Surgical management of periodontitis II Flashcards
Indications for an apically repositioned flap?
Pocket elimination
Crown lengthening
Disadvantages of apically repositioned flaps?
Roots exposed - sensitivity and increased risk of caries
Poor aesthetics
Stages of making an apically repositioned flap?
Incisions:
- Labically - inverse bevel incisions
- Palatally - gingivectomy (cut a bit more)
- Relieving incisions may be necessary - so you can slide the flap down
Raising flap, curettage and RSD
- Raise flap labially beyond the mucogingival junction
- Curettage of pocket lining
- Root surface cleaning
- Reposition apically
Repositioning apically
- Raising the flap beyond the MGJ
- Moving the flap in an apical direction
Suturing and securing the flap apically
- Sling sutures tied labially
- Pack to cover the palatal gingivectomy and secure the flap apically
Post op care and healing
- Pack and sutures for 1 week
- Healing with pocket elimination
- Root surface exposed
Frenectomy?
Prominent labial frenum attached to interdental papilla
Incision around frenum
Lip wound and underminding of edges
Suture the wound
What is gingival augmentation?
Gingival augmentation = Making the width of keratinised tissue bigger
What are root coverage procedures?
Root coverage procedures = cover root when recession present
What is papilla reconstruction?
Papilla reconstruction = managing the loss of interdental papilla surgically
How to do gingival augmentation with free gingival grafting?
Remove and lower the loose tissues and suture them at the depth of the sulcus
Creates a wound but the loose mucosa is now tied to the depth of the sulcus = healing = fixed gingivae - cut palate and suture piece of keratinised tissue over the wound = increased band of keratinised tissue
Indications for the surgical tx of localised gingival recession?
Continued infammation Progressive breakdown Aesthetics Frenal pull - can impact OH Pocketing beyond MGJ Some situations when advanced restorative procedures are planned
Techniques of the surgical management of localised gingival recession?
Laterally repositioned flap Coronally repositioned flap Free gingival graft followed by coronally repositioned flap Guided tissue regeneration CT graft
How to do a pre-op assessment?
Is surgical tx necessary Is recession stable following monitoring Med and social assessment Tooth vitality Radiographic examination - bone levels Informed consent and clinical records
Millers classification for recession?
class I - recession that doesnt pass the MGJ and the papilla is intact class II - still have interdental tissue but recession reaches the MGJ Class III - loss of interdental papilla above the MGJ Class IV - when interdental papilla has gone to the MGJ
Which classes of recession respond to root coverage tx?
Class I and II, class III partially
Laterally repositioned flap?
Can raise a flap, rotate it to cover the tooth
Not used often
Coronally repositioned flap?
Use the same tooth and raise a flap around it, remove epithelium and advance the flap and suture it over the dental papilla
Good if thick keratinised tissue there - if not, can receed again
Need enough interdental support
