Post Surgical Management Flashcards
What is the general advice to give for post-surgical perio?
Give written and verbal
Expect pain (especially donor sites) - painkillers
Advise swelling/bruising - ice pack can be useful
Bleeding
Soft diet 1 week
Don’t look/play with site
What is important to consent patient to if having graft?
Failure of graft
How long can donor sites be painful for?
4-6 weeks
What OHI should give to pt who has just had perio surgery?
Clean adjacent teeth gently Clear set of teeth as usual Avoid brushing surgical area 2 weeks - clean teeth in surgical area w/ CHX No interdental cleaning graft site CHX rinse 2x day 2 weeks
Common follow up regimen for surgical perio pt?
1 week - sutures removal donor site and check progress
4 weeks -suture remove recipient site
3 month - assess healing
What is involved at 1 week check up?
Removing suture donor site
Rubber cup polish is large plaque deposit
Warnings to give with CHX?
Staining, mucosal irritation, altered taste
When can areas be probed after surgery?
NO EARLIER than 3 months
If carrying out regenerative procedure and want to assess with radiograph, when?
9 month post surgery assess improvement bone level
4 stages of wound healing?
Haemostasis
Inflammation
Granulation
Maturation
What happens in haemostasis part of healing?
Capillary damage = blood clot
Blood clot = protect exposed tissue and matrix for cell migration
What happens in inflammation part of healing?
Growth factor in clot recruit inflammatory cells
What happens in granulation part of healing?
Migration and proliferation of fibroblast and endothelial cells
Initial collagen formed
Matrix connection = tension in wound = contraction
What happens in maturation part of healing?
Fibroblast replace provisional fibrin matrix = collagen matrix
Smooth muscle actin = wound contraction
Endothelial cells migrate = agigonesis
How does periodontal wound differ from epidermal wound?
Same sequence normal healing
Only one wide will be vascular
Have natural break epithelium = contamination
How long does it take for pocket reduction following non-surgical tx?
3 months
1 week = long junctional epithelium
Resolution inflammation 2 weeks
Remodelling connective tissue and maturation 2 -3 months
Two types of healing?
Regeneration
Repair
What is regeneration?
Reproduction or reconstruction of lost tissue in way architecture and function is restored
Example of regenerative procedure?
GTR
What is repair?
Wound tissue doesn’t fully restore function/architecture of the tissue
Why may no repair occur?
Insufficient control of infection
Inadequate debridement
No long term amaintance
What are other types of histological healing see post-perio tx?
No repair Long junctional epithelium attach root surface CT attach root surface New bone separated root surface New bone ankylosis root surface
Local factors which affecting healing?
Infection Poor blood supply Foreign body Movement Ionising radiation Type/size and location injury
Why can movement affect healing?
Cause lack of stability graft - compromised fibrin clot
What are systemic factors which affect healing?
Age Poor nutrition Hormones - e.g corticosteroids Smoking Uncontrolled diabetes Haematological abnormalities
What is healing by primary intention?
When edges of wound are approximated at surgical site
Not much loss tissue/cells
What is healing by secondary intention?
Wound not approximated, may have extensive loss of tissue = open w/ large tissue defect
How does wound heal by secondary intention?
Granulation tissue from bottom up w/ epithelial cover
Adv prei surgeyr?
Improved access and visualisation
Improved aesthetic - alter position gingival margin
How long does healing following curettage take?
Restoration and epithelialisation begins 2-3 days and completed 7-10 days
Pocket epithelium removed allowed cells populate root surface
What does curettage involve?
Scraping inner epithelial lining, epithelial attachment and underlying CT - remove inflammed soft tissue
How does wound of gingvectomy heal?
Secondary intention
How long does it take for gingivectomy wound to seal?
Complete = 6 weeks
What a 4 stages of pedicle flap healing?
Adaptation
Proliferation
Attachement
Maturation
How long to reach maturation stage of pedicle flap healing?
2-3 months
What does survival of free tissue graft depend on?
Diffusion of products and oxygen through tissue plasma - graft doesn’t have own blood supply
Phases of healing of free tissue graft?
Initial phase
Revascularisation
Tissue maturation
How does a free graft vascularise?
Anastomses established between blood vessel of recipient bed and those in grafted tissue
Capillary proliferation
Fibrous union between graft and tissue bed
How does successful healing of free graft rely on?
Close adaptation - metabolic products shorter distance diffuse, shorter distance cellular migration, lack mobility in graft
3 main types bone regeneration materials?
Osseoconductive
Osseoinductive
Osseoproliferative
Examples regenerative procedures?
GTR
Enamel matrix derivatives
What is osseoproliferative regeneration?
New bone formed by bone forming cells contained in graft
What is osseoconductive regeneration?
Graft acts as passive scaffold for adjacent host bone cells
What is osseoinductive regeneration?
Bone formation induced in surrounding soft tissue via bone inducing substance
Aim GTR?
Selectively guide tissue regeneration in periodontium
What does GTR involve?
Placing physical barrier to prevent apical migration of epithelium and CT along root surface
How can healing truly be assessed?
Histologically - impractical
How measure perio healing clinically?
Probing - pocket depth
Radiograph - bony infill
Bleeding index
Signs clinical success following debridement?
Decreased inflammation Reduced BOP Decreased PD Increase attachment Elimination poss No increase mobility Improved tissue contour Stabilisation bone levels
What are clinical signs of success following root coverage procedure?
Marginal tissue reach CEJ
Clinical attachement
Sulcus depth 2mm of less
Absent BOP
Complication may occur during periodontal tx?
Pain, bleeding, exposed apex, damage flap
Inadequate anaesthesia
Complications may occur after perio tx?
Pain Bleeding Sensitivity Infection Swelling Dysasthessia Failure graft
Long-term complication perio tx?
Recession
Sensitivitt
Poor aesthetic
Altered sensation
What are pt factors that can produce variable outcome?
OHI
Smoking
General health/MH
What are defect characteristics which can produce variable outcomes?
Defect width
Amount attachment loss
Amount bone loss
Occlusal loads
