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Week 77 > Surgical & Nonsurgical Principles of Perio-Dr. Paquette > Flashcards

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
        *
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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
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3
Q

What are the Nonsurgical Therapy options?

A
  • Scaling
  • Root Planing
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4
Q

What is the rationale behind Scaling & Root Planing

A
  • Restore Periodontal Health
  • Arrest the progression of further destruction
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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
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6
Q

Scaling and Root Planing

A
  • Not separate procedures
    • same principles & techniques
  • Enamel Deposits
    • scaling
  • Root surfaces
    • scaled and/or root planed
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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
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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
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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
  • Access to bone for respective procedures (osseous surgery)
    • restore physiological (positive) architecture
    • Ostectomy
    • Osteoplasty
  • Access to place regenerative Materials
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10
Q

ostectomy vs osteoplasty

A
  • Ostectomy
    • removal of supporting bone
  • Osteoplasty
    • removal of non-supporting bone
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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
  • Patient compliance
    • Plaque accumulation ≤ 20%
    • General Motivation
  • Patient/dentist relationship already exists
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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
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13
Q

What are the critical zones in perio surgery?

A
  • Soft tissue wall of the pocket
  • tooth surface
  • underlying bone
  • attached gingiva
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14
Q

Anatomic considerations of Alveolar bone

A
  • 2mm away from CEJ
  • Scalloped appearance
    • mimics scalloping of gingiva
  • Dehiscence
  • Fenestration
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15
Q

Anatomical Considerations in Perio Surgery

A
  • Osseous structures
  • Vascular supply
  • innervation
  • musculature
  • anatomic spaces
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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
  • 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
Q

Gingivectomy Knives

A
  • Only soft tissues
  • Kirkland
    • plow
    • gingivectomy
  • Orban
    • interdental spaces
26
Q

What is this instrument

A
  • Kirkland
    • Gingivectomy Knife
27
Q

What is this instrument?

A
  • Orban
    • gingivectomy knife
28
Q

What is this instrument?

A

Woodson Elevator

29
Q

What is this instrument?

A
  • Ochsenbein Chisels
    • Ostectomy:
      • sculp bone to scalloped shape
30
Q

What is this instrument?

A
  • Back Action Hoe/Chisel
    • shave/smooth/blend bone
31
Q

What is this instrument?

A

Conventional Needle Holder

32
Q

What is this instrument?

A

Castroviejo Needle Holder

33
Q

What is this instrument?

A
  • Goldman-Fox Sissors
34
Q

What are the different Types of Pockets?

A
  • 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
Q

Gingivectomy

A
  • 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

Week 77 (11 decks)

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