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Periodontology > Periodontal Surgical Concepts > Flashcards

Periodontal Surgical Concepts Flashcards

1
Q

what is resective?

A

removing the tissues

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2
Q

what is the primary outcome of periodontal therapy?

A

long junctional epithelium and resolution of inflammation

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3
Q

what is the way we want the tissues to heal?

A

shrinkage of the tissues

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4
Q

is it possible to grow new PDL fibers and a new alveolar bone?

A

yes

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5
Q

what is the fundamental goal of periodontal surgery

A

provide an environment in the periodontium that can be maintained in health and comfort throughout the life of the patient

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6
Q

when is surgery necessary

A

when the periodontium is unhealthy and cannot be repaired with nonsurgical treatment

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7
Q

what are some indications for perio surgery

A
  • remove tissues
  • reduce pocket depth
  • regenerate periodontium
  • enhance prosthetic dental care
  • improve appearance of periodontium
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8
Q

what does relative contraindications mean?

A

each patient is different from all others

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9
Q

what are some relative contraindications for perio surgery

A
  • high risk for dental caries
  • unrealistic expectations
  • systemic diseases/conditions
  • non compliant with home care
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10
Q

systemic disease and conditions that would contraindicate perio surgery

A
  • uncontrolled hypertension and diabetes
  • kidney dialysis
  • HIV infection
  • recent history of heart attack
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11
Q

why can’t someone who has a high caries risk get perio surgery?

A

perio surgery can expose portions of tooth roots

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12
Q

what are terms to describe healing?

A

healing by:

  • repair
  • reattachment
  • new attachment
  • regeneration
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13
Q

define healing by repair? what procedure would result in healing by repair?

A

healing is complete, tissue is not completely the same in appearance or function though

  • results in long junctional epithelium
  • example is healing that takes place after instrumentation (root debridement or scaling)
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14
Q

define healing by reattachment? what procedure would result in healing by reattachment?

A
  • reunion of connective tissue and root that was separated by incision or injury NOT disease
  • moving healthy tissue on a tooth may be necessary to access damaged tissue on an adjacent tooth
  • example would be surgical extraction of a tooth
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15
Q

define healing by new attachment? what procedure would result in this?

A
  • new attachment describes union of pathologically exposed root with connective tissue or epithelium
  • occurs when epithelium and connective tissues are newly attached to root where periodontitis previously destroyed the attachment
  • example would be mucogingival surgery or soft tissue grafts
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16
Q

difference between reattachment and new attachment

A

reattachment does not involve disease while new attachment is from disease

17
Q

define healing by regeneration? what procedure would result in this?

A
  • biologic process by which architecture and function of lost tissue are completely restored
  • tissues look exactly the same as before
  • reformed alveolar bone, PDL, and cementum that were lost
  • example would be guided tissue regeneration
18
Q

define healing of a wound by primary intention

A
  • wound margins are closely adapted to each other

- IDEALLY all periodontal surgery wounds heal this way, but not possible

19
Q

define healing of a wound by secondary intention

A
  • margins or edges of the wound are not in close contact with each other
  • many wounds in perio surgery involve healing this way
20
Q

define healing of a wound by tertiary intention

A
  • healing of a wound that is temporarily left open with the specific intent of surgically closing that wound at a later date
  • not common in dentistry
21
Q

common types of periodontal surgery

A
  1. periodontal flap
  2. bone replacement graft
  3. crown lengthening
  4. guided tissue regeneration
  5. gingivectomy
  6. dental implant placement
22
Q

what is the most common periodontal surgery?

A

periodontal flap

23
Q

what is a periodontal flap surgery?

A

incisions are made in the gingiva to allow separation of the epithelium and connective tissues from the underlying tooth roots and underlying alveolar bone

24
Q

indications for perio flap surgery

A
  • provide access for treatment of tooth roots or bone

- flip can be elevated for periodontal instrumentation to access bone to reshape or fill defects

25
Q

two classifications of periodontal flaps

A
  • based on bone exposure

- based on location of flap margin

26
Q

two sub classes of perio flaps based on bone exposure and features of them

A
  1. full-thickness flap: lifting of the entire thickness of soft tissue, complete access to underlying bone, and blunt instruments used
  2. partial-thickness flap: elevation only of epithelium and thin layer of underlying Connective tissue, sharp instruments used
27
Q

two sub classes of perio flaps based on location of flap margin

A
  1. nondisplaced flap: flap that is sutured with the margin of the flap placed at its original relationship to the CEJ of the tooth
  2. displaced flap: flap that is sutured with the margin of the flap placed at a position other than its original position in relation to the CEJ
28
Q

two types of incision

A
  1. horizontal: parallel to gingival margin in mesiodistal direction
  2. vertical: perpendicular to gingival margin in apico-occlusal direction (lifts tissues away from teeth)
29
Q

can you add bone to horizontal bone loss? why?

A

no because there is no where to put the bone or no where to make it stay

30
Q

what is the flap for access? another name for it?

A

modified widman

  • allows more efficient instrumentation of root surfaces for pocket depths deeper than 6 mm
  • tissue is sutured at original position (nondisplaced)
31
Q

what is an open flap debridement surgery?

A

more extensive flap elevation that displaces flap margin to new location

32
Q

after flap surgery it is healing by ____

A

repair

33
Q

what is osseous resective surgery? what is the main goal?

A

corrects deformities of the alveolar bone resulting from advanced periodontitis
-main goal is to eliminate periodontal pockets

34
Q

define osectomy

A

removal of the alveolar bone attached to the tooth

35
Q

define osteoplasty

A

reshaping the alveolar bone without removing the supporting bone

36
Q

what is an apically positioned flap with osseous resective surgery

A
  • combines displaced flap in apical direction with the resective osseous surgery
  • gingival margin is apical to the CEJ
  • increase root exposure and reduced pocket depths
37
Q

what must you warn the patient of before giving flap surgery?

A

there may be exposed root surfaces and potential for dentinal sensitivity

Periodontology (28 decks)

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