Tuesday, January 2, 2018

Periodontal surgery procedures

Objectives of Perio Surgery
-reduction in pocket depth
-gain access to root and underlying bone
-regenerate periodontal tissues destroyed by disease
-arrest disease progression
-create an oral environment that is maintainable by pt and hygienist

Indications for Perio Surgery
-pocket elimination/reduction on teeth with gingival/periodontal pockets
-correction of mucogingival defects
-establishment of aesthetics
-creation of a favorable restorative environment
-placement of dental implants
-incision and drainage of a gingival or periodontal abscess
-regeneration of attachment apparatus that was destroyed by disease

Contraindications to Perio Surgery
-systemic disease that cannot be controlled by medications
-systemic diseases that are associated with excessive bleeding
-patients taking intravenous bisphosphonate
-patients who are noncompliant with plaque control or appointments
-concern for negative cosmetic outcomes
-treating teeth that have hopeless prognosis

Gingivectomy
-excision or removal of the gingiva in order to eliminate a pocket

Gingivoplasty
-reshaping of the ginigiva

Perio Flap Surgery
-goal is to gain access to the root surface and bone
-flap is a loosened portion of the gingiva, and alveolar mucosa that is separated from the underlying structures expect at its base, from which the flap receives its blood supply

Full Flap
-mucoperiosteal flap
-gingiva, alveolar mucosa, a nd periosteum are refelcted from the root and underlying bone surface

Partial Flap
-split flap
-periosteum and some gingival connective tissue are left attached to the bone and is not included in the reflected flap

Flap Surgery with Osseous Resection
-periodontitis results in destruction of alveolar and supporting bone (horizontally or vertically)
-procedure where bone is modified to eliminate soft tissue pockets and obtain more maintainable bone and gingival contours

2 Types of Osseous Defects
-horizontal bone loss
-vertical bone loss

Ostectomy
-procedure done during perio surgery after flaps are reflected
-remove supporting bone with high speed handpiece and plenty of water or hand chisels (osseous resection)
-level out bony defects/decrease depth of osseous defect and achieve physiologic contours

Osteoplasty
-procedure done during perio surgery after flaps are reflected
-reshape or recontour the nonsupporting bone (bone not in contact with the tooth)

Periodontal/Gingival Plastic Surgery
-completed at sites with inadequate width and thickness of attached gingiva that exhibit persistent inflammation/bleeding

Periodontal Regeneration
-guided tissue regeneration
-uses barrier membranes that prevent gingival tissue from contacting the root surface thus creating a space for regeneration

3 Types of Healing after Perio Surgery
1. repair - healing of periodontium with tissues that do no replicate the original lost structures
2. reattachment - reunion of epithelial or connective tissue to a root surface that was not damaged or destroyed by periodontal disease
3. regeneration - attachment apparatus is reformed on a root surface that was previously pathologically exposed

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