l23_general principles of periodontal surgery.pptx

8/16/2019 L23_General Principles of Periodontal Surgery.pptx

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NERAL

INCIPLES PERIODONTALRGERY

Rikko HudyonoUnsoed-2015


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Outpatient surgery

Hospital PeriodontalSurgery

OUTLINE


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1. Patient Preparation

2. Emergenc E!"ipment

#. $ea%"re% to pre&ent tran%mi%%iono' in'ection

(. Se)ation an) anae%t*e%ia

+. Ti%%"e management

,. Sca-ing an) Root P-anning. /emo%ta%i%

0. Perio)onta- Dre%%ing

. Po%toperati&e proce)"re%

OUTPATIENT SURGERY


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3NO4 YOURPATIENT

1. PATIENT PREPARATION

3NO4 YOUR PATIENT


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Patient overall health status

Know your operation site.

Re-evaluation after phase I Therapy

Premediation

Smo!ing

Informed "onsent

1. PATIENT PREPARATION


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#eneral assessment of thepatient$s physial harateristisfor a%normalities in gait& %ody

movements& %ody symmetry&posture& 'eight& s!in& eyes&speeh& and a%ility to thin!learly(

Patient$s ardiovasular and

respiratory funtions

)( P*TIENT

PREP*R*TION

Patient Overall HealthStatus

+henever there is some ,uestion amedial onsultation is

reommended


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Surgial site anatomialstruture

*natomial spaes

Innervation of nerves

*rterial %ranhes

)( P*TIENT

PREP*R*TION

no' your operation site

+henever there is some ,uestion amedial onsultation is

reommended


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Eliminate some lesions entirely

Render tissues more .rm and

onsistent

*,uaint the patient 'ithdental o/ e

)( P*TIENT

PREP*R*TION

Reevaluation after phase) Therapy

Re-probing and re-examination all

findings that previously indicated the

need for surgery


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)( P*TIENT

PREP*R*TION


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Redue an0iety see Sedation

Prophylati anti%ioti

Espeially for patient 'ith mediallyompromised patient

It is supposed to have greatersuess rate for the ne' attahmentor any tissue engineering proedure

)( P*TIENT

PREP*R*TION

Premediation

lthough the rationale for prophylactic

antibiotic uses seem logical! no research

evidence is available to support it


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NS*I1s 2I%uprofen&3ethampyron 4 1ia5epam&3efenami aid6

"ortiosteroid21e0amethasone& 3ethylPrednisolon6

3outh'ashes 2"hlorhe0idine&"hlorine 1io0ine& Hyaluroni*id& *loe 7era& 'arm %rine6

)( P*TIENT

PREP*R*TION

Premediation


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)( P*TIENT

PREP*R*TION

Smo!ing

The deleterious e8ets ofsmo!ing had %een 'elldoumented

Patient should %e informed ofthis fat and as!ed to ,uitsmo!ing 9-: 'ee!s after the

proedure


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)( P*TIENT

PREP*R*TION

Smo!ing


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)( P*TIENT

PREP*R*TION

Informed "onsent

Patient should %e informed atthe initial visit a%out thediagnosis& prognosis& and

di8erent possi%le treatment&'ith their e0peted results&and all pros and ontras ofeah approah(


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The operator& all assistants& and o/ e personnelshould %e trained to handle all the possi%leemergenies that may arise( 1rugs and e,uipment foremergeny use should %e readily availa%le at a ll

times(

;*SI" LI


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=(E3ER#EN">

E?UIP3ENTS

Respiratory E,uipments

"irulatory E,uipments

"he most important


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=(E3ER#EN">

E?UIP3ENTS

3ediaments

Ephinephrine#luoortioids 2Prednisone6

3orphine or its derivatives

Infusion solutions

Inhaled short-ation %eta-=mimeti

Nitroglyerin

et

9 3E*SURES TO PRE7ENT


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Universal Preaution

Sterili5ation

1isposal

9( 3E*SURES TO PRE7ENT TR*NS3ISSION O<

IN


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Ut! mengurangi !eemasan perlu di%erio%at penenang atau o%at sedasi ut!mengurangi rasa ta!ut dan !eemasan(

1pt di%eri!an seara inhalasi& oral&intramus!ular& dan intravenous( "ontoh @%en5odia5epine(

Ut! mengurangi rasa sa!it saat operasima!a perlu pem%erian anastesi lo!alse%elumnya

(. SEDATION 5

ANEST/ESIA


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:( SE1*TION4

*NESTHESI*

SE1*TION

#afe and $uite

effective


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1. Operate gently and carefully .

2. Observe the patient at all times .

3. Be certain the instruments are

sharp .

+. TISSUE

$ANAGE$ENT


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,. SCALING 5 ROOT PLANING

ll exposed root surface should be carefully explored and

planned as needed as part of the surgical procedure


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;e sure no %leeding disorders( It isimperative to reogni5e that e0essive%leeding may %e aused %y systemidisorders

;e familiar 'ith your surgial site

#ood aspiration 'ith ontinuous sutioning

Ie-moist sterile gau5e *%sor%a%le gelatin sponge

. /E$OSTASIS

%lear visuali&ation of the surgical siteis H'( )* of success


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A( PERIO1ONT*L 1RESSIN#S

Bin O0ide Eugenol

1eveloped %y +ard in )C=9 ;ased on reation of eugenol and 5in o0ide(

Noneugenol Pa!s ;ased on reation of fatty aid and metalli o0ide

Other non eugenol pa!s inlude yanorylates& tissueonditioners 2metharylate gel6& 5in o0ide and glyolalohol


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A(PERIO1ONT*L

1RESSIN#S

egunaan PeriodontalPa!

3elindungi lu!a dari gese!ansehingga dapat mem%antupenyem%uhan

3engurangi perdarahan denganmenDaga %e!uan darah tetap ditempatnya

3engurangi !egoyangan gigi

3enDaga posisi ap searame!anis

3em%eri %entu! pada Daringan%aru


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A(PERIO1ONT*L

1RESSIN#S

"H*R*"TERI"S O< PERIO1ONT*LP*"

Nonto0i or nonirritating to thetissue

"onveniently prepared& plaed andremoved 'ith minimal disomfort topatient

Should maintain adhesion to itselfand to the teeth& !ept in plaemehanially %y interlo!ing ininterdental spaes


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A(PERIO1ONT*L

1RESSIN#S

Bin Eugenol Pa!

1idasar!an pada rea!si dr 5ino0ide eugenol(

;ahan tam%ahan lainnya adalahas%estos s%g %ahan pele!at dan

pengisi serta tani aid(*s%estos dpt menye%a%!anpenya!it paru dan !arsinogeni!serta tani aid menye%a%!an!erusa!an hati

Eugenol dapat mening!at!anrea!si allargi yg menga!i%at!an'arna !emerahan pd daerah ygdi!enai dan rasa nyeri seperti

ter%a!ar pada %e%erapa


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A(PERIO1ONT*L

1RESSIN#S

Retention of Pa!s

3ehanial interlo!ing of interdental spaes

*nti%aterial properties

*llergy

3ay %e enhaned %y inorporatinganti%iotis in pa!

So far& ontat allergy 'ith eugenol andresin had %een reported


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A(PERIO1ONT*L

1RESSIN#S

PERIO1ONT*L1RESSIN#S

%+, %. the most /idelyused periodontal dressings


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A(PERIO1ONT*L

1RESSIN#S

The linial e8 ets of a perio)onta- )re%%ing after modi. ed +idman ap surgery'ere studied( * total of thirty surgial sites in)9 patients 'ere inluded in the s tudy( Half of

the sites 'ere not overed %y a perio)onta- )re%%ing 'hile the other half 'ere( *llpatients 'ere instruted in oral hygieneproedures and reeived ru%%er upprophyla0es and ossing at ) 'ee!& = 'ee!s&) month and = months postoperatively(

*t the onlusion of the study& a ,uestionnaire'as administered to eah patient( Nosigni.ant di8erenes 'ere found %et'eendressed and undressed segments regardinghanges in linial attahment levels& po!et

depth& or gingival inammation( The omissionof a )re%%ing did not result in a greaterinidene of disomfort( 3ore patients statedpreferene for no )re%%ing (

"omparison of results follo'ing modi.ed +idman ap surgery 'ith and 'ithout surgial)re%%ing(2eng6 ;y@ *llen 1R& "a8esse R#& Fournal Of Periodontology GF Periodontol& ISSN@

==-9:C=& )CA9 *ugJ 7ol( K: 2A6& pp( :-KJ P3I1@ M9K=ACMJ

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A(PERIO1ONT*L1RESSIN#S

+ound dressing has a positive e8eton linial long-term results using at'o-step non-surgial proedure(

3oreover& removing the dressingafter A days leads to learly %etterresults than removing it earlier(

Sigush ;+& P.t5ner *& Niet5sh T& #lo!mann E(Periodontal dressing 27oopas6 inuenes outomesin a t'o-step treatment proedure( F "lin Periodontol=KJ 9=@ :):K(


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HO+ TO PREP*RE "OE-P*"

2-


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HO+ TO *PPL> "OE-P*"

#upposed to be kept for 1 /eek


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C( POST OPER*TI7EPRO"E1URES

"lear and %rief instrution ande0planation shall %e given to thepatient after the pa! is plaed


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C( POST-OPPRO"E1URES


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3outhare

Patient is advised to !eep area lean& aspla,ue and food aumulation mayimpair healing

Soft tooth%rushes and light 'aterirrigation are advised( Rinsing 'ithhlorhe0idine

;leeding is normal& and 'ill su%side ashealing progresses


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3anagement of Post-opPain

3inor pain and disomfort are normalfollo'ing periodontal surgery

"ommon soure of post operative painis overe0tension of periodontal pa!


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Treatment ofHypersensitivity

*t home1entri.es ontaining strontium

hloride& potassium nitrate& and sodiumitrate

In o/ e These produts and treatments aim to

derease hypersensitivity %y %lo!ingdentinal tu%ules 'ith either a rystallinesalt preipitation or an applied oating

2varnish or %onding agent6 on the rootsurfae

HOSPIT*L PERIO1ONT*L


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HOSPIT*L PERIO1ONT*LSUR#ER>

Ordinarily& periodontal surgery is an o/eproedure performed in ,uadrants or se0tants&usually at %i'ee!ly or longer intervals(

Indiations for hospital periodontal surgeryinlude

optimal ontrol and management of

apprehensiononveniene for individuals 'ho annot

endure multiple visits to omplete surgialtreatment

patient protetion(


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SUR#I"*L INSTRU3ENT

1 ,xcisional and incisional instruments

2 #urgical curettes and sickles

3 eriosteal elevators

4 #urgical chisels

5 #urgical files

6 #cissors

7 Hemostats and tissue forceps


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E"ISION*L *N1 IN"ISION*LINSTRU3ENTS


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SUR#I"*L "URETTES *N1 SI"LES


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PERIOSTE*L ELE7*TORS


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SUR#I"*L "HISELS


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SUR#I"*L


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S"ISSORS *N1 NIPPERS


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HE3OST*TS *N1 TISSUE

l23_general principles of periodontal surgery.pptx

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