Surgical Principles Flashcards
What advantages offered by surgical treatment
Increased visibility Increased access Increased SRP effectiveness Modify osseous defect Repair/Regen possible Reduce PD Improve contour Perio plastic surgery
What are the contrindications of surgery
High caries
Uncontrolled medical condition
Poor plaque control
Unrealistic expectation
What is the infection rate with perio surgery
4%
What is the single most important surgical principle
blood supply must be maintained
What are the major branches of the external carotid
Maxillary
Lingial
Facial
How far away is the greater palatine bundle in palates
Depends on contour: 7, 12 , 17
How many days until CT maturation
CT 21 - 28 days
JE 28 - 42 days
Where do you never place a releasing incision
Over a bony prominence
What are the contra indication to gingivectomy
Intrabony defect Narrow KT PD past MGJ Root exposure Aesthetics High Caries risk Thermal sensitivity
what used for first lie haemostasis
5 min of pressure
What are the absorbable sutures
Surgical Gut
Surgical gut chromic
Vicryl
Monocryl
Advantage of double continuous sutures
Allow positioning of FL flap independent of opposing flap
What are the considerations of suture removal
removed when not stabilizing the tissue
What are the indications for surgery
Access
Remove Calculus
Remove persistent disease
Alter periodontium for aesthetics or reconstruction
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 Remodelling Maturation
What determines LA onset of action
Ionization constant
Tissue pH
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
Normal blood loss foloowing surgery
134 ml
Local haemostatic agents
Oxidized cellulose Ferric Sulphate Topical Thrombin Absorbable Gelatin sponge LA with vasoconc Bone Wax
Key suturing principles
Flap adaption and stability Passive Minimal material under flap Knots at side Adequate tissue bites Smallest diameter possible Remove carefully
Why use perio dressings
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
Aesthetics
Remove soft tissue crater
Gingival enlargement
Types of gingivectomy
Internal or external bevel
Why is internal bevel better
Less sore
Heal primary intention
Other gingivectomy procedures
Electrosurg
Laser
How often do you change perio dressings
Every 5 - 7 days for 2 - 3 weeks
What is the objective of MWF flap
maximum healing
What are the advantages of MWF flap
Healthy collagen attached to tooth New cementum Optimal root coverage bone conservation increased regen potential
What are the tuberosity reduction techniques
Inverse bevel triangular distal wedge
Inverse bevel linear distal wedge
Tuberosity pedicle flap
What are the results of open flap debridement
Increased removal of plaque
Reduced PD
Some gain CAL
Heal long JE
Distance to CEJ in bone and health
2.0 mm
Shallow, medium and deep craters
Shallow: 1 - 2 mm
Medium: 3 - 4 mm
Deep: 5+ mm
Why palatal technique
Avoid buccal furcation
Increased embrasure
Increase access
Palate all keratinized
Why use lingual technique
Improve access
Tooth tilt
Lingual plate thickness
Recession after surgery: Flap reflection and flap and osseous
Flap refelction: 0.2 mm
Flap and osseous 0.6 mm
What size defect is regenerable
below 3 mm
