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DS4101 > W2 - Surgical Perio Therapy Part 1 - Sharma > Flashcards

W2 - Surgical Perio Therapy Part 1 - Sharma Flashcards

1
Q

How can prognosis of the periodontically involved tooth be improved? (3)

A
  1. Create accessibility for effective debridement
  2. Improve gingival or tooth morphology to improve pt self-care
  3. Regenerate lost periodontal attachment
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2
Q

What is the True End point of periodontal therapy VS Surrogate end points?

A

True End point: Prevention of tooth loss

Surrogate end points: No BOP, pocket “closure” (<4mm)

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3
Q

What are some relative medical contraindications to perio surgery? (4)

A

Relative bc you can still do perio surgery, just be cautious. Very few conditions exist where surgery should not commence

  1. Bleeding disorders (haemophilia, anticoagulants)
  2. Poorly contolled diabetes
  3. Uncontrolled hypertension
  4. Immunocompromised patients (leukemia, pt taking cyclosporin)
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4
Q

Wall defect card

A
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5
Q

What are the 4 possible pocket therapy results

A
  1. Recurrence of pocket
  2. Root resorption / ankylosis
  3. Long junctional epithelium
  4. New attahcment: regeneration GTR
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6
Q

What is the most common pocket therapy result? Why?

A

Long junctional epithelium

  • they are the fastest growing cells
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7
Q

Indications for Periodontal Surgery (6)

A
  1. Irregular bony contours / structure
  2. Persistent inflammation in moderate-deep pockets
  3. Deep pockets on teeth where complete removal of root irritants is not clinically possible (posterior)
  4. Grade II or III furcation
  5. Infrabony pockets on distal surfaces of last molars causing irritation (pericoronitis)
  6. Areas with shallow pockets but persistent inflammation due to mucogingival problem
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8
Q

List 5 examples of hemostasis products

A
  1. Gelfoam
  2. Oxycel
  3. Surgicel absorbable hemostat
  4. CollaCote/CollaTape/CollaPlug
  5. Thrombostat
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9
Q
A

Kirkland knife used for gingivectomy

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10
Q
A

Orban (interdental) knife

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11
Q
A

Periosteal elevator

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12
Q

What are the 6 types of incisions in periodontal surgery?

A
  1. External bevel
  2. Internal bevel
  3. Sulcular
  4. Releasing
  5. Cutback
  6. Periosteal
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13
Q

What is an external bevel and what is it used for?

A

Coronally directed incision

  • Used for gingivectomy, crown lengthening
  • to remove height of soft tissue
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14
Q

What is an internal bevel and what is it used for?

A

Apically directed incision

  • Removes thickness but not height, height remains the same
  • Excisional new attachment procedure, flaps, gingival enlargement
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15
Q

What is a sulcular incision and what is it used for?

A

Apically directed incision, placed in gingival crevice and directed toward alveolar crest
- Used when preservation of gingiva is critical (aesthetic areas or guided tissue regeneration procedures)

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16
Q

2 Types of periodontal dressing

A

Eugenol-based

Eugenol-free (more common)

17
Q

Examples of eugenol-free periodontal dressing

A

Coe-Pak (GC) - chemical cured

Periocare - chemical cured

Barricaid - light cured

18
Q

Benefits of using periodontal dressings (6)

A
  • Improved flap adaptation to underlying bone and root surface
  • Control of immediate post-op bleeding
  • Wound protection and immobilisation
  • Helps retain bone graft materials
  • Patient comfort
  • Temporary splinting of mobile teeth
19
Q

What are the 3 surgical approaches

A
  1. Conservative (preserving tissues)
  2. Resective (removing tissues)
  3. Reconstructive (regenerating tissues)
20
Q

What factors govern the surgical approach? (4)

A
  1. Anatomy of the residual pocket - Supra/infrabony? amount of keratinized gingiva?

2. Anatomy of the tooth - single or multi rooted? Furcation?

  1. Position of tooth in dentition - cosmetic area?
  2. Complexity and predictability - patient and operator factors
21
Q

What are gingivectomies and gingival curettage surgeries?

A

Periodontal pocket reduction surgery limited to the gingival tissues only, not involving underlying osseous structures, without flaps

22
Q

What is meant by gingival curettage?

A

Scraping of the gingival wall of a periodontal poclet to remove diseased soft tissue
Arrow A

Inadvertent curettage - unintentional curettage during S/C

23
Q

What is subgingival curettage?

A

Incision performed apical to the junctional epithelium that severs the connective tissue attachment down to the osseous crest

Arrow B

24
Q

Rationale behind gingival curettage

A

Lateral wall of pocket contains granulation tissues, inflamation, bacterial colonies

  • If SRP done alone, this tissue is slowly resorbed and bacteria slowly killed off by host defense mechanism
  • Curettage speeds up this process by just cutting it all out
  • However, need for curettage is debated according to recent studies
25
Q

Indications for curettage (3)

A
  1. Moderately deep intrabony pockets in accessible areas
  2. As a non-definitive procedure in cases contraindicated for flaps, to reduce inflammation
  3. As a method of maintenance for recurrent inflammation and pockets
26
Q

Basic technique of curettage (3)

A

Should always be preceded by S/C

  1. LA
  2. Select curette and place cutting edge against tissue
  3. Engage inner lining of pocket and scrape along soft tissue in horizontal stroke while supporting the external surface
27
Q

Describe the Excisional New Attachment Procedure technique

A

Type of subgingival curettage

Step 1: Internal bevel incision

Step 2: Remove excised tissue with curette and SRP

Step 3: Suture and dress

Note that this hardly ever actually ends up with new attachment

28
Q

How do the tissues heal after curettage?

A

Blood clot fills pocket area

Rapid proliferation of granulation tissue with decrease in small blood vessels

Restoration/epithelialisation of sulcus in 2-7 days (JE)

Immature collagen fibers appear within 21 days

29
Q

Indications for gingivectomy (3)

A

Elimination of suprabony pockets

Elimination of gingival enlargement

Elimination of suprabony periodontal abscesses

30
Q

Contraindications for gingivectomy (2)

A

Need for osseous surgery or examination of bone morphology

Bottom of pocket is apical to the mucogingival junction

31
Q

Steps of gingivectomy (5)

A

Step 1: Use pocket marker to mark depths

Step 2: Kirkland knife on a 45 degree angle to cut the marks, Orban knife for interdental areas

Step 3: Remove excised pocket wall

Step 4: Curette the granulation and remove any remaining calc and necrotic cementum to leave a clean surface

Step 5: Cover the area with a surgical pack

32
Q

What is a gingivoplasty and what are the indications?

A

Purpose is to reshape the gingiva and recontour in the absence of pockets

Indications: gingival clefts, craters, NUG (crater-like interdental papillae)

33
Q

Disadvantage of using electrosurgery for gingivectomy

A
  • Cannot be used for pacemaker pts
  • Odour
  • Very large risks if you touch bone, root, metal
34
Q

What are needle shaped electrodes used for (electrosurgery) (2)

A

Abscess drainage

Incisions

35
Q

What are loop shaped electrodes used for (electrosurgery) (2)

A

Frenum and muscle reattachment/relocation

Scraping away tissue

36
Q

What are ball shaped electrodes used for (electrosurgery)

A

Hemostasis

37
Q
A

DS4101 (43 decks)

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