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Perio lectures > Principles of surgery > Flashcards

Principles of surgery Flashcards

1
Q

Surgery Def

A

-Any surgical procedure used to treat periodontitis or to modify the morphology of the periodontium -Surgical manipulation of periodontal soft tissues, root and bone

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2
Q

Goal of periodontal surgery

A

To create an oral environment that is conducive to maintaining the patient’s dentition in health, comfort, function and esthetics

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3
Q

Indications for periodontal surgery

A

Indications: #1 Access to the root surface and bone Regeneration Pre-prosthetic Surgery Abscess treatment Mucogingival surgery Gingival enlargement Implant placement Exploratory surgery

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4
Q

Types of pre prosthetic surgery

A

Crown lengthening Gingival augmentation Ridge augmentation Sinus floor elevation Ridge augmentation Tori reduction Tuberosity reduction

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5
Q

Contraindications for periodontal surgery

A

Medical - uncontrolled disease Poor plaque control High caries risk Patient desires

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6
Q

Deferent surgical therapies

A

Gingivectomy/Gingivoplasty Curtain Procedure Modified Widman Flap Flap Curettage Osseous therapy Laser Surgery

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7
Q

Types of Osseous therapy

A

Resective Regenerative -GTR -Bone grafts -EMD, PDGF…

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8
Q

Surgical Approach is based on…

A

Type of disease Severity of disease Location of disease Morphology of osseous defects

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9
Q

Surgical Objectives

A

1 - Provide access Modify osseous architecture Repair / regenerate the periodontium Pocket reduction Establish acceptable soft tissue contours

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10
Q

Surgical Objectives #1 Access

A

Opened approach to debridement: Increased visibility Increased efficiency Less tissue trauma

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11
Q

Surgical Objectives Osseous Modification

A

Re-create physiologic contour Eliminate osseous defects Resection Regeneration Provide a maintainable periodontium

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12
Q

Surgical Therapy Repair/Regenerate

A

Reattachment Repair New Attachment Regeneration

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13
Q

Reattachment

A

To attach again The reunion of epithelial and connective tissue with a root surface following separation by incision or physical injury (not by disease). Not to be confused with new attachment.

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14
Q

Repair

A

Healing of a wound with tissue that does not fully restore the architecture or function of the original part. LJE and scar

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15
Q

New Attachment

A

The union of connective tissue or epithelium with a root surface that has been deprived of its original attachment apparatus. This new attachment may be epithelial adhesion and/or connective adaptation or attachment and may include new cementum. i.e. DISEASED

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16
Q

Regeneration

A

Reproduction or reconstitution of a lost or injured part in a manner similar or identical to its original form. In periodontics, refers to the formation of new bone, cementum, and a functionally-oriented periodontal ligament at a site deprived of its original attachment apparatus. In edentulous spaces, refers to the surgical augmentation of a resorbed ridge.

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17
Q

Surgical Objectives - Pocket Reduction

A

Reduce probing depth to a manageable level Improve subgingival access - Easier plaque control Improve long term stability of the periodontium

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18
Q

Surgical Objectives Acceptable Contours

A

Provide acceptable soft and hard tissue contours to: Reduce pocket depths Improve plaque control Improve esthetics

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19
Q

Surgical Principles

A

Know your patient Develop thorough treatment plan Know anatomy of surgical sites Provide profound anesthesiaAtraumatic tissue managementAseptic technique HemostasisNon-irritating sutures Obliterate dead space Quiescent wound healing

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20
Q

Atraumatic Tissue Management

A

Sharp, smooth incisions and dissection Adequate flap release Conserve vascular supply Keep it wide at base (2:1 width to height) Avoid - overthinning, excessive flap tension, perforation/tears Don’t desiccate the flap and bone, keep them well hydrated

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21
Q

Aseptic Technique

A

Sterile peri-operative field Sterile instruments and gloves Pre-operative mouthrinse/ peri-oral alcohol wipe Prophylactic antibiotics prn

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22
Q

Infections Post-surgically

A

1% infection rate post-surgery (<1% without, 2% with antibiotics) Pack & Haber, 1983 4.2% of 498 cases No difference if bone removed or teeth ext. Quad surgeries infected more often then sextant No difference between group with prophylactic antibiotics and those without BL: low rate of infection following periodontal surgery; use of antibiotics to prevent infection not warranted

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23
Q

Surgical Hemostasis

A

Preoperative Medical history Medications/coagulation disorders Intraoperative Pressure Vasoconstrictors Local agents Surgicel, Avitene, topical thrombin, HemCon (chitosan), bone wax, Gelfoam Bovie

24
Q

Blood loss during surgery

A

134 ml, mean blood loss from periodontal flap surgery (range 16-592ml) Duration of surgery and amount of anesthetic used correlated with blood loss Mand surg ~151 ml Max surg ~ 110 ml

25
Q

Post op hemostasis

A

rest wound stability Tranexamic acid

26
Q

Surgical Principles Atraumatic Suturing

A

Small needle/fine suture Select suture with less tissue reactivity Use least number as is necessary Minimize flap tension Place in keratinized tissue when possible Take adequate “bite” of tissue

27
Q

Surgical Principles Obliterate Dead Space

A

Attain hemostasis Primary closure Flap pressure

28
Q

Pain Management Preoperative Assessment

A

medical / dental history past response to surgery/analgesics substance abuse

29
Q

Pain Management Preemptive measures

A

administer analgesic 1-2 hrs prior long acting local anesthetics

30
Q

Pain Management Postop care

A

appropriate analgesics Motrin 800mg x 40 tabs, take 1 tab q8h prn pain Tylenol 500mg x 40 tabs, take 2 tabs q6-8h prn pain Tylenol #3 x 12 tabs, take 1 tab q4-6h prn pain Others..Percocet, Norco, Ultram……

31
Q

Stress Management

A

Patient - provider rapport Profound anesthesia Consider IV or oral sedation

32
Q

Quiescent Wound Healing

A

Wound Stabilization Flap adaptation / hemostasis Appropriate suturing technique Avoid post-operative trauma limit oral hygiene delay suture removal periodontal dressing? Optimize infection control

33
Q

Wound Stability

A

0-1 d - Fibrin linkage and clot adhesion - weak strength 3d - Granulation tissue - weak 14 D - Epithelial attachment and collagen adhesion - mod strength 21 d Maturation of CT and Cementum Formation - strong

34
Q

Wound stability of full thickness flaps/sutures in dogs

A

2-3 d 225 gms flap separation 7 d 340 gms flap separation 14 d 1,700 gms suture pull through 1, 4, 6 mo 1,700 gms suture pull through

35
Q

Types of incisions

A

External bevel Internal bevel Sulcular Releasing Thinning (dissecting) Stepback Cutback Periosteal release

36
Q

External Bevel

A

Coronally directed Gingivectomy

37
Q

Internal Bevel

A

–Apically directed

–Inverse bevel

–Reverse bevel

38
Q

Sulcular incisions

A
39
Q

Vertical Releasing locations

A

•Unfavorable

–Interdental

–Midfacial

•Favorable

–Line angles

40
Q

Vertical Releasing advantages

A

–Increase access

–Avoid non-diseased sites

–Eliminate flap tension

–Allows flap positioning

41
Q

Vertical Releasing contraindications

A

–Distal to second molars

–Exostoses

–Mandibular concavities

42
Q

Flap design considerations

A

–Anatomical constraints

–Blood supply

–Tissue morphology

–Required access

–Degree of flap mobility required

–Final flap position

43
Q

Flap design

A

To maintain adequate blood supply to the flap the ratio of flap height to flap base should not exceed 2 to 1.

44
Q

Full thickness flap

A

Elevation of entire soft tissue complex

45
Q

Full thickness advantages

A

–Increased visibility

–Access to alveolar bone

–Easier, quicker procedure

46
Q

Full Thickness disadvantages

A

–Exposure of root dehisence/fenestration

–More alveolar bone loss?

47
Q

Split Thickness flap

A

Elevation of only the superficial epithelialized portion of soft tissue leaving the periosteum intact

48
Q

Split Thickness advantages

A

–Does not expose root dehisence/fenestrations

–Reduced alveolar bone loss

–Leaves a soft tissue bed for graft placement

49
Q

Split Thickness disadvantages

A

–Not indicated in areas of thin tissue

–More technically demanding and time consuming

–Risk of perforation

50
Q

Flap Reflection “Mopuse hole”

A
  • Don’t “mouse hole”
  • Increases surgical trauma
  • Poorer visibility
  • Inadequate debridement
  • Increased operator fatigue/frustration
  • Inferior surgical results
51
Q

Type of flap repositioning

A
  • Replaced
  • Apically positioned
  • Coronally positioned
52
Q

what type of positioning is this

A

Coronal

53
Q

What kind of repositioning is this

A

Apical

54
Q

Suture needle facts

A

–Stainless steel

–3/8s, half, 5/8s

–tappered, cutting, reverse cutting

55
Q

Suture selection

A

–tissue reactivity

–handling properties

–knot security

–tissue type

Perio lectures (10 decks)

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