Surgical Periodontal Treatment Flashcards
What are the treatment goals of periodontal surgery?
- Prevent disease progression
- Reduction/resolution BOP to at least <25%
- Reduction PPD (<5mm)
- Eliminate deep furcation involvements
- Satisfy patient’s demands regarding aesthetic and function
What are the biological rationale for periodontal surgery?
- Root surfaces can be inspected and cleaned by direct vision
- Better calculus removal
- Better control of amount of hard tissue removal
- Smoother surfaces
- Tissue are more easily and radically changed and/or removed
- Granulation tissue removal
What are some indications for periodontal surgery?
- Deep pockets not responding to SRP
- Concavities
- Root fissures
- Grooves
- Defective subgingival restorations
- Gingival aberrations
- Pre-prosthetic surgery
- Cosmetic
- Infrabony lesions
- Deep furcation involvements
What are some contra-indications to periodontal surgery?
• Patient’s co-operation/compliance • Poor plaque control • MH: - MI in last 6 months - Anticoagulant therapy (INR 2-4) - Blood disorders (acute leukaemia, severe anaemia) - Poorly controlled DM - Neurological disorders (ME, Parkinson’s, epilepsy) • Smoking?
Why is poor OH a contra-indication to periodontal surgery?
Periodontal surgery without the appropriate OH and maintenance care may lead to increase rate of disease progression
What were the findings of the following study: ‘Lindhe et al, 1982 - Healing following surgical non‐surgical treatment of periodontal disease’
- Subgingival scaling and root planing and modified Widman flap were both equally effective in establishing gingival health and preventing further attachment loss
- Treatment on shallow sites will cause clinical attachment loss
What were the findings of the following systematic review: ‘Heitz-Mayfield et al, 2003- A systemic review of the effect of surgical debridement vs non-surgical debridement for the treatment of chronic periodontitis’
- Both scaling and root planing alone and scaling and root planing combined with flap procedure are effective methods for the treatment of chronic periodontitis in terms of attachment level gain and reduction in gingival inflammation
- In the treatment of deep pockets open flap debridement results in greater PPD reduction and clinical attachment gain
State some design features of a good flap
- Good access to root surfaces and/or alveolar bone
- Wide diverging base to maintain good blood supply
- No damage to vasculature or nerves
What is the purpose of a modified flap operation? What is this flap also known as
Kirkland flap
- Facilitate root surface debridement and removal of pocket epithelium and granulation tissue
- Cause minimal trauma to periodontal tissues and discomfort to patient
- Does NOT intend to cause extensive sacrifice of non-inflamed tissue, cause apical displacement of the gingival margin
What is required to perform an apically repositioned flap?
Adequate zone of attached gingiva
What are the advantages of an apically repositioned flap?
- Minimum pocket depth post-op
- Post-surgical bone loss can be minimal IF good soft tissue coverage obtained
- Post-surgical position of the gingival margin as well as the mucogingival complex can be controlled and maintained
What are the disadvantages of an apically repositioned flap?
- Great recession/exposure of root surfaces
- Hypersensitivity
- Aesthetics
What are the advantages of a modified Widman flap?
- Minimal trauma to alveolar bone and connective tissues
* Less exposure of root surfaces and hence better approach to anterior segments
Name the different types of incisions
- External bevel incision
- Horizontal incision
- Internal bevel incision
- Vertical incision
- Distal Wedge Incision
What are the advantages of vertical incisions?
- Access and visibility
- Ability to move or position tissue to a new location
