Surgical Principles Flashcards
What advantages are offered by surgical treatment? (5)
a. ACCESS- primary objective
b. Modification of osseous defects
c. Repair or regeneration of the periodontium
d. Pocket Reduction
e. Provide acceptable soft tissue contours
What are the contraindications of surgery (4)
a. Uncontrolled medical conditions
b. Poor plaque control
c. High caries risk
d. Unrealistic patient expectations
What is the infection rate with perio surgery
4.4% - Checchi
According to Rose/Mealey, what is the single most important surgical principle?
blood supply must be maintained
3 Major branches of external carotid artery most important for the oral cavity
Maxillary
Facial
Lingial
Distance of the greater palatine neurovascular bundle in Shallow, Average, and Deep Palate
a. Shallow: 7mm
b. Average: 12 mm
c. Deep: 17m
-REISER study (measured from crest)
What are the number of days until Connect Tissue (CT) and Epithelial maturation?
CT: 21 - 28 days (Why we like to wait to remove sutures so we have the most flap strength)
Epithelial: 28 - 42 days
Where do you never place a releasing incision
Over a root prominence
What are the contraindications to gingivectomy
- Narrow zone of Keratinized Tissue
- Defect present amenable with regeneration
- Risk of root exposure and esthetic considerations
- Intrabony defects
- PD past MGJ
- Unfavorable anatomical characteristics
- High caries index
- Thermal sensitivity
First means to obtain hemostasis?
Direct pressure on the flap for 5 minutes
What are the types of absorbable sutures?
a. Plain gut
b. Chromic gut
c. Vicryl
d. Monovicryl
What is the advantage of double continuous sling suture?
Allows for apical positioning and facial and lingual flaps to be closed independently
What are the considerations of suture removal?
If sutures are no longer stabilizing the wound
What are the indications for surgery
- Access
- Modification of Osseous Defects
- Repair or Regenerate Periodontium
- Removal calculus
- Remove persistent disease
- Gingival Enlargement
- Implant Surgery
- Perio Plastic Surgery
What is the advantage of a shallow sulcus
Maintainable
Long Term stability
What are the 3 types of wound healing
Primary
Secondary
Tertiary
What are the phases of wound healing
Inflammation Proliferation Granulation Remodeling Maturation
What determines Local Anesthesia onset of action?
- Ionization constant
2. Tissue pH -Lower pKa, more free base, faster onset
What determines LA duration of action
Protein binding capacity
What is the maxmium dose of Lido
4.4mg / kg,
What are the 3 types of flap design
Envelope
Pedicle
Triangular
What is the average blood loss during the average periodontal surgery
134 ml (Baab)
Topical Hemostatic Agents
Oxidized cellulose Absorbable collagen Ferric sulfate Topical Thrombin LA with vasoconstrictor Absorbable gelatin sponge (gelfoam) Bone Wax
Key suturing principles
- Flap adaption and stability
- Passive Tension
- Minimal material under flap
- Suture Knots at side
- Adequate tissue bites
- Smallest diameter needle possible
- Remove carefully
Why do we use perio dressings?
They assist/increase flap adaption
What are the perio dressings available
Coe Pack: Zn Oxide, mineral oil, bacteriocidal
Barricaid: VLC gel, UDMA
Cyanacrylate: Not FDA approved, used over soft tissue allografts
Indications gingivectomy
- Eliminate Suprabony pocket
- Esthetics
- Remove soft tissue crater
- Gingival enlargement
Types of Gingivectomy
Internal or external bevel
Why is internal bevel incision better?
Less sore
Heal primary intention
(Remove pocket epithelium and provide direct apposition of healthy CT to the root surface)
What are 2 other types of gingivectomy procedures
Electrosurgery
Laser
How often do you change perio dressings
Every 5 - 7 days for 2 - 3 weeks
Synatzke’s Lecture Notes:
First post op appointment is 7-10 after surgery—assess healing, remove dressing
What is the Main objective of Modified Widman Flap (MWF)
Maximum healing
What are the advantages of Modified Widman Flap (MWF)
Healthy collagen attached to tooth New cementum Optimal root coverage bone conservation increased regeneration potential
What are the tuberosity reduction techniques
(1) Triangular wedge
(2) Inverse bevel linear wedge technique
(3) Pedicle flap
What are the results of open flap debridement
Increased removal of plaque
Reduced PD
Some gain CAL
Heal long Junctional Epithelium (JE)
Roots are planed, defects are degranulated, and flaps are closed either at or apical to their original position
What is the distance from the CEJ to the alveolar bone crest in health
2.0 mm
What is the size of Shallow, Medium and Deep Craters?
Shallow: 1 - 2 mm
Medium: 3 - 4 mm
Deep: 5+ mm
Why do we use palatal approach technique?
Avoid buccal furcation
Increased embrasure space
Increase access
Palate is all keratinized
Why use lingual technique
Improve access
Tooth angulation toward lingual
Lingual plate thickness
How much Bone loss do you get after surgery:
- Flap reflection
- Flap Reflection and osseous
Flap refelction: 0.2 mm
Flap and osseous 0.6 mm
What size defect is regenerable
below 3 mm
