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DS4101 > W7 - Flap Surgery Part II - Sharma > Flashcards

W7 - Flap Surgery Part II - Sharma Flashcards

1
Q

T/F - Teeth with furcation involvement respond more favourably to non-surgical periodontal therapy

A

False

  • Teeth with furcation respond less favourably and have reduced prognosis
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2
Q

What are the two surgical treatment options (big picture) for furcation involved teeth

A

Resective surgery

Regenerative surgery

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3
Q

What are the two types of resective surgery offered to furcation involved pts

A

Furcation plasty

Hemi-section / root resection / bicuspidization

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4
Q

3 Grades of furcation involvement

A

Grade I - Incipient, catch

Grade II - Bone loss, not through and through, “cul de sac”

Grade III - bone loss through and through

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5
Q

What affects the perio pocket in a furcation lesion (anatomy) (3)

A
  • Anatomy of the soft tissue (thick, thin?)
  • Bone - horizontal or angular loss
  • Inter-radicular tooth anatomy
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6
Q

What does a furcation plasty involve? What is the purpose/outcome?

A

Odontoplasty

Osteoplasty

Gingivoplasty

Purpose is to improve access for pt to clean

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7
Q

Technique of furcation plasty

A
  1. Flap to access inter-radicular area
  2. Odontoplasty to widen furcation entrance
  3. Osteoplasty to reduce intra-bony defect and decrease thickness of the bone
  4. Position the flap at the level of the alveolar bone crest
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8
Q

Why should aggressive odontoplasty for furcation plasty be avoided on vital teeth?

A

Risk of hypersensitivity

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9
Q
A

Furcation plasty

  • non surgical therapy did not help
  • Exposed the furcation for better cleaning
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10
Q

What is a tunnel preparation? Purpose?

A

Exposing / clearing the furcation in deep grade II and III FI teeth

  • Md molars only - mx molars will have palatal root in the way
  • Allows for easier cleaning
  • Delays the need for extraction
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11
Q

What is the rationale behind hemi-section, root-resection and bicuspidization?

A

Complete elimination of the furcation defect

  • Multidisciplinary approach (endo and restorative)
  • Endo usually done before surgery
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12
Q

What is going on here?

A

Hemi section

  • Sectioning of tooth into two and removing half of it
  • Remove the root where endo has failed
  • Typically mesially half is extracted
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13
Q

What is a root resection?

A

Removal of one or two roots

  • only done in the mx teeth
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14
Q

Technique of root resection and hemisection

A
  1. Create mucoperiosteal flap to expose furcation
  2. Sectioning of root or tooth with straight line cut
  3. Careful removal of root (root resection) or tooth section (hemisection)
  4. Re-positioning of the flaps at bone crest level
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15
Q

Outcome of root resection / hemisection

A

Remaining root(s) have improved/adequate bone support

Good prognosis if endo therapy and occlusion is sound

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16
Q

Why do root rections / hemisections most often fail?

A

Failures are usually due to endo complications and/or occlusion issues

  • Not usually due to periodontal complications
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17
Q
A

Bicuspidization

  • splitting the tooth into two and retaining both sections
18
Q

Technique of bicuspidization

A
  1. Mucoperiosteal flap to expose furcation
  2. Section of tooth with straight line cut
  3. Re-position flaps at level of the bone crest
19
Q

What is regenerative surgery?

A

Formation of new cementum, PDL and bone that was destroyed by periodontal disease

20
Q

How can you confirm regeneration?

A

Cannot verify true regeneration without removing tooth and surrounding bone for histological evaluation

Decreased pocket depth may suggest it however this could just be due to tightly adapted gingiva with long junctional epithelium

21
Q

What 4 tissues can fill the space after flap surgery

A

Epithelium (most common)

Connective tissue

Bone

PDL

22
Q

What are the indications for bone grafts (4)

A
  1. Infra/intra bony defects (three and two walled) - vertical or angular BL
  2. Grade II furcation
  3. Preparation of implant placement site
  4. In combination with GTR (tissue regeneration)
23
Q

What is GBR and GTR?

A

Guided Bone Regeneration

Guided Tissue Regeneration

24
Q

Contra-indications for bone grafts (4)

A
  • Horizontal bone loss (no walls to give support - physical and vascular)
  • Lack of soft tissue coverage
  • Poor OH / plaque control
  • Systemic issues - smoking and poor general health
25
Q

Rank the 4 types of graft materials from best to worse

A
  1. Autogenous graft
    * From self - Retromolar area if small, hips or ribs if large
  2. Allograft
    * From other humans
  3. Xenograft
    * From animals
  4. Alloplast
    * Synthetic
26
Q

Define osteogenic bone graft

Example?

A

Graft which can: provide the appropriate cellular elements which survive transplantation

and

synthesize new bone at the recipient site

Example: autografts

27
Q

Define osteoinductive bone graft

A

Grafts that send signals to attract, proliferate and differentiate cells capable of forming bone

Ex - allograft

28
Q

Define osteoconductive graft

A

Graft that serves as a scaffolding that bone cells can attach to and grow/divide

Ex. allografts and xenografts

29
Q

Why are autografts considered the “gold standard” of graft materials (4)

A

Most compatible

Can pick shape - blocks or chios

Multiple sites - intra oral/extra oral

Forms new bone

30
Q

Pros and cons of harvesting autografts from extra-oral sites

Locations?

A

Pro: can take out larger quantities

Cons: -increased morbidity (need GA),

-theatre cost

Common sites: Iliac crest (hips), ribs, fibula, tibia

31
Q

Pros and cons of harvesting autografts from intra-oral sites

Locations?

A

Pros: lesser morbidity (under LA)

Cons: -limited quantity (smaller)

-surgical expertise

Possible sites:

Extraction sites, md retromolar area, ramus, tuberosity, tori

32
Q

What tool is used to remove chips of/from bone for grafts

A

Bone scraper

33
Q

2 Types of allograft materials

A

Freeze dried bone (FDB)

Decalcified Freeze dried bone (DFDB)

34
Q

What is “Selective Repopulation”

A

Type of GTR

Placement of membrane allows for selective repopulation of space

  • blocks off the epithelium and connective tissue
  • only allows PDL and bone to fill space
35
Q

What are the only two ways of obtain bone regeneration in the mouth

A
  1. Bone grafts
  2. GTR - Selective repopulation
36
Q

What’s going on here?

A

Selective Repopulation

37
Q

What are non resorbable membranes used for? (selective repopulation)

Disadvantages?

A

GBR

  • requires second surgery to remove
  • If not covered with soft tissue, can lead to infection
38
Q

2 Examples of nonresorbable membranes

A

Goretex

Cytoplast

39
Q

3 Examples of resorbable membranes

Advantage?

A

Collagen (Bio-Gide)

Polylactic acid

Polyglycolic acid

40
Q

Advantages of resorbable membranes (4)

A

Second surgery for removal not necessary

More tissue-friendly

Enhance tissue coverage

Resist or prevent microbial colonisation (infection)

41
Q

Disadvantages of resorbable membranes

A

May elicit immunologic or inflammatory reaction

Time of resorption can’t be controlled

42
Q

What is “socket preservation”

A

GBR

usually done to allow for bone regeneration for implant placement

  • Use of non-resorbable membranes at exo site

DS4101 (43 decks)

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