Suturing And Healing/Osseous Defects Flashcards
T/F: We use needles with an eye to thread the suture material.
False
Disposable, reverse cutting needle with press-fit suture
What is the preferred needle holder in perio suturing?
Castroviejo needle holders
More flexible
T/F: Silk sutures must be removed within ten days.
True
Will start to absorb food and cause a host response
What are the advantages and disadvantages of PTFE (polyester) as a suture?
Can be kept in the mouth for a long time
Expensive
How long does it take chromic gut to resorb?
Coated vicryl?
Chromic gut — 7-10 days (proteolytic enzymes)
Coated vicryl — 56-70 days (slow hydrolysis
Sutures should be entered into the more ___________ flap first, and should be placed at least ______ away from the edge of the flap.
Mobile; 2-3 mm
When might the figure 8 suture technique be used?
Mandibular molar area; keeps you from pointing the needle at the tongue
What is the advantage of the sling sutures?
Can suture multiple papillae with one suture
How do you tie a surgeons knot?
Wrap the long end around needle holder twice -> pull short end through -> wrap long end once in the opposite way -> pull short end through
What is a major disadvantage to using a periodontal dressing?
Can predispose to colonization underneath of dressing if left on too long
When would you use periodontal dressings?
Healing via secondary intention
T/F: You should cut the sutures as close as possible to the tissue in order to avoid pulling contaminated suture through the wound.
True
What are the three phases of post surgical healing?
- Inflammation (first few days)
- Granulation (7-10 days)
- Matrix formation and remodeling (several weeks)
__________ tissue replaces the blood clot in primary closure.
Granulation
How long does it take for epithelium to attach to the root during wound healing?
1 week
How long does it take for the wound to regain most of its original tensile strength?
2 months
What happens to the bone during healing after a full thickness flap?
Roughly 1mm of bone loss
T/F: There is more inflammation and granulation tissue with secondary intention.
True
Which growth factors are released from the blood clot that helps with healing?
- PDGF
- EGF
- TGF-beta
What factors are released by fibroblasts and macrophages that help with healing?
- TNF
2. IL-1beta
How do we minimize bacterial colonization during healing?
Chlorohexidine rinse
What type of attachment do you get after a gingivectomy?
Long junctional epithelium
No new PDL, bone, or cementum
What type of attachment occurs after an apically positioned flap?
Long JE
No new bone, PDL, or cementum
What type of attachment do you get after a modified Widman flap?
Long JE
Less bone resorption than an apically positioned flap
T/F: Healing by long junctional epithelium is considered regeneration.
False
Long JE is repair because it does not replace PDL, bone, cementum
What are the steps of healing after surgery?
- Debridement — inflammatory cells
- Regeneration — parenchymal cells
- Migration/Proliferation — parenchymal and CT cells
- Synthesis of extracellular matrix proteins
- Remodeling of connective tissue and parenchymal components
- Increase in strength
What are three etiologies of alveolar bone loss?
- Extension of gingival inflammation
- Trauma from occlusion
- Systemic disorder
*must have plaque for all three
What is the best way to determine the type of bony defect?
Bone sounding
T/F: Patients with thin bone will often have horizontal bone loss rather than angular.
True
What is the multiple burst model of perio disease?
Loss of equilibrium between formation and resorption is episodic
What is buttressing bone formation?
Bone is trying to make up for bone loss and deposits bone in other areas
T/F: Buttressing bone is removed as part of perio surgery.
True
Which type of buttressing is seen when opening a flap for perio surgery?
Peripheral — occurs on the external surface (will trap plaque)
Central is the other type that occurs within the jaw
Describe reverse architecture.
Interdental areas will lose bone before buccal-lingual areas
This creates a reverse U shape around the teeth, rather than the normal U shape of bone in health
Which type of defect has the best prognosis for regeneration?
3 wall defect
What are the classifications for Furcation loss?
F1 — feel concavity but not catching prob
F2 — Furcation catches prob
F3 — through and through
T/F: Furcation involvement can be diagnosed with just X-rays.
False
Must have clinical exam
T/F: Regeneration surgery works for class III furcation.
False
Just resective
T/F: Class II furcations are good for regeneration.
True
What are the main goals in treating horizontal bone loss?
Pocket reduction, and correct reverse architecture
If you have a patient with horizontal bone loss and limited keratinized tissue what would be the best surgery?
Open flap debridement
OS — needed if reverse architecture needs corrected
GV — not indicated due to limited keratinized tissue
What are the goals in treating angular defects?
Pocket reduction and restore attachment
What are the treatment options for angular defects?
OS — especially for less walled defects
GTR — works best with 3 walled defects
What are the treatment options for furcation defects?
- SRP — F1
- OFD — F1-2
- OS — F3
- GTR — F2
What is the flap design for Osseous surgery?
Full thickness flap, apically positioned
What is the flap design for regenerative surgery?
Full thickness flap, coronally positioned flap
T/F: Scalloped incisions are mostly used during Osseous surgery.
True
Sulcular if keratinized tissue is limited
T/F: Scalloped incisions are used with regenerative surgery.
False
Sulcular
Why might vertical incisions be needed?
In order to make the flap more mobile
