SPT and implant diseases Flashcards
Briefly discuss treatment modalities available for periodontitis
- Mechanical therapy: mechanical removal of biofilm, calculus, stains and toxins from the crowns and root surfaces
- Other adjunctive chemotherapeutic treatment modalities aimed at halting periodontal disease progression: locally delivered antimicrobial agents, antimicrobial irrigation, systemic antibiotics and other host modulation treatment strategies
List advantages of Non-surgical therapy
- Supragingival and root surface decontamination (biofilm ↓red complex, calculus)
- Establishment of microbial flora compatible with periodontal health
- Reduces the inflammation (↓BOP)
- Promotes healing (host tissue-beneficial conditions)
- PD reduction, AL gain, slight bone remodeling
- Reliable and effective treatment
- Allows daily plaque control by patient, prevents re-colonisation
List factors that impact the results of NSPT
- Patient compliance and oral hygiene maintenance
- Initial PPD (large pocket depths may reduce efficacy of NSPT)
- Furcation involvement (makes it harder to remove biofilm due to limited acceess)
- Root anatomy (concavities make biofilm removal difficult)
- Patient’s medical history and presence of systemic risk factors (e.g poorly controlled diabetes, smoking)
Briefly explain how effective non surgical treatment is in removing calculus in deeper pockets
- In pockets equal to and more than 7mm, residual calculus and biofilm can remain on 66% of the root after NSPT
- However, NSPT is quite effective for 4-6mm pockets
- Studies do say that pockets less than or equal to 6mm is best managed through SPT. Pockets 5mm and under are best suited to NSPT.
List advantages and objectives of SPT
• Improve access for root debridement
• Improved accessibility to pathologically exposed root surfaces which enables increased efficacy of SRP
• More probing depth reduction following surgery
Greater increase in clinical attachment level after
Objectives:
• Pocket reduction and facilitate oral hygiene with favourable gingival contours
List three indications for SPT
- Pockets with a PPD > 6 mm after subgingival debridement, where even after re-evaluation there is persistent inflammation and/or attachment loss. It is important to note that SPT SHOULD ONLY TAKE PLACE AFTER NSPT
- Molars with Class II / Class III Furcation involvement
- Infra-osseous bone defects
List the two types of surgery techniques
Resective procedures
• Gingivectomy
• Osseous resection (crown lengthening, tunnel)
• Root separation and resection
Access procedures:
• undisplaced flap-
• apically displaced flap-
• MWF, OFD
Regenerative procedures • Bone grafts • GTR • Biologically active regeneration-enamel matrix derivative (EMD) • PDGF • PRP • BMP
List advantages of resective (3) and regenerative (3) surgical procedures
Resective
• Pocket reduction/elimination by removing affected tissue
• Periodontal tissue repair
• Gingival recession and root exposure
Regenerative
• Tissue preservation
• Periodontal tissue regeneration
• Less gingival recession, better aesthetics
Explain how soft and hard resective procedures work
- Removal of the “soft“ pocket wall: e.g. gingivectomy, undisplaced flap, apically displaced flap
- Removal of the “hard” pocket wall (tooth side): tooth extraction or partial tooth extraction ( e.g. hemisection, root resection where a section of the root is removed with a bur)
Explain what flap procedure is
• Exposing the root surface, by removing/ pulling back the gum, for meticulous instrumentation
• The pocket epithelium and granulation tissue is removed
Some flaps may be non- displaced (where the gum is returned to original position), or displaced flaps (whether it is apical, lateral or coronally).
List 5 indications for flap surgery
- Persistent inflammation in areas with moderate to deep pockets
- Grade II or III furcation involvement
- To perform a root resection / hemisection
- Irregular bony contours and deep bony craters
- Infrabony pockets
List advantages of access flap surgery
- Root cleaning with direct vision
- “Tissue friendly”-preserves gingival tissue
- Reparative, with healing by primary intention (due to sutures)
- Minimal crestal bone resorption
- Lack of post-operative discomfort
Describe the 4 types of oseo healing after a bone graft
- Osteoinduction: proteins (cytokines) in graft carry signals for bone regeneration (autograft and allograft)
- Osteoconduction: bone graft serves as matrix for new bone formation (provide space and minerals for bone precursor cells)
- Osteogenesis: bone graft contains cells that produce bone (autograft only)
- Osteointegration: (newly formed bone fused with surrounding bone)
List indications for bone grafts
- Deep infrabony defects (3 walls-regenerative procedures, good response to treatment)
- Osseous defects in furcations (II class, mandibular molars)
- Regeneration
- Aesthetics
- Smoking IS A CONTRAINDICATION
Explain what guided tissue regeneration (GTR) is, and explain the surgery process
- GTR uses a resorbable or non-resorbable artificial membranes to keep soft tissue from growing into bone defects. This membrane is crucial because it blocks the faster migrating soft tissue cells from growing into the site, while allowing the slower migrating bone-producing cells to populate and grow there instead.
- These membranes can be non-resorbable- ePTFE (needs second stage surgery for removal) OR resorbable (collagen, polylactic/polyglycolic acid, takes 2 months to resorb).
