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BOARDs > Periodontics Part 4: Surgical Therapy > Flashcards

Periodontics Part 4: Surgical Therapy Flashcards

1
Q

Flap Design

A
  1. Wider base-adequate blood supply
  2. Incisions over intact bone– NOT over bondy defects or eminences
  3. Rounded Corners
  4. Vertical Releases at Line angles
  5. Avoid Vital Structures
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2
Q

Partial vs Full Thickness Flap

A

Partial Thickness Flap
* includes: Gingiva/mucosa, submucosa
* mucogingival surgery-unecessary to expose bone, leaves vascular bed intact

Full Thickness Flap
* Gingiva/mucosa, submucoa, periosteum
* osseous surgery & periodontal regeneration to permit primary closure
* exposes bone-expect 1mm of bone resorption and remodeling

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3
Q

Papilla Preservation Flap

A

=Papilla Preservation Flap:
* preserve the papilla

Dont want conventional flap
-splits papilla

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4
Q

Full thickness flap: what types of incisions are used

A

3 horizontal incisions:
internal or reverse bevel:
* 1 mm from gingival margin
* removes pocket lining, but preserves outer gingiva
Sulcular or crevicular
* through base of pocket to alveolar crest
interdental or interproximal
* removes tissue collar

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5
Q

Periodontal Pack

A
  • consists of ZOE

placed for 1 week following surgery

protect surgical wound
minimize discomfort
maintain tissue placement
prevent post-op bleeding
* do NOT enhance healing

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6
Q

Gingival Surgery: Gingivectomy vs Gingivoplasty

A

Gingivectomy
* excision of suprabony pockets or enlarged gingiva

Gingivoplasty:
* excise gingiva to reshape tissue deformities

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7
Q

Gingival Surgery: Distal Wedge

A

FOR Pocket reduction
* Distal to terminal molars
* common after 3rd molar ext

Maxillary: Full thickness flap w/parallel incisions
Mandible: Full thickness flap w/v-shaped incisions

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8
Q

What are the different types of Mucogingival Surgery

A
  1. Free Gingival Graft
  2. Connective Tissue Graft
  3. Frenectomy
  4. Frenotomy
  5. Vestibuloplasty
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9
Q

Free Gingival Graft

A

to widen keratinized tissue
* Adds more attached gingiva

ADVANTAGES
Increase:
* esthetics
* Plaque Removal

Decrease:
* inflammation around abutment teeth and implants

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10
Q

What is the advantages of adding more attached gingiva with a Free Gingival Graft?

A

Increase:
* esthetics
* Plaque Removal

Decrease:
* inflammation around abutment teeth and implants

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11
Q

Connective Tissue Graft

A

Root Coverage
* occurs above gingival margin

Graft:
* palate
* Inner Connective tissue ONLY, (No epithelium)

Donor site requires enough attached gingiva

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12
Q

What is the most common donor site for Free Gingival Graft vs Connective Tissue Graft

A

Palate for BOTH!

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13
Q

Frenectomy

A

Complete removal of frenum

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14
Q

Frenotomy

A

Freenum Incision

  • incision of Freenum
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15
Q

Vestibuloplasty

A

Deepen vestibule

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16
Q

What is the purpose of Osseous Surgery?

A

Visualize
Bony architecture
* Positive, Negative, Flat

Bone Defect
* type
* extent

Positive vs Negative vs Flat architecture

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17
Q

Osseous Surgery: Positive vs Negative vs Flat Architecture

A

positive architecture:
* interproximal bone is above radicular bone (Around root)
* normal/ideal

flat Architecture
* interproximal and radicular bone=same level

Negative architecture:
* interproximal bone is below radicular bone

18
Q

What are the different type of osseous surgery?

A

Ostectomy

Osteotomy

19
Q

Osseous Surgery: Ostectomy vs Osteotomy

A

Ostectomy
* remove supporting alveolar bone

Osteotomy
* remove nonsupporting bone
* bone away from tooth

20
Q

What are the mechanisms of healing after osseous surgery?

A

Regeneration:
* Completely restore architecture and fxn

Repair:
* does NOT completely restore architecture & fxn
* form long JE (Scarring)

Reattachment:
* epithelial and CT reconnect w/root surface

New Attachment:
* New PDL fibers connect to New cementum

21
Q

Periodontal Regeneration

A

Guided Tissue Regeneration (GTR):
* regenerate bone, cementum, & PDL

Required materials: (3 B’s)
1.Barrier Membrane: (TANK)
2.Bone Graft (Damge)
3.Biologic Agent: (HEALER)
4.medicine

22
Q

GTR: Biologic Agent

A

creates environment conductive for tissue formation

23
Q

GTR: Barrier Membrane

A

1.Barrier Membrane: (TANK)
* prevents soft tissue downgrowth
* allows bone ingrowth

24
Q

GTR: Bone Graft

A

Bone Graft
* regenerate bone
* osteoconductive, osteoinductive, &/or osteogenic

25
Q

Periodontal Regeneration Healing: Cells that populate the wound from fastest to slowest

A

Cells that populate wound: (fastest to slowest)
1. epithelial cells
2. CT Cells
3. PDL Cells
4. Bone Cells

26
Q

What happens during healing if we opted to do nothing instead of periodontal regeneration?

A

Long Junctional Epithelium
* Repair, NOT regeneration

27
Q

Root Surface Treatment

A

Chelating agents: EDTA & Citric Acid
* demineralize–>expose collagen
* improve new attachment

28
Q

Osteogenic vs Osteoinductive vs Osteoconductive

A

Osteogenic:
* Make bone

Osteoinductive:
* convert progenitor cells into osteoblasts

Osteoconductive:
* scaffold

29
Q

Types of Bone Graft

A

Autograft
Allograft
Xenograft
Alloplast

30
Q

Autograft

A
  • From yourself
  • osteoconductive
  • osteoinductive
  • Osteogenic
31
Q

Allograft

A

from another human
* usually cadavear

Osteoonductive
osteoinductive

32
Q

Xenograft

A

from another animal
* usually cows

Osteoconductive

33
Q

Alloplast

A

Synthetic

Osteoconductive

34
Q

Periodontal Surgery Summary: Additive vs Subtractive

A

Additive:
* Periodontal regeneration
* FGG
* CTG
* Coronally advanced flap

Subtractive: bring levels down & reduce PD
* Resective osseous surgery (ostectomy)
* Gingivectomy
* Apically positiioned flap

35
Q

What is the necessary treatment for infrabony defects?
(1-2-3-4- wall defects)

A

1/2-wall defects
* Resection (ostectomy)
* recontour bone to restore positive architecture

3/4-wall defects
* Regeneration
* better blood supply & cell source proximity

36
Q

What scenarios are ideal for regneration?
(infrabony, furcation, recession)

A

Deep Narrow 3-wall
* infrabony

Hamp Class II
* buccal upper or either buccal or lingual lower
* furcation

Miller Class I
* w/thick gingival biotype & wide band of Keratinized tissue (at least 2 mm)
* 100% root coverage w/CTG
* recession

37
Q

What is the most important procedure after periodontal surgery?

A

Post-op plaque control

38
Q

When bone is exposed, how much bone resorption should be expected?

A

1mm of bone resorption and remodeling

39
Q

Modified Widman Flap

A

Modified Widman Flap

3 Horizontal incisions: internal/reverse bevel
Sulcular/crevicular
Interdental/interproximal

Access subgingival areas for debridement
* Goal=New attachment

40
Q

Apically Repositioned Flap

A

3 incisions + vertical releasing

internal/reverse bevel
Sulcular/crevicular
Interdental/interproximal

incisions made beyond mucogingival jxn
* pocket reduction

41
Q

Tetracyclines

A

Congregate in GCF
* Doxycycline: 1 dose per day

42
Q
A

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