Post Surgical Management

Question 1

What is the general advice to give for post-surgical perio?

Answer 1

Give written and verbal
Expect pain (especially donor sites) - painkillers
Advise swelling/bruising - ice pack can be useful
Bleeding
Soft diet 1 week
Don’t look/play with site

Question 2

What is important to consent patient to if having graft?

Answer 2

Failure of graft

Question 3

How long can donor sites be painful for?

Answer 3

4-6 weeks

Question 4

What OHI should give to pt who has just had perio surgery?

Answer 4

Clean adjacent teeth gently
Clear set of teeth as usual
Avoid brushing surgical area 2 weeks - clean teeth in surgical area w/ CHX 
No interdental cleaning graft site
CHX rinse 2x day 2 weeks

Question 5

Common follow up regimen for surgical perio pt?

Answer 5

1 week - sutures removal donor site and check progress

4 weeks -suture remove recipient site

3 month - assess healing

Question 6

What is involved at 1 week check up?

Answer 6

Removing suture donor site

Rubber cup polish is large plaque deposit

Question 7

Warnings to give with CHX?

Answer 7

Staining, mucosal irritation, altered taste

Question 8

When can areas be probed after surgery?

Answer 8

NO EARLIER than 3 months

Question 9

If carrying out regenerative procedure and want to assess with radiograph, when?

Answer 9

9 month post surgery assess improvement bone level

Question 10

4 stages of wound healing?

Answer 10

Haemostasis
Inflammation
Granulation
Maturation

Question 11

What happens in haemostasis part of healing?

Answer 11

Capillary damage = blood clot

Blood clot = protect exposed tissue and matrix for cell migration

Question 12

What happens in inflammation part of healing?

Answer 12

Growth factor in clot recruit inflammatory cells

Question 13

What happens in granulation part of healing?

Answer 13

Migration and proliferation of fibroblast and endothelial cells
Initial collagen formed
Matrix connection = tension in wound = contraction

Question 14

What happens in maturation part of healing?

Answer 14

Fibroblast replace provisional fibrin matrix = collagen matrix
Smooth muscle actin = wound contraction
Endothelial cells migrate = agigonesis

Question 15

How does periodontal wound differ from epidermal wound?

Answer 15

Same sequence normal healing
Only one wide will be vascular
Have natural break epithelium = contamination

Question 16

How long does it take for pocket reduction following non-surgical tx?

Answer 16

3 months

1 week = long junctional epithelium
Resolution inflammation 2 weeks
Remodelling connective tissue and maturation 2 -3 months

Question 17

Two types of healing?

Answer 17

Regeneration

Repair

Question 18

What is regeneration?

Answer 18

Reproduction or reconstruction of lost tissue in way architecture and function is restored

Question 19

Example of regenerative procedure?

Answer 19

GTR

Question 20

What is repair?

Answer 20

Wound tissue doesn’t fully restore function/architecture of the tissue

Question 21

Why may no repair occur?

Answer 21

Insufficient control of infection
Inadequate debridement
No long term amaintance

Question 22

What are other types of histological healing see post-perio tx?

Answer 22

No repair
Long junctional epithelium attach root surface
CT attach root surface
New bone separated root surface
New bone ankylosis root surface

Question 23

Local factors which affecting healing?

Answer 23

Infection
Poor blood supply
Foreign body
Movement 
Ionising radiation
Type/size and location injury

Question 24

Why can movement affect healing?

Answer 24

Cause lack of stability graft - compromised fibrin clot

Question 25

What are systemic factors which affect healing?

Answer 25

``` Age Poor nutrition Hormones - e.g corticosteroids Smoking Uncontrolled diabetes Haematological abnormalities ```

Question 26

What is healing by primary intention?

Answer 26

When edges of wound are approximated at surgical site | Not much loss tissue/cells

Question 27

What is healing by secondary intention?

Answer 27

Wound not approximated, may have extensive loss of tissue = open w/ large tissue defect

Question 28

How does wound heal by secondary intention?

Answer 28

Granulation tissue from bottom up w/ epithelial cover

Question 29

Adv prei surgeyr?

Answer 29

Improved access and visualisation | Improved aesthetic - alter position gingival margin

Question 30

How long does healing following curettage take?

Answer 30

Restoration and epithelialisation begins 2-3 days and completed 7-10 days Pocket epithelium removed allowed cells populate root surface

Question 31

What does curettage involve?

Answer 31

Scraping inner epithelial lining, epithelial attachment and underlying CT - remove inflammed soft tissue

Question 32

How does wound of gingvectomy heal?

Answer 32

Secondary intention

Question 33

How long does it take for gingivectomy wound to seal?

Answer 33

Complete = 6 weeks

Question 34

What a 4 stages of pedicle flap healing?

Answer 34

Adaptation Proliferation Attachement Maturation

Question 35

How long to reach maturation stage of pedicle flap healing?

Answer 35

2-3 months

Question 36

What does survival of free tissue graft depend on?

Answer 36

Diffusion of products and oxygen through tissue plasma - graft doesn't have own blood supply

Question 37

Phases of healing of free tissue graft?

Answer 37

Initial phase Revascularisation Tissue maturation

Question 38

How does a free graft vascularise?

Answer 38

Anastomses established between blood vessel of recipient bed and those in grafted tissue Capillary proliferation Fibrous union between graft and tissue bed

Question 39

How does successful healing of free graft rely on?

Answer 39

Close adaptation - metabolic products shorter distance diffuse, shorter distance cellular migration, lack mobility in graft

Question 40

3 main types bone regeneration materials?

Answer 40

Osseoconductive Osseoinductive Osseoproliferative

Question 41

Examples regenerative procedures?

Answer 41

GTR | Enamel matrix derivatives

Question 42

What is osseoproliferative regeneration?

Answer 42

New bone formed by bone forming cells contained in graft

Question 43

What is osseoconductive regeneration?

Answer 43

Graft acts as passive scaffold for adjacent host bone cells

Question 44

What is osseoinductive regeneration?

Answer 44

Bone formation induced in surrounding soft tissue via bone inducing substance

Question 45

Aim GTR?

Answer 45

Selectively guide tissue regeneration in periodontium

Question 46

What does GTR involve?

Answer 46

Placing physical barrier to prevent apical migration of epithelium and CT along root surface

Question 47

How can healing truly be assessed?

Answer 47

Histologically - impractical

Question 48

How measure perio healing clinically?

Answer 48

Probing - pocket depth Radiograph - bony infill Bleeding index

Question 49

Signs clinical success following debridement?

Answer 49

``` Decreased inflammation Reduced BOP Decreased PD Increase attachment Elimination poss No increase mobility Improved tissue contour Stabilisation bone levels ```

Question 50

What are clinical signs of success following root coverage procedure?

Answer 50

Marginal tissue reach CEJ Clinical attachement Sulcus depth 2mm of less Absent BOP

Question 51

Complication may occur during periodontal tx?

Answer 51

Pain, bleeding, exposed apex, damage flap | Inadequate anaesthesia

Question 52

Complications may occur after perio tx?

Answer 52

``` Pain Bleeding Sensitivity Infection Swelling Dysasthessia Failure graft ```

Question 53

Long-term complication perio tx?

Answer 53

Recession Sensitivitt Poor aesthetic Altered sensation

Question 54

What are pt factors that can produce variable outcome?

Answer 54

OHI Smoking General health/MH

Question 55

What are defect characteristics which can produce variable outcomes?

Answer 55

Defect width Amount attachment loss Amount bone loss Occlusal loads