Quiz Ch 14 Perio Flashcards
What is the incisional surgery commonly called
Periodontal flap surgery
Periodontal flap surgery is the choice when what cannot be performed for pocket reduction
excisional periodontal surgery
this procedure is called flap surgery becasue
the tissue are pushed away from the underlying tooth roots and alveolar bone, much like the flap of an envelope
The usual incisional technique for pocket reduction with flap surgery is called
The apically positioned flap
Why is it called the apically positioned flap
Because the flap is sutured at a more apical location on the tooth roots to reduce pocket depth
what has fewer contraindications than gingivectomy , so incisional procedures are the most common type of surgery performed by periodontists
Flap surgery
what are the primary indication for incisional surgery
deepened periodontal pockets
What kind of pockets are best treated by flap surgery
suprabony pockets
Flap surgery also allows access to
infrabony pockets
what are the few contraindication for periodontal flap surgery
*gingival tissues must be wide and thick enough to allow proper incision, often the incision must be modified to preserve as much keratinized tissue as possible
What are special modifications of pocket reduction surgery include
combinations of incisional and excisional techniques, such as distal wedge surgery and internal beveled gingivectomy.
what does the distal wedge procedure permits
adequate plaque control on the distal surface of the last tooth in the mandibular arch
the goal of access flap procedures is to what
provide access to the root surfaces for debridement and to create conditions for reattachment of the gingival tissue to the root
what is the modified Widman flap
the excisional new attachment procedure, and open flap curettage
What uses three incisions to separate the pocket lining from the tooth in a controlled manner, whereas the excisional new attachment procedure usually does not involve elevating the flap past the mucogingival junction
modified Widman flap
what are the goal for access flap procedures
to gain access to the root surface for plaque biofilm and calculus removal, including scaling and root planning.
pocket reduction by apical positioning is not the goal of what
access flap procedures
what is access flap procedures are used to treat
periodontal pockets in aesthetically sensitive areas or where pocket reduction is not desired or indicated
That procedure is when incisions are made through thee crest of the gingiva, and the gingival tissues are reflected only far enough to allow the clinician to see the root surfaces and the crest of the alveolar bone
Access flap techniques
what is the major goal of access flap techniques
is to reattachment of the connective tissues to the root surface during healing or creation of a long junctional epithelium resulting in increased attachment for the teeth.
contraindications for access flap procedures
pt should understand that pocket depths may continue to be greater than 3 or 4mm after therapy
by definition involves attachment loss of the connective tissue to the root surface of the tooth and loss of alveolar bone
Periodontitis
What does bone loss create around the tooth
osseous defects
what makes healing unpredictable and result in gingival architecture that is difficult for the pt to maintain with acceptable plaque biofilm control and difficult for the hygienist to maintain with periodic scaling and root planning
osseous defects
what is ostectomy
if the alveolar bone that contains periodontal fibers that support the tooth is removed
what is osteoplasty
if only bony ledges or nonsupporting bone are removed
what is the primary indications for osseous defects
when periodontal pockets that extend below the level of the osseous crest, or infrabony pockets.
this is a indication for osseous defects
thick bony ledges
what is a type of bone loss in which the interproximal bone is apical to the facial and lingual bone (the reverse of the configuration in health), permits periodontal pockets to re-form during healing
Reverse alveolar bony architecture
Areas of serve bone loss are often best treated by what
reducing pocket depths and performing frequent maintenance care
recession is a common finding among pts with
periodontal disease
recession can lead to extension of the periodontal pockets beyond the mucogingival junction so that no attached gingiva exists on the tooth surface, what are these areas called
mucogingival defects and have been implicated in the spread of periodontal disease into deeper tissues , although this role remains controversial
mucogingival defects may be developed by what
orthodontic tx
forceful toothbrushing
this includes a variety of periodontal plastic surgery procedures to augment the thickness of keratinized tissues, increase the zone of attached gingiva, improve gingival aesthetics by covering root surfaces, or augment edentulous spaces
Mucogingival surgery
how are the areas of recession tx
pedicle grafts or free mucosal grafts, althrough connective tissue grafts have been increasingly used
what should be considered for tissue-grafting
area of recession that significantly reduce the width of the keratinized gingiva or have progressed beyond the mucogingival junction
what is the most quoted idea for attached gingival tissue
3mm
what are some other indications for surgical intervention to control mucogingival problems
broad labial or lingual frenum attachments near the gingival margin that may result in unsightly diastemata and a shallow vestibular depth that must be deepened to improve the fit and retention of removable dental prostheses
what are the most common procedures for mucogingival defects
lateral pedicle gingival graft
free autogenous gingival graft
subgingival connective tissue graft
what type of graft is sliding of gingival tissue from an adjacent tooth or papilla, has been suggested as the best technique to attempt to cover exposed root surfaces bec it bring their blood supply with them
Lateral Pedicle Grafts
what are the limitations to pedicle grafts
depend largely on the availability of an adequate source of donor tissue adjacent to the area that needs augmentation
another important limitation to pedicle grafts is
risk of causing gingival recession to the donor site, particularly if the alveolar bone housing is thin or bony dehiscences are exposed during the surgical procedure
this grafts have donor sites located somewhere in the mouth away from the site that requires grafting
Free gingival graft
what is the most common donor site for free gingival graft
the palate, but edentulous areas are also used edentulous areas are also used
How long should the free gingival graft tissue be immobile for
the first week after surgery to allow for the establishment for circulation to the grafted tissue
what is generally not included as part of the donor tissue for free gingival graft
palatal rugae
includes a variety of surgical techniques that attempt t restore the periodontal tissues lot through disease
Regeneration surgery
by definition, periodontal regeneration is
the formation of new alveolar bone, new cementum, and new periodontal ligament on a tooth root surface that was previously diseased
this category of surgery is reserved for procedures that increase the predictability of the growth of new tissues of the attachment apparatus
regeneration surgery
what is created from donor bone from the pts own body. Bone may be taken from intraoral sites, such as tori, the maxillary tuberosity, or bone removed during osteoplasty
Autografts
created from bone that comes from another person. Cadaver bone, obtained from bone banks accredited by the American Association of Tissue Banks, is the most common source of bone allografts used in periodontics
Allografts
this graft uses a variety of synthetic bone materials.
Alloplasts
this graft is made out of hydroxyapatite material or ceramics, such as plaster of Paris and tricalcium phosphate
Alloplasts
these are created from bone taken from another species, such as bovine (cow) or porcine (pig) bone
Xenografts
the most successful use of this materials has been had been as fillers for large osseous defects, using graft materials with all organic tissue chemically removed
Xenografts
indications for bone grafts is
defects with sufficient osseous walls to promote healing, ideally three-wall defects
what are some other defects indications for bone grafts
furcation defects, particularly mandibular molar buccal furcation of grade 2 (not through and through)
Are they any contraindication for bone fill procedures
NO
what is guided tissue regeneration
healing by selected cell repopulation
what appears to be the best candidates for guided tissue regeneration
infrabony defects and furcation’s
what are the most promising sites for guided tissue regeneration
osseous lesions that are likely to respond well to other forms of bone fill or grafting
what is the procedure for guided tissue regeneration
Flaps are reflected and after debridement of the intraosseous lesion, a membrane is placed over the opening in the bone or furcation and fastened to the tooth by suturing or other stabilizing methods
when the epithelium is closed over the membrane in the guided tissue regeneration procedure how long is the wound allowed to heal for
a period of 30 to 60 days
how long does it take for the polylactic acid material resorbs through hydrolysis
within 6 to 12 months
what is required to close the periodontal surgical wounds and to secure grafts into position
sutures
What type of sutures does periodontal surgeons generally use
Braided black silk sutures
when does the sutures have to be removed
7 to 14 days
what is the infection called resulting from sutures retained too long
stitch abscess
at least __ or __ mm of suture “tail” should be left beyond the knot
2 to 3 mm
what must be documented in the chart
the location and number of sutures placed
this is sometimes placed over the sutures to hold the flaps tightly to the teeth and underlying bone when pocket reduction surgery has been performed
periodontal dressing or pack
what is the most common type of pack
consists of a paste mixture that sets chemically to a firm, rubbery consistency,
postoperative procedures include
prescription for an analgesic and possibly an antibiotic
what type of mouthwash may be used to freshen the mouth and inhibit plaque during primary healing in the first week or two after surgery
chlorhexidine or essential oil
what are some postoperative instructions
physical activity should be limited
soft diet
avoid smoking
homecare plaque
when should the pt return for a postoperative visit
1 week after periodontal surgery
the area if surgery shouldn’t be probe for how long
1 month
Relative Contraindications to Periodontal Surgery
- Patients with certain systemic diseases/conditions
A. Uncontrolled hypertension
B. Recent history of myocardial infarction
C. Uncontrolled diabetes
D. Certain bleeding disorders
E. Kidney dialysis
F. History of radiation to the jaws
G. HIV infection - Patients totally non-compliant with self-care.
- Patients with a high risk for dental caries.
- Patients with unrealistic expectations.
what is root SENSITIVITY cause by
- Exposure of root surfaces (previously covered by gingiva) to the oral environment.
- Apically positioned periodontal flaps,
- Gingival shrinkage during healing,
- Root planning with cementum removal
- Dentinal tubules exposed to the oral environment and hydrodynamic forces.
Treatment of Tooth Sensitivity:
Home Fl gels/rinses for 1 month post operatively (containing potassium nitrate)
At Office- application of topical desensitizing agents containing potassium oxalate or ferric oxalate
Sensitivity usually diminishes in 1-2 months
what can cause the tooth to become mobile
periodontal surgery as the result of swelling of the periodontal ligament.
OR Removal of calculus bridge.
Healing After Periodontal Surgery
Blood clot forms at the surgical site.
The blood clot acts as a matrix or scaffolding.
Should be thin.
Firm pressure helps thin the clot, decrease bleeding, and approximate the edges of the flap.
Four Potential Sources of Cells in a Healing Periodontal Surgical Wound
Gingival Epithelium
Gingival Connective Tissue
Bone Cells
Periodontal Ligament Cells
what are the 4 Categories for healing
Repair
Reattachment
New Attachment
Regeneration
In the category of repair what does not form
new bone, new cementum, or PDL during the healing process.
what category is Healing of a periodontal wound by the reunion of the connective tissue and root surface where they have been separated by incision or injury – NOT by disease.
reattachment
Describes the union of a pathologically exposed root with connective tissue or epithelium (where periodontitis had previously destroyed this attachment.)
new attachment
this results in the regrowth of the precise tissues that were present before the disease or damage occurred. (ie. Reformation of lost cementum, lost PDL, and lost alveolar bone.)
Healing by regeneration
Can be accomplished with modern periodontal surgical procedures but cannot be regenerated predictably in all sites.
regeneration
what are the 3 forms of healing
Primary Intention
Secondary Intention
Tertiary Intention
what form of healing is this Wound margins and edges are closely adapted to each other. Heals Quickly
(Ex. Flap surgery-incisional flap)
primary intention
what type of graft Obtain their nutrients by diffusion for the first 2 weeks after surgery from the prepared site.
free gingival graft
Wound margins are not close to each other.
Heals more slowly
A large clot must form over the entire surface
Epithelial cells must migrate long distances.
Can result in more post-operative pain.
(Ex. Gingivectomy-Excisional removal of tissue.)
secondary intention
Wound temporarily left open with the intention of closing at a later date.
Tertiary Intention
Window-like openings in the alveolar bone over a root surface
Fenestration
Root is denuded of bone and portions of the root surface are covered only by soft tissue. Characterized by a long, narrow defect of bone.
Dehiscence
refers to a fissure in the gingival tissues and may be caused by abnormal frenula, trauma from occlusion, or pierce related trauma.
Gingival cleft
a severe abscess or multiple boil in the skin, typically infected with staphylococcus bacteria.
Carbuncle
what are the 2 techniques for removal of aberrant fremun
frenoectomy
frenectomy
this refers to the complete removal of the frenum, including its attachment to the underlying bone
frenectomy
this is the incision of the frenum, it usually is done to relocate the frenal attachment so as to create a zone of attacked gingiva between the gingival margin and the frenum
frenoctomy
is a specializeddentalprocedure, whereby one rootis removed from a multi-roottooth. The tooth is then stabilized and rendered fully functional with a crown or filling.
Root amputation
This procedure may be successful to maintain teeth where bone loss has exposed the furcation. Treatment also involves treating the pulp of the tooth with root canal therapy and placement of a crown.
Root amputation
