s10 - Surgical therapy

Question 1

What are the three main purposes of surgical periodontal therapy?

Answer 1

1) Control periodontal disease. 2) Correct defects favoring plaque accumulation. 3) Facilitate implants (placement/function).

Question 2

What is the primary objective of the surgical phase of periodontal therapy?

Answer 2

Eliminate pathological changes in the pocket wall and create a plaque-control-friendly environment.

Question 3

Why is post-operative plaque control critical for surgical success?

Answer 3

Prevents disease recurrence and ensures healing.

Question 4

Name three medical conditions that contraindicate periodontal surgery.

Answer 4

Poorly controlled diabetes, acute leukemia, recent MI (<6 months).

Question 5

What is the key difference between resective and regenerative periodontal surgery?

Answer 5

Resective removes tissue (e.g., gingivectomy); regenerative rebuilds tissue (e.g., bone grafts).

Question 6

What are two indications for gingivectomy?

Answer 6

1) Gingival enlargement. 2) Suprabony pockets.

Question 7

What is a contraindication for gingivectomy in the anterior maxilla?

Answer 7

Esthetic concerns (risk of exposing root surfaces).

Question 8

Describe the incision angle for a gingivectomy.

Answer 8

45° bevel to the tooth surface.

Question 9

Why is gingivoplasty performed?

Answer 9

Reshape gingiva to create physiologic contours (e.g., fix craters, clefts).

Question 10

What instruments are used for gingivoplasty?

Answer 10

Periodontal knives/scalpels.

Question 11

What is the limitation of gingivectomy in modern periodontics?

Answer 11

Doesn’t conserve keratinized gingiva or allow primary closure.

Question 12

Define gingival curettage.

Answer 12

Scraping the gingival pocket wall to remove inflamed tissue.

Question 13

Why is curettage less favored today?

Answer 13

Scaling/root planing alone often resolves inflammation.

Question 14

What are the two types of periodontal flaps based on bone exposure?

Answer 14

Full-thickness (mucoperiosteal) and partial-thickness (mucosal).

Question 15

How is a full-thickness flap reflected?

Answer 15

Blunt dissection (elevates periosteum).

Question 16

What is the key difference in reflection for a partial-thickness flap?

Answer 16

Sharp dissection (leaves periosteum on bone).

Question 17

What is an undisplaced flap?

Answer 17

Flap sutured back to its original position.

Question 18

Give an example of a displaced flap.

Answer 18

Apically positioned flap.

Question 19

What is the main use of a conventional flap?

Answer 19

Narrow interdental spaces (splits papilla).

Question 20

What incision removes the pocket lining in flap surgery?

Answer 20

Internal bevel (reverse bevel) incision.

Question 21

What is the purpose of the internal bevel incision?

Answer 21

Conserves outer gingiva, thins flap margin, removes pocket lining.

Question 22

Where is the crevicular incision made?

Answer 22

From pocket base to bone crest.

Question 23

What does the interdental incision separate?

Answer 23

Gingival collar from bone (3rd incision).

Question 24

What are the three flap techniques for pocket reduction?

Answer 24

Modified Widman, undisplaced, apically displaced.

Question 25

What is the goal of the modified Widman flap?

Answer 25

Access for root instrumentation (not pocket reduction).

Question 26

What are two indications for an apically displaced flap?

Answer 26

1) Pocket eradication 2) Widening attached gingiva

Question 27

When would you choose a split-thickness vs full-thickness apically displaced flap?

Answer 27

Split-thickness: When minimal KG exists; Full-thickness: Adequate KG present

Question 28

What is the key advantage of apically displaced flaps over gingivectomy?

Answer 28

Preserves/transforms keratinized tissue into attached gingiva

Question 29

How are vertical incisions used in apically displaced flaps?

Answer 29

Extend beyond MGJ to allow flap mobility

Question 30

What suture stabilizes a full-thickness apically displaced flap?

Answer 30

Sling suture around tooth

Question 31

Why is a thick flap preferred in reconstructive surgery?

Answer 31

Prevents graft/membrane exposure from margin necrosis

Question 32

What are the two flap designs for reconstructive surgery?

Answer 32

Papilla preservation flap (PPF) and conventional flap

Question 33

How does the PPF access interdental areas?

Answer 33

Crevicular incisions + horizontal papilla base incision

Question 34

What is the main objective of MIST?

Answer 34

Minimize trauma while achieving regeneration

Question 35

Name three benefits of MIST.

Answer 35

1) Reduced morbidity 2) Better flap stability 3) Primary closure

Question 36

How does M-MIST differ from MIST?

Answer 36

Only elevates buccal flap; papilla remains connected to crest

Question 37

What defect type is MIST best suited for?

Answer 37

Isolated deep intrabony defects

Question 38

What are the two principles guiding crown lengthening?

Answer 38

1) Biologic width preservation 2) Adequate keratinized gingiva

Question 39

What measurements determine if gingivectomy suffices for crown lengthening?

Answer 39

≥3mm soft tissue coronal to bone (thin biotype)

Question 40

When is osseous recontouring required in crown lengthening?

Answer 40

Thick biotype with bony ledges or <3mm soft tissue

Question 41

What is the minimum sound tooth structure needed above bone post-surgery?

Answer 41

4mm

Question 42

Why must crown lengthening extend to adjacent teeth?

Answer 42

Blend osseous architecture and prevent gingival discrepancies

Question 43

How is flap position determined post crown lengthening?

Answer 43

Based on KG width: >4mm=1mm coronal to bone; <3mm=apical to bone

Question 44

What are two esthetic indications for crown lengthening?

Answer 44

1) Gummy smile 2) Altered passive eruption

Question 45

What lip factors influence "gummy smile" treatment planning?

Answer 45

Lip line height during speech/smile, upper lip size/shape

Question 46

When is crown lengthening contraindicated?

Answer 46

If creating unesthetic results or excessive bone removal needed

Question 47

What surgical step ensures detection of subgingival caries/fractures?

Answer 47

Thorough degranulation and osseous recontouring

Question 48

Why is preoperative temporization used in crown lengthening?

Answer 48

Assess esthetics/function before final restoration

Question 49

How is the biologic width maintained during osseous surgery?

Answer 49

Keep ≥3mm from restoration margin to alveolar crest

Question 50

What flap type is used for crown lengthening with minimal KG?

Answer 50

Split-thickness flap apical to bone crest