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Periodontology module 7 > Periodontal Surgery Part 2 > Flashcards

Periodontal Surgery Part 2 Flashcards

(72 cards)

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1
Q

types of resective surgery

A

gingivectomy
root resection

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2
Q

types of repair surgery

A

OFD
MWF

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3
Q

types of regenerative surgery

A

GTR
grafts
emdogain

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4
Q

what is resective surgery

A

pocket elimination procedure which establish a morphologically normal attachment but with apical displacement of the dents-gingival complex

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5
Q

causes of gingival overgrowth

A

inflammatory
drug induced
related to systemic diseases

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6
Q

indications for gingivectomy

A

gingival enlargement
supra-bony periodontal pocketing
trauma caused by gingival overgrowth
interference with speech/ aesthetics
excellent at home care
wide zone of attached gingivae

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7
Q

contraindications for gingivectomy

A

narrow attached gingivae
planned osseous contouring
infra-bony periodontal pockets
medical considerations - bleeding disorders

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8
Q

advantages of gingivectomy

A

simple
good vision
can achieve ideal soft tissue morphology

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9
Q

disadvantages of gingivectomy

A

limited indications
heal by secondary intention-painful
risk bone exposure
wastes attached gingivae
excessive recession in pd disease

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10
Q

electrosurgery for gingival recontouring

A

for smaller areas of recontouring
traditionally - electrosurgery
now - lasers

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11
Q

what is surgical crown lengthening

A

surgical procedure which apically repositions the soft tissue and alveolar bone to expose more tooth structure and increases length of clinical crown

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12
Q

surgical crown lengthening indications

A

toothwear
poor gingival aesthetics
restoration of subgingival lesions
replacement of crowns with deep margins
management of coronal third fractures
management of infringement of biological width
develop ferrule for pulpless teeth restored with posts

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13
Q

surgical crown lengthening contraindications

A

poor plaque control
poor compliance
non-functional teeth
periodontal destruction
endodontic compromise
medical history considerations

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14
Q

surgical crown lengthening complications

A

poor aesthetics due to black triangles
transient mobility of the teeth
root sensitivity
rebound of marginal tissues
root resorption

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15
Q

what is repair surgery

A

pocket reduction but with replication of the normal attachment

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16
Q

what is repair surgery referred to as

A

open flap debridement

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17
Q

aim of open flap debridement

A

access for root surface debridement
assessment of root surface

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18
Q

types of open repair surgery

A

open flap debridement
modified Widman flap

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19
Q

open flap debridement indications

A

excellent maintenace
site over 6mm with BOP or suppuration
horizontal bone loss pattern
vertical defect less than 3mm
isolated periodontal pockets remain

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20
Q

contra-indications for open flap debridement

A

aesthetic region
need for graft/membrane
complex furcation/ bone defects

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21
Q

open flap debridement advantages

A

healing by primary intention
minimal crystal bone resorption
effective in pockets 6-7mm

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22
Q

open flap debridement disadvantages

A

can be unpredictable
no new true attachment - healing by long junctional epithelium
risk of recession
interdental craters

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23
Q

what is regenerative surgery

A

recreations of the complete attachment apparatus of bone/cementum/ functionally orientated periodontal ligament against previously exposed root surface

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24
Q

repair vs regeneration

A

regeneration - new cementum, new pdl and new alveolar bone
repair - long junctional epithelium, crestal remodelling

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25
aims of regenerative surgery
gain clinical attachment minimise soft tissue recession increase bone volume enhance access for plaque control and maintenance remove factors associated with disease progression
26
which cells are useful for regeneration
mesenchymal cells
27
case selection for regeneration
infra bony defect associated with periodontal pocket over 6mm class 2 furcation in mandibular molars single class 2 furcation in maxillary molars
28
regenerative techniques
guided tissue regeneration bone graft materials enamel matrix proteins combinations
29
what is guided tissue regeneration
use of mechanical barrier (membrane) to selectively enhance the establishment of PDL and peri-vascular cells in osseous defects to initiate periodontal regeneration
30
when is guided tissue regeneration used
teeth with periodontal bone loss and infrabony defects
31
aim of guided tissue regeneration
stop rapid down growth of epithelial cells create space for pluripotent cells from PDL access root surface improve local anatomy, function and prognosis of teeth
32
what do membranes do in guided tissue regeneration
act as a barrier to prevent cells apart from PDL migrating into site
33
types of bone grafts and sources
Autograft - from same person Allograft - different person Xenograft - animal source Alloplast - synthetic source
34
name of enamel matrix protein
Emdogain
35
regeneration advantages
successful in treatment of deep sites of 6mm or greater healing by primary intention improvement in volume of supporting tissues of tooth less recession
36
regeneration disadvantages
technically challenging can be unacceptable for patients regarding certain materials used expensive materials
37
furcation involved teeth options
NSPT odontoplasty open flap debridement tunnelling procedures root resection or separation regenerative procedures extraction
38
what is odontoplasty
reduces plaque accumulation by reshaping tooth surface with a bur
39
when is open flap debridement effective
effective in shallow defects to eliminate pockets used to access and clean with direct vision
40
what is root resection
removal of one root of a multi rooted tooth where there is uneven bone loss
41
when is root separation indicated
carried out infrequently indicated in extensive furcation involvement where bone loss around both roots is similar
42
when is tunnel preparation used
mandibular molars with deep degree 2 and 3 lesions
43
what does the tunnel preparation aim to do
improve ability for oral hygiene measures
44
what can tunnel preparation increase risk of
root caries sensitivity loss of vitality
45
what is gingival recession
location of the marginal tissue apical to the cement-enamel junction with exposure of the root surface
46
what must be present in gingival recession
a hard tissue dehiscence
47
aetiology of recession
traumatic - toothbrushing, partial dentures traumatic overbite periodontal disease poor restorative margins
48
non-surgical intervention of recession
monitoring and prevention composite restorations gingival prosthesis orthodontics
49
surgical intervention of recession
frenectomy grafting surgery
50
what is frenectomy
removal of local muscle insertion
51
aims of frenectomy
stabilise tissue improve access for oral hygiene measures
52
frenectomy indications
unstable local tissue blocking access for OH measures non-recession indications
53
contraindications for frenectomy
medical/bleeding disorders scar formation will make further procedures more challenging
54
aims for surgery
improve/ create band of keratinised attached gingiva avoid scarring optimal tissue bled/ colour match improve access for OH 100% root coverage
55
pedicle flaps vs free grafts
pedicle flap - local tissue maintaining own blood supply, single site surgery, surgery limited by local anatomy Grafts - material from distant donor site, two site surgery, large quantity of CT, more technically demanding, no direct blood supply so risk graft can fail
56
what is a pedicle flap
moving adjacent attached gingiva to cover a region of recession using a split thickness flap
57
indications of a pedicle flap
narrow defect on single tooth adjacent teeth with thick phenotype or endulous area deep vestibule
58
contraindications of pedicle flap
deep periodontal pocketing loss of interdental tissue large root prominences
59
pedicle flap advantages
one site surgery good vascularity to pedicle flap root coverage possible
60
pedicle flap disadvantages
limited by amount of keratinised adjacent tissue risk of recession at donor site risk of dehiscence at donor site limited to a single tooth
61
what is a free gingival graft
graft from palate formed by epithelium and small amount of underlying connective tissue is placed into a region with localised recession
62
aim of free gingival graft
to create a band of keratinised mucosa remove frenal attachments prepare site for second procedure to increase root coverage
63
free gingival graft indications
discomfort during OH measures ongoing local inflammation lack of keratinised tissue in region of recession defect prevention of further recession insufficient localised keratinised tissue for pedicle flap
64
free gingival graft contraindications
aesthetic region aim for complete coverage donor site tissue poor medical contraindications
65
free gingival graft advantages
relatively simple surgery increase vestibular depth
66
free gingival graft disadvantages
second surgical site palatal wound heals by 2ndry intention unaesthetic
67
what is connective tissue grafting
surgical procedure where a split thickness flap is raised, released then replaced in a more coronal position
68
what can connective tissue grafting be combined with
connective tissue graft from palate especially when limited attached gingival apical to recession shallow sulcus buccally placed root interdental CAL
69
connective tissue grafting advantages
possible for one site surgery microsurgical technique - better handling and minimal scarring excellent colour match better vascularisation of flap best root coverage outcomes with CT graft
70
disadvantages of connective tissue grafting
often benefits from CT graft technically demanding
71
what is the general aim of procedures
improve prognosis of tooth retention
72
to be effective what do all procedures require
non-smoking optimal OH optimised non-surgical tx

Periodontology module 7 (2 decks)

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