ENDO-PERIO SEMINAR
Indications for periodontal surgery
Areas with irregular bony contours or deep craters.
Pockets on teeth in which a complete removal of root irritants is not considered clinically possible. (molars).
In cases of grade II or III furcation involvement. Infrabony pockets in distal areas of last molars. Persistent inflammation in areas with
moderate to deep pockets may require a surgical approach.
Contraindications
Patients who do not exhibit good plaque control.
Uncontrolled or progressive systemic disease (uncontrolled diabetics,leukemia ect.).
Patients taking large doses of corticosteriods may have reduced resistance to stress associated with surgery ..
Patients with imminent terminal disease who are debilitated are not candidates for surgery.
Classification of periodontal surgery
• Resective Procedures.
• New attachment procedures.
• Regeneration procedures.
Resective procedures
• It is the procedure that means to
eliminate or reduce the pocket, by
excising or amputating the tissue
constricting the pocket wall.
(in this case we remove bone).
Resective procedures includes:
Gingivectomy, Gingivoplasty.
Apically positioned flap without
osseous surgery.
Apically positioned flap with osseous
surgery (Osteoplasty, Osteoctomy).Root resection.
Gingivectomy
Gingivoplasty
New attachment procedures
It is the reunion of connective tissue by formation of new cementum with inserting collagen fibers on root surface that has been deprived of its periodontal ligament.
New attachment procedures
Gingivectomy,Gingivoplasty Gingivectomy: Excision of soft tissue wall of
periodontal pocket.
Basic rational is pocket elimination to allow access
for root instrumentation.
Gingivoplasty: To restore gingival contours.(not
commonly used now days).
External bevel incision is done to remove excess
gingiva and healing is by secondary intention.
Regeneration procedures
Are surgical procedures aimed at
Reproduction or reconstruction of lost or
injured periodontium.
Aim is to restore the periodontium to the
normal physiologic levels.
b) Therapeutic options, such as bone grafts, enamel matrix derivative (EMD),
platelet-derived growth factor (PDGF) or platelet-rich plasma (PRP), can be
placed in the periodontal defect.
c) A membrane (shown in blue) is inserted to guide tissue regeneration (black
arrows).
General post-operative complications
Swelling and bruising
Pain, excessive bleeding, exposing the apex,
damage to flap.
infection, secondary to bleeding and pain.
Possible nerve injury may follow depending on site
Infection
Post operative instruction
Pain killer
Keep pack in place.
Avoid hot food.
Use ice pack on the face.
Do not brush the area.
Use mouth rinse after one day.
Do not smoke, follow normal activity, however avoid
excessive exertion.
Come back to your next appointment.
Measure recessionfrom the
cementoenameljunction to thegingival margin
Recession
Nabors Probe
Nabors Probe
Furcation Classifications
Furcation Involvement:
Class I - Incipient furcal involvement
Class II - Patent furcal involvement
Class III - Communicating furcal involvement
Class IV - Clinically visible furcation
WHAT IS A DENTAL IMPLANT? WHAT IS A DENTAL IMPLANT?
Dental implant is an artificial
titanium fixture which is placed
surgically into the jaw bone to
substitute for a missing tooth and
its root(s).
Alternative Solutions
Partial and Full Dentures
Crowns
Bridges
Screw Implants (Left to Right: TPS screw, Ledermann screw, Branemark screw, ITI Bonefit screw) Cylinder Implants (Left to Right: IMZ, Integral, Frialit-1 step-cylinder, Frialit-2 step-cylinder)
Types of Implants
First Surgical Phase (Implant Placement)Under Local anesthetic the dentist places dental implants into the jaw bone with a very precise surgical procedure. The implant remains covered by gum tissue while fusing to the jaw bone.
Second Surgical Phase (Implant Uncovery)After approximately six months of healing. Under local anesthetic, the implant root is exposed and a healing post is placed over top of it so that the gum tissue heals around the post.
Prosthetic Phase (Teeth)Once the gums have healed, an implant crown is fabricated and screwed down to the implant.
Procedure
Nature of tissue disruption and wound closure
Quality of healing response is also influenced by the nature of tissue disruption and circumstances surrounding wound closure.
Categorized into:
Healing by First Intention
Healing by Second Intention
Healing by Third intention
First/Primary intention
This occurs when a clean laceration or surgical incision is
closed primarily with sutures/clips with the edges in
apposition.
Healing proceeds rapidly with no dehiscence and
minimal scar formation
Soundly united within 2weeks and dense scar tissue is
laid down within 1 month.
Secondary Intention
Occurs when the wound edges are separated and the gap
between them cannot be bridged directly.
Commonly associated with avulsive injury, local infection
or inadequate closure of wound
Healing occurs slowly from bottom to the surface by a
protracted filling of the tissue defect with granulation and
connective tissue
Results in greater scar tissue formation
Scars shrink in time resulting in wound contracture.
Third Intention
Occurs through a staged procedure that combines
secondary healing with delayed primary closure.
Avulsive or contaminated wound are repeatedly
debrided, along with antibiotic therapy and allowed to
granulate and heal by secondary intention for 5-7 days.
Once adequate granulation tissue has formed and risk of
infection minimal, the wound is then sutured close to
heal by primary intention.