Post surgical management

Question 1

General post-op care (7)

Answer 1

 Give general advice, preferably written, on what to
expect – some pain, swelling etc.
 Oral hygiene advice:
Clean adjacent teeth gently.
Avoid surgery area.
No interdental cleaning.
Chlorhexidine mouthwash 0.2% (flap)
Clean rest of mouth as usual
Return in one week

Question 2

Post-op care: one week later (4)

Answer 2

 Removal of pack or sutures.
 Rubber cup polish.
 Cleaning advice:
Gentle brushing, soft brush, gums will bleed.
Interdental cleaning gently.
Continue mouthwash (another week – beware staining, mucosal irritation, parotid problems, altered taste)
Treat any sensitivity – sensitive toothpaste or
varnish.
 See again at 1 month and 3 months.

Question 3

Healing (2)

Answer 3

 After flap surgery – primary intention. Long
junctional epithelium.
 After gingivectomy – secondary intention.

Question 4

Primary intention: replaced flap (7)

Answer 4

 Fibrin and clot between tooth and flap.
 Organisation and replacement by granulation tissue.
 Epithelium grows down from gingival margin.
 Long junctional forms. This takes about 6 weeks.
 The deep of any vertical bone defect fills in. The alveolar crest resorbs.
 Over time the healed tissue shrinks and more crown is exposed.
 These changes are maximal at 3 months but occur up to about six months.

Question 5

Secondary intention: gingivectomy (5)

Answer 5

 Initial fibrin cover over wound under pack
 Growth of epithelium from retained islets in wound
and margins of area.
 Initial epithelialisation takes up to 2 weeks - it may be necessary to repack after 1 week.
 Following healing the gingiva regrows to a certain
extent, and the gingival level moves coronally.
 These changes occur up to about six months.

Question 6

Signs of success - flap surgery (8)

Answer 6

 Decrease in inflammation
 Less bleeding on probing
 Decrease in pocket depth
 Increase in attachment
 Eliminate pus
 No increase in mobility
 Improvement of tissue contour
 Stabilisation of bone levels

Question 7

Review apts (4)

Answer 7

 One week
 (4-6 weeks OH support)
 3 months (DO NOT PROBE BEFORE THIS)
 6 months (may need to wait before probing with some regenerative techniques)

Question 8

Complications - flap surgery (3)

Answer 8

 During
Pain, excessive bleeding, apex exposed, damage to flap
 After:
Pain, secondary haemorrhage, sensitivity,
infection, swelling
 Long term:
Recession, dentine sensitivity, poor aesthetics

Question 9

Variability in tx outcome depends on (3)

Answer 9

 Surgical procedure: technique ,operator skills
 Patient factors: oral hygiene, smoking & infection
control, general condition
 Defect-characteristics: defect angle & width amount
of loss of attachment & bone

Question 10

Disadvantages of flap surgery (2)

Answer 10

More plaque accumulation on dentine surfaces –> recurrence of disease
Resection can give rise to tissue damage on neighbouring teeth