Perio Surgery Flashcards
(33 cards)
What did the long term data show for surgical vs non surgical?
Heitz and mayfield 2002
No difference between CAL and PPD. Between surgical or non surgical
Which paper looked at the effect of non surgical vs surgical treatment and when it is effective?
Heitz and mayfield 2002
Pockets 1-3mm there was more CAL with RSD than surgery so just need scale and OHI
Pockets 4-6mm: less CAL with surgery than RSD, PPD reduced more with RSD than with surgery so need OH and RSD consider topical abs
Pockets more than 6mm: more CAL gained with surgery than RSDand PPD reduced with surgery: OH and open flab debridement and RSD
How do you manage furcation?
Insufficient data of effectiveness Options are: Flap and debride Apically repositioned flap Tunnel prep
How do you manage patients with chronic perio?
Full mouth assessment RSD >3mm Re assess in 2/3 months If poor response repeat RSD Consider surgery or Antimicrobials
What are aims of surgery?
Gain access to root surface
Increase visualisation for effective debridement
Remove excess tissue or re contour tissues to establish better gingival morphology
Reference or replace lost periodontal tissues
What are the indications for perio surgery?
Deep pockets Adverse pocket morphology Bone defects Furcations Muco gingival problems Aesthetics Short clinical crown height
What are the pre surgical requirements?
MH Consent Corsodyl MW Analgesics No smoking
What are thr post op requirements?
POI
Corsodyl
Nonsmoking
Analgesics and review in 1/52
What are the options for flaps design?
Full flap with 2 relieving incisons
Trianglukar flap with 1 incisions
Modified flap with no relieving incison
Full thickness
Partial thickness: mucoperositum attached to bone
How do you perform a gingivectomy?
Measure also pocket deoth with a probe and mark them with blood points
Incise using beveled incison using no12 blackes knife to maintain gingival contour
Curettage tisseue and dress for one week
MaintainOH
Wings is a gingivectomy indicated?
Drug induced hyperplasia
Genetic gingival hyperplasia
What is a gingivoplassty?
Surgical re contouring or remodelling of the tissues
What is the purpose of combing a ginvectomy with a gingivoplassty?
People that have deep pockets and these are then reduced and then re contoured to provide a better contour
What type of flap do you do for deep pockets?
Modified widman flap
Deep pockets
Adverse morphology
Failure of access with RSD
How do you do a modified widmand flap?
Intracreviscular incision
Retract tissues
Curete
Elimate pocket epithelium and granulation tissue and then suture and maintain OH and obtain long junctions epithelial
What are advantages of modified widman?
No extensive sacrifice of non inflamed tissue
No apical displacement of tissues
Close adaptation of tissue with root surface
Less exposed root surface for sensitivity and aesthetics
Minimum trauma to CT and alveolar bone
What are the muco gingival suergey options?
Frenectomy
Laterally repositions flap
Free epithelial graft
What is a Frenectomy?
Fraenal reduction
How do you manage recession?
This is displacement of soft tissues apical to CEJwith exposed root surface mainly seen in adults
Conservative: prevent further damage
Gingival augmentation: if sensitive/ aesthetics
Where is recession common?
High standard of OH: buccal edge shape defects
Also poor OH and perio disease
How can recession be classified?
Local or general
Local more likely trauma
General more likedl perio
What is the aetiology behind recession?
Mechanical brushing Localised plaque induced Prominently position teeth Destructive perio Loss of perio support Ortho Development
In ortho, what will determine if recession will develop?
Thickness of tissue rather than quality
What is pseudo recession?
The margin is apical compared to adjacent teeth but CEJ not involved
