032. periodontal surgery

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Periodontal Surgery

Classification of periodontal surgery:

A. Pocket reduction surgery: • Resective: Gingivectomy, apically displaced flap and undisplaced flap with or without osseous resection. • Regenerative: Flaps with grafts and membranes.


B. Correction of anatomic/morphologic defects: • Plastic surgery techniques to widen attached gingiva: – Epithelial grafts – Connective tissue grafts • Esthetic surgery: – Root coverage – Recreation of gingival papillae • Preprosthetic surgery techniques: – Crown lengthening – Ridge augmentation – Vestibular deepening • Placement of dental implants: – With GBR – Sinus grafts


Indications Of Periodontal Surgery 1. Areas with irregular bony contours, deep craters and others requiring a surgical approach. 2. Deep pockets where complete removal of root irritants is not possible, especially in inaccessible areas like molars and premolar areas. 3. In cases of Grade II and III furcation involvement, where apart from removing local irritants, necessary root resection or hemisection can be considered. 4. Infrabony pockets in non-accessible areas which are nonresponsive towards nonsurgical methods. 5. Persistent inflammation in areas with moderate and deep pockets. 6. Correction of mucogingival problems


Contraindications Of Periodontal Surgery These may be oral or systemic. 1. In patients of advanced age where teeth may last for life without resorting to radical treatment (Procedures indicated in a person of 60 years of age may not be justified in someone of 70 years of age). 2. Patients with systemic diseases such as cardiovascular disease, malignancy, liver diseases, blood disorders, uncontrolled-diabetes, consultation with the patient’s physician is essential. 3. Where thorough subgingival scaling and good home care will resolve or control the lesion. 4. Where patient motivation is inadequate. 5. In the presence of infection. 6. Where the prognosis is so poor that tooth loss is inevitable.


General Principles Of Surgery

a. Preparation of the patient initial or preparatory phase of therapy. (scaling + root planing and removal of etiotropic elements) b. The general conditions that are common to all periodontal surgical techniques

Premedication

Sedation and Anesthesia

Tissue Management

Operate gently and carefully

Observe the patient at all times

Be certain the instruments are sharp

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Types of Needles A. On the basis of shape: i. Straight ii. Curved: 1/4, 3/8, 1/2, 5/8 B. On the basis of eye: i. Eyed: Suture material is tied to the ii. Eyeless/swaged: The suture material is inserted intomanufacturing and metal is compressed around it. Needle is not reusable.

: Suture material is tied to the needle and is designed to reuse.

: The suture material is inserted into hollow end during compressed around it. Needle is not reusable.

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designed to reuse.

hollow end during compressed around it. Needle is not reusable.


C. On the basis of function: i. Tapered: Used for closing mesenchymal layereasily penetrable. ii. Cutting: Used for keratinized mucosa and skin. a. Conventional cutting b. Reverse cutting

: Used for closing mesenchymal layers such as muscle/fascia that are soft and

: Used for keratinized mucosa and skin.

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such as muscle/fascia that are soft and


Types of Suture Materials A. Based on the number of filaments: a. Monofilament, e.g. steel, nylon b. Multifilament, e.g. silk, cotton. B. Based on suture diameter by US Pharmacopoeia in descending order from 5 4 3210 till 11-0 size. 1-0 being the largest diameter and 11-0 the smallest one. C. Based on resorbability of suture material: a. Absorbable b. Non absorbable


D. Based on the source: a. Natural: • Absorbable Plain gut, chromic gut, fast absorbing gut, plain collagen,

chromic collagen. • Nonabsorbable

Silk, cotton, linen.


b. Synthetic: • Absorbable– Polyglactin, Polyglyconate, Polyglycolic, Polydioxanone. • Nonabsorbable–

Nylon, Polybutester, Polyester, Decron, Polypropylene, Nurolone.


Goals of suturing 1. Maintains hemostasis 2. Permits healing by primary intention 3. Reduces postoperative pain 4. Permits proper flap position 5. Prevents bone exposure resulting in delayed healing and unnecessary resorption.


Suturing Techniques Interrupted Suture a. Direct or loop suture b. Figure eight c. Horizontal mattress d. Vertical mattress e. Distal wedge or Anchor suture f. Periosteal suturing Continuous Suture a. Papillary sling b. Horizontal mattress c. Vertical mattress


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Periodontal Dressing Various commercially-available periodontal dressings are: a. Coe pak b. Kirkland periopak c. Peridress d. Periocare e. Periodontal pack f. Perio-putty g. Zone periodontal pak

Coe pak Zinc oxide : Main ingredient Vegetable oil : For plasticity Gum : For cohesiveness Lorothidol : Fungicide Liquid coconut : Fatty acids Chlorothymol : Bacteriostatic agent Colophony resin


Postoperative Instructions And Care Appropriate postoperative instructions should be given both verbally and in written to the patient including an explanation concerning: 1. Discomfort and potential complications; 2. All medications, especially analgesics and antibiotics; 3. Diet modification Instructions to the Patient after Surgery Do’s

Take 2 tablets of acetaminophen every 6 hours on first day.

Chew on the non operated side

Take semisolid food

Apply ice, intermittently for alternating 20 minutes on and 20 minutes off, on the face over the operated side on the first day

Use chlorhexidine mouthwash

If the bleeding does not stop, take piece of gauge and form it into U-shape and hold it in thumb and index finger, apply it to both sides of the pack, and hold it there under pressure for 20 minutes

Swelling is usual in extensive surgical procedure. It subsides in 3 or 4 days. Apply moist heat if it persists

If any other problem arises do call the doctor.


Do Not’s × Avoid hot food × Do not smoke or take alcohol × Avoid citrus, highly spicy food × Do not brush over the pack × Avoid exertion × Do not try to stop bleeding by rinsing


Complications During Surgery

Syncope

Hemorrhage

Persistent bleeding after surgery

Sensitivity to percussion

Swelling

Feeling of weakness

Postoperative pain

Sensitive Roots/Root hypersensitivity

Health & Medicine

032. periodontal surgery