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PeriodontalSurgery

Surgical Procedures Gingivectomy

Periodontal Flaps

Osseous Contouring

Bone Grafts

Laterally Sliding Flap

Free gingival Graft

Periodontal Flaps

Increase access to root

Reduce pocket depth

Expose area for regeneration

Crown lengthening

Horizontal Incision

VS

Vertical Incision

Incision Design

Internal bevelscalloped

Dr. Larry WolffPeriodontology III

Spring Semester, 2009School of Dentistry

University of Minnesota

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Internal Bevel Scalloped




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Correct

Incorrect

Vertical Incision

Vertical Releasing Incision Bard Parker with

1. #15 Blade

2. #11 Blade

3. #12 Blade

4. #12B Blade




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Full Thickness Flap

VS

Partial Thickness Flap

Full-Thickness Flap Partial Thickness Flap

Full-Thickness (Mucoperiosteal Flap) Partial Thickness Flap




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Full-Thickness Flap

6 months Post FTF - Bone Loss on Premolar

Conventional Flap Technique Sulcular Incision

Repositioned Flap

VSApically Positioned

Flap




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Apically Positioned Flap

Flap

Indications

Probing Beyond Mucogingival Junction Surgical Crown Lengthening




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Biologic Width

Restorative margin cannotbe placed closer than 2 mm

to crestal bone or will

disrupt attachment structure

Biologic Width

Expose 3-4 mm of tooth

coronal to bone during

surgery to accommodate 2

mm biologic width

Surgical Crown Lengthening




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Primary Incision - Flap Reflected Secondary Incision

Buck or Orban Knives Remove Interproximal Tissue

Full Thickness Flap Reflected Full Thickness Flap Reflected




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Suturing Suturing

Interrupted Sutures Interrupted Sutures

Coe Pack Placed




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Dressing Removal Times

General Guidelines

Minimum - 3 to 4 days

Maximum - 7 to 10 days

Post-Surgical Hemorrhage

Pressure Remove pack, sutures, clot

Identify source/stop

bleeding

Chlorhexidine Rinses 4 Weeks Postoperative

Free Gingival

Grafting

Recession, no attached gingiva




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Suture to Reflect Graft Free Gingival Graft

Place Graft on Recipient Site Place Coe Pack over Recipient Site

Donor Surgical Site Coe Pack over Donor Site




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10 Days Post Surgery Six Weeks Post Surgery

Pain

Management

A Flexible Analgesic Strategy

If aspirin-like drugs are indicated

Mild Pain 200 to 400 mg ibuprofen or 650 mg aspirin

Inadequate pain relief

600 to 800 mg ibuprofen


Moderate Pain

400 mg ibuprofen plus non-narcotic/narcotic

combination analgesic equivalent to 60 mg

codeine


Severe Pain

600 to 800 mg ibuprofen plus non-narcotic

combination analgesic equivalent to 10

oxycocodone

A Flexible Analgesic Strategy

If aspirin-like drugs are contraindicated

Mild Pain 650 to 1000 mg acetaminophen


Mod Pain 600 to 1000 mg acetaminophen and narcoticequivalent to 60 mg codeine or hydrocodone


Severe Pain1000 mg acetaminophen and narcotic equivalent

to 10 mg oxycocodone

Distal Wedge

Procedures




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Types of

Incision

Design forDistal

Wedge

Surgical

Procedures

Types of

Incision

Design forDistal

Wedges

Surgical

Procedures

Distal - 2nd Molar - 7 mm Pocket

Distal Wedge - Diverging Incisions Full-Thickness Flap Reflected




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Documents

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