Surgical management of periodontitis I Flashcards
(19 cards)
What is RSD?
Removal of deposits (plaque, calculus) and a thin layer of cementum bound endotoxin from the root surface
Limitations of RSD?
May not stop aggressive and progressive disease completely
Persistent acute episodes (e.g. periodontal abscess)
Deep complex bone defects - difficulties with adequate debridement
Severe hyperplasia or tissue deformity
Pathology e.g. epulides
Aims of perio surgery?
Gain access to root surface for effective debridement Visualisation of bone defects Improve tissue contours Reduce pocket depths Removal of chronically inflamed tissue Encourage regeneration Removal of hyperplastic gingival tissue Crown lengthening
Indications for surgery?
Gingivectomy
- Hyperplasia
- False pockets
- Adequate attached gingiva
Open flap debridement
- Deep persistent bleeding (suppurating) pockets
Apically repositioned flap
- Pocket elimination
- Crown lengthening
- Unsuccessful gingivally enroaching restorations
What to consider before surgery?
Has non-surgical therapy been undertaken and reviewed at an appropriate interval?
Is pt suitable - medically, emotionally?
Do they understand the procedure? - consent, limitations, complications, aesthetic effect
Is oral hygiene/compliance adequate? - if poor OH surgery will make it worse as spreads bac
Has restorative strategy been considered? - what are you doing after surgery, aesthetic work, crown teeth, composite, dentures?
Surgical techniques?
Excisional e.g. gingivectomy
Flap - replacement e.g. original and modified widman (reattachmen)
Flap - repositional e.g. lateral, apical, coronal
Mucogingival procedures e.g. gingival grafts
Gingivectomy technique?
LA Measure pocket depth and mark margins Incisions - cut gingivae at an EXTERNAL BEVEL Removal of excised tissue Scaling of root surface Achieve haemostasis Dressing
Goldman’s technique for gingivectomy?
Measure pocket depths and pierced the mucosa from outside = creates bleeding points = shows you the path of incision along the bleeding points
Flap procedure stages?
la Incisions (use of relieving incisions) - crevicular incision Raise flap Curettage RSD Irrigation Sutures
Open flap debridement incisions?
1st = internal beveling 2nd = through sulcus and crevicular incision to relieve the attached tissue 3rd = remove base attachment with a perpendicular incision
Exposes healthy epithelium and CT
What to do after raising the flap?
RSD and granulation tissue removal
Root surface treatment and application of therapeutic agents if appropriate
Odontoplasty = remove dentine from root surface
Root devision/amputation e.g. if a root has no bone support
Osteoplasty = if very thick bone you can reduce the prominence, do not remove supporting bone - just the outside of the bone
Ostectomy = remove bone and bring it higher, brings the bone apically e.g. when crown lengthening
Placement of
Difference between osteoplasty and ostectomy?
Osteoplasty only removes the outer layer of the bone, not the supporting bone
Ostectomy brings the bone apically
Modified widman flap?
Incision 1mm buccally from gingival margin preserving interdental papillae
Flap raised exposing only a few mm of bone
Intracrevicular/horizontal incisions to release pocket lining
Careful curettage of bone
Debridement of root surface
Replace flaps to cover interdental bone and suture
Flap management?
Raising flaps
Relieving incisions
Replacement of flap
What to use to do RSD?
Ultrasonics
Hand instruments
Irrigate with saline
Types of suturing?
Interrupted Vertical mattress Horizontal mattress Sling Continuous
Post op care?
Appropriate analgesia
Suture removal 7-10 days
CHX 0.2% m/w 2x daily for the first 2-3 weeks - pts do not perform mechanical cleaning and not to chew in the treated area during this period
Use of soft toothbrush and toothpicks for interdental areas after the above period
2 weekly dental visits to monitor plaque control
Signs of success after flap surgery?
Decrease in inflam Less BOP Decrease in pocket depth Increase in attachment Eliminate pus No increase in mobility Improvement of tissue contour Stabilisation of bone levels Regeneration
Evidence for success of surgery?
Michigan group and gothenburg group
- all surgical procedures = decrease in PD with greater reduction at initially deeper sites
- in molar sites, outcome of surgical approach was better than non-surgical tx
- Pt with good post op plaque control maintained clinical attachment levels and PD reductions after surgery more consistently than pts with poor OH
