Periodontal Surgery 1

Question 1

What is RSD/ PMPR

Answer 1

Removal of deposits (plaque/ calculus) and thin layer of cementum bound endotoxins on the root surface

Question 2

What are the limitations of RSD?

Answer 2

May not stop progressive/ aggressive disease completely

Question 3

What cases are RSD of limited use?

Answer 3

Persistent acute episodes e.g abscess
Deep complex bone defect
Severe hyperplasia
Pathology

Question 4

What are the aims of periodontal surgery?

Answer 4

Gain direct access root surface
Visualisation of defect
Improve tissue contour 
Reduction pocket depth - gain tissue attachemnet
Removal chronically inflammed tissue 
Encourage regeneration
Removal hyper plastic tissue

Question 5

What is the chronically inflamed tissue at bottom of pocket and why is it present?

Answer 5

Granulation tissue

Lost bone replaced granulation tissue

Question 6

What is a gingivectomy?

Answer 6

Resect the excess gingival

Question 7

What cases are gingivectomny indicated?

Answer 7

Hyperplasia

False pockets

Question 8

When is open flap debridement indicated?

Answer 8

Deep persistent bleeding/ suppurating pockets

Inflammatory/ intra-bony defect

Question 9

When is an apical repositioned flap indicated?

Answer 9

For pocket elimination

Crown lengthening

Question 10

Give example of when crown lengthening can be useful?

Answer 10

When have ginigvally encroaching restoration - inadequate biological width

Question 11

What needs to be considered prior perio surgery?

Answer 11

Has non-surgical tx been carried out and reviewed?
Is pt suitable - medical
Consent
Oral hygiene adequate

Question 12

What would be contraindication for gingivectomy?

Answer 12

Inadequate attached gingiva

Question 13

What surgical technique is used for gingivectony?

Answer 13

Excision

Question 14

What is a false pocket?

Answer 14

Position of margin of pocket is above the CEJ

Question 15

Stages of gingivectomy?

Answer 15

1. LA
2. Pocket depth marking
3. Incisions

Question 16

What LA should be given when carrying out gingivectomy?

Answer 16

Normal and inter-papilla

Inter-papillary - reduce bleeding

Question 17

What is Goldman’s technique used for?

Answer 17

Pocket depth marking

Question 18

How is Goldman’s technique used?

Answer 18

Probe to measure depth of pocket
Pierce from outside to create bleeding point
Correspond to depth of pocket
Incision leave 1-2mm pocket depth

Question 19

What incisions are used in gingivectomy?

Answer 19

External bevel incisions

Base of incision lies bleeding point

Question 20

Stages of gingival flap?

Answer 20

1. LA
2. Relieving incision
3. Raise flap
4. Curettage
5. PMPR
6. Irrigation
7. Suture reposition flap

Question 21

Difference curettage and PMPR?

Answer 21

Curettage - remove granulation tissue

PMPR - remove deposits and thin layer cementum bound endotoxins

Question 22

Adv of internal bevel incision?

Answer 22

Preserve tissue while elimination pocket

Question 23

Adv of reliving incision?

Answer 23

Allows flap to be raise for better visulisation

Question 24

Adv of crevicular incision?

Answer 24

Maintains soft tissue - indicated aesthetic regions

Question 25

When is odontoplasty used?

Answer 25

When furcation invovlement

Question 26

What is osteoplastys used?

Answer 26

If bone is causing prominent gingival appearance - supporting bone removed

Question 27

What does modified Widman flap preserve?

Answer 27

Interdental papilla

Question 28

What instrument used to raise flap?

Answer 28

Periosteal elevator

Question 29

What post-op care should be given following periodontal surgery?

Answer 29

Analgesia advice Removable suture 7-10 days CHX mouth rinse 2x day 2/3 weeks - pt not to chew in treated area in this period Use of soft toothbrush after 3 weeks

Question 30

How long before probing surgery sites?

Answer 30

3 months | 6 months if regeneration

Question 31

Signs of healing?

Answer 31

Good contour | Good parameter: PD, bleeding, aesthetic and attachment

Question 32

Signs of success for flap surgery?

Answer 32

``` Decrease in inflammation Less BOP Decrease in pocket depth Increase attachment Elimination suppuration Improvement tissue contour Stabilisation bone levels ```

Question 33

What sutures are useful for XLA socket?

Answer 33

Horizontal mattress

Question 34

What sutures are good for root coverage proceudre?

Answer 34

Sling suture

Question 35

Other types of suture methods?

Answer 35

Interrupted Vertical mattress Horizontal mattress