Surgical & Nonsurgical Principles of Perio-Dr. Paquette Flashcards
1
Q
Critical Pocket Depths
A
- surgical intervention:
- > 5mm →Clinical attachment gain
- Don’t do on pockets <5mm= clinical attachment loss
- SRP:
- < 4mm→clinical attachment gain
- don’t do on pockets >3
*
- don’t do on pockets >3
- < 4mm→clinical attachment gain
2
Q
Gingival Curretage
A
- invert gracey curettes
- cutting edge towards pocket lining
- removal of pocket epithelium and underlying CT
- remove inflamed granulation tissue
- Not used bc SRP does it
- remove inflamed granulation tissue
3
Q
What are the Nonsurgical Therapy options?
A
- Scaling
- Root Planing
4
Q
What is the rationale behind Scaling & Root Planing
A
- Restore Periodontal Health
- Arrest the progression of further destruction
5
Q
Restore Periodontal Health
A
- Remove elements that cause inflamattion
- plaque biofilm
- calculus
- endotoxin
- Shift composition of sub gingival plaque
- Gram (-) → Gam (+) facultative organisms
- Reduce:
- spirochetes,
- motile rods
- putative pathogens
- Increase:
- Streptococci
- Reduced Clinical Inflammation
6
Q
Scaling and Root Planing
A
- Not separate procedures
- same principles & techniques
- Enamel Deposits
- scaling
- Root surfaces
- scaled and/or root planed
7
Q
What is the therapeutic Goal or Objective of Scaling and Root Planing?
A
- Create biologically compatible root surface
- resolve inflammation
- Decrease pocket depth
- improve or maintain CAL
- Facilitating patient oral hygiene procedures
- prepare periodontal tissues for surgical procedures
8
Q
Disadvantages of Nonsurgical Therapy
A
- Incomplete root preparation
- plaque and calculus removal
- can’t reach all areas
- Root damage
- due to over instrumentaiton
- Requires more time
9
Q
Advantages of Surgical Therapy
A
ACCESS!
- Visual and mechanical access
- Plaque, biofilm and calculus
- 1-2 mm from bone
- in infrabony defects, furcations, root concavities
- Plaque, biofilm and calculus
- Access to bone for respective procedures (osseous surgery)
- restore physiological (positive) architecture
- Ostectomy
- Osteoplasty
- Access to place regenerative Materials
10
Q
ostectomy vs osteoplasty
A
- Ostectomy
- removal of supporting bone
- Osteoplasty
- removal of non-supporting bone
11
Q
Timing of the Surgical Phase of Perio Therapy
A
- Soft tissue response to initial therapy (SRP) has been assessed
- Evaluation of initial therapy (EIT) or reevaluation
- 4-6 wks
- Evaluation of initial therapy (EIT) or reevaluation
- Patient compliance
- Plaque accumulation ≤ 20%
- General Motivation
- Patient/dentist relationship already exists
12
Q
What is the rationale for the surgical phase of perio therapy?
A
- control or eliminate perio disease
- Correct anatomic conditions that favor:
- perio progression
- impair esthetics
- impede placement of prosthetic appliances
- Improve prognosis, function, and esthetics:
- eliminate pathologic changes in pocket walls
- create a stable, maintainable state
- Promote regeneration
- Place implants to replace teeth
- improve environment for placement and function
13
Q
What are the critical zones in perio surgery?
A
- Soft tissue wall of the pocket
- tooth surface
- underlying bone
- attached gingiva
14
Q
Anatomic considerations of Alveolar bone
A
- 2mm away from CEJ
- Scalloped appearance
- mimics scalloping of gingiva
- Dehiscence
- Fenestration
15
Q
Anatomical Considerations in Perio Surgery
A
- Osseous structures
- Vascular supply
- innervation
- musculature
- anatomic spaces
16
Q
Osseous Structures
A
- Mandible is more dense than maxilla
- External Oblique ridge
- more difficult to reflect flap
- Vertical bony prominence of mandibular ramus
- Maxillary sinus
- Palatal exostosis or flat palate presentation
17
Q
Flap Design
A
- Incision and manipulate tissue attached at a base
- preserved blood supply
- Types
- Full Thickness Flap
- Partial thickness flap
- Avoid lingual and greater palatine arteries
18
Q
Full thickness flap vs partial thickness flap
A
-
Full Thickness Flap
- reflect all soft tissue
- gingiva, CT, periosteum
- gain access to bone
- reflect all soft tissue
- Partial thickness flap
- gingiva and CT (split CT)
- correct soft tissue defect (ex: recession defect)
19
Q
Flap Design: Management of bleeding complications
A
- Pressure, epinephrine, and/or suturing
20
Q
Perio Surgery: Innervation
A
- CN5 (trigeminal) branches
- motor portion=muscles of mastication
- Sensory portion: Face, oral mucous membranes, teeth
- V2 (Maxillary) and V3 (Mandibular) Divisions
21
Q
Perio Surgery: How do you reduce risk of nerve trauma?
A
- Avoid mental and lingual nerve
- take PA & PAN
22
Q
Anatomic Spaces
A
- Found in subcutaneous or submucosal connective tissues
- outlined by fascial membranes
- allow communication w/orbit, neck, mediastinum
- infection rate=low
23
Q
List some of the anatomic spaces
A
- Canine (space)
- buccal
- masticator
- mental
- submandibular
- (submental, sublingual, submaxillary)
- lateral pharyngeal
- retropharyngeal
24
Q
Ludwig’s Angina
A
- cellulitis of the submandibular space
- Floor of the mouth=swelling
- dyspnea
25
Gingivectomy Knives
* Only soft tissues
* Kirkland
* plow
* gingivectomy
* Orban
* interdental spaces
26
What is this instrument
* Kirkland
* Gingivectomy Knife
27
What is this instrument?
* Orban
* gingivectomy knife
28
What is this instrument?
Woodson Elevator
29
What is this instrument?
* Ochsenbein Chisels
* Ostectomy:
* sculp bone to scalloped shape
30
What is this instrument?
* Back Action Hoe/Chisel
* shave/smooth/blend bone
31
What is this instrument?
Conventional Needle Holder
32
What is this instrument?
Castroviejo Needle Holder
33
What is this instrument?
* Goldman-Fox Sissors
34
What are the different Types of Pockets?
* Suprabony
* Gingival
* no attachment loss
* mainly pseudopockets
* Periodontal
* attachment loss above crystal bone
* Infrabony:
* 3 wall defect
* Trough
* 2-wall defect
* crater
* 1-wall defect
* hemiseptal
* Combination
* ex: 2-wall defect w/3-wall component (apical)
35
Gingivectomy
* Removal of gingiva and connective tissue
* long bevel incision
* Tx for gingival enlargement (ex: drug induced) or pseudopockets
* Technique:
* Walk probe
* transfer pocket depth to external gingiva→stick in→bleeding point
