial dentures
traumatic overbite
periodontal disease
poor restorative margins

48
Q

non-surgical intervention of recession

A

monitoring and prevention
composite restorations
gingival prosthesis
orthodontics

49
Q

surgical intervention of recession

A

frenectomy
grafting surgery

50
Q

what is frenectomy

A

removal of local muscle insertion

51
Q

aims of frenectomy

A

stabilise tissue
improve access for oral hygiene measures

52
Q

frenectomy indications

A

unstable local tissue
blocking access for OH measures
non-recession indications

53
Q

contraindications for frenectomy

A

medical/bleeding disorders
scar formation will make further procedures more challenging

54
Q

aims for surgery

A

improve/ create band of keratinised attached gingiva
avoid scarring
optimal tissue bled/ colour match
improve access for OH
100% root coverage

55
Q

pedicle flaps vs free grafts

A

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

56
Q

what is a pedicle flap

A

moving adjacent attached gingiva to cover a region of recession using a split thickness flap

57
Q

indications of a pedicle flap

A

narrow defect on single tooth
adjacent teeth with thick phenotype or endulous area
deep vestibule

58
Q

contraindications of pedicle flap

A

deep periodontal pocketing
loss of interdental tissue
large root prominences

59
Q

pedicle flap advantages

A

one site surgery
good vascularity to pedicle flap
root coverage possible

60
Q

pedicle flap disadvantages

A

limited by amount of keratinised adjacent tissue
risk of recession at donor site
risk of dehiscence at donor site
limited to a single tooth

61
Q

what is a free gingival graft

A

graft from palate formed by epithelium and small amount of underlying connective tissue is placed into a region with localised recession

62
Q

aim of free gingival graft

A

to create a band of keratinised mucosa
remove frenal attachments
prepare site for second procedure to increase root coverage

63
Q

free gingival graft indications

A

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

64
Q

free gingival graft contraindications

A

aesthetic region
aim for complete coverage
donor site tissue poor
medical contraindications

65
Q

free gingival graft advantages

A

relatively simple surgery
increase vestibular depth

66
Q

free gingival graft disadvantages

A

second surgical site
palatal wound heals by 2ndry intention
unaesthetic

67
Q

what is connective tissue grafting

A

surgical procedure where a split thickness flap is raised, released then replaced in a more coronal position

68
Q

what can connective tissue grafting be combined with

A

connective tissue graft from palate especially when
limited attached gingival apical to recession
shallow sulcus
buccally placed root
interdental CAL

69
Q

connective tissue grafting advantages

A

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

70
Q

disadvantages of connective tissue grafting

A

often benefits from CT graft
technically demanding

71
Q

what is the general aim of procedures

A

improve prognosis of tooth retention

72
Q

to be effective what do all procedures require

A

non-smoking
optimal OH
optimised non-surgical tx

Periodontology module 7 (2 decks)

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