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PERIODONTAL SURGERY

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by

Reena Wadia

on 6 September 2013

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Transcript of PERIODONTAL SURGERY

PERIODONTAL SURGERY
Suggested Indications
Accessibility
Improve gingival contour
Pocket depth reduction
Apical repositioning
Facilitate restorative treatment
Regenerative or mucogingival procedures
Objective
ACCESS
Residual probing depths >6mm
Multi-rooted teeth
Furcation involvement
Objective
ACCESS
Poor plaque control
Poor patient motivation and compliance
Smoker
Uncontrolled systemic disease
Contraindications
Excellent plaque control
No gingival bleeding
What do we want to achieve from surgery?
Tooth vitality
Periapical radiographs

Surgical Assessment
Surgical Assessment
Post-operative pain, discomfort and swelling
Post-operative root sensitivity
Longer clinical crowns
Suture removal
Commitment to compliance
Commitment to long term maintenance
Pre-operative Consideration
Overview
1. Incision and elevation
2. Removal of granulation tissue
& root surface debridement

3. +/- Bony recontouring
4. Flap replacement and closure
Surgical Techniques
Open flap debridement
Modifed Widman flap
Apically repositioned flap
Gingivectomy

Open Flap Debridement
1. Deep pocket
3. Following debridement, the flap is replaced as close as possible to original level of attachment
2. Flap raised to expose defect
4. Healing after 2-3 months
Modified Widman Flap
1. Initial incision
2. Partial mobilisation of the mucoperiosteal flap
3. Second incision - Sulcular incision
4. Third incision - horizontal incision, also interdentally; removal of the delineated tissue and all granulation tissue
5. Root surface debridement
6. Flap adaption
Post-operative Care
Post-operative Care
Rest
Appropriate analgesia
2% chlorhexidine mouthwash
Soft diet for 24 hours
No brushing or interdental cleaning
Suturing
Terminology
Cutting point
Body
Swaged end
Suture thread
Suture Thread Material
Suture Thread Size
Natural or synthetic
Absorbable (also called resorbable) or non-absorbable
Mono-filament or multi-filament
The greater the gauge number, the thinner the suture thread
Suture Packet
Types of Sutures
Simple interrupted
Continuous
Vertical mattress
Horizontal mattress

Simple interrupted
Thank you for listening
For further details, please see our booklet
Created by Reena Wadia
Full transcript