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Periodontal Surgery

Presented by:

Michelle R. Mould, RDH, MSDH

Objectives

Describe the goals, indications, andconsiderations for periodontal surgery

Identify and discuss various types of periodontalsurgery

Explain the postoperative instructions given to theperiodontal surgery patient

Explain the role of the dental hygienist inperiodontal surgery

Goals

Arrest diseaseprogression

Preserve periodontalattachment

Regenerate tissue lost todisease

Create maintainableenvironment

Indications

Tissue

Resection/Removal

Access

oo e r emen

Osseous defects

Correction of MG defects

Improved esthetics

Regeneration

Considerations

Rate of disease progression

NSPT

Probing depths

Bone loss

Tooth function and esthetics

Relative contraindications

Types of Periodontal Surgery

Resective

Access

Root Amputation orHemi-section

Mucogingival

Regeneration

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Resective Periodontal Flap for Access

Modified Widman

Access for debridement

Preservation of gingivaltissue

Pocket reduction Long JE

No new CT attachment

Apically Positioned Periodontal Flap

with Osseous Surgery

Elevate flap

Reshape alveolar bone

Position tissue apically

Contraindications ???

Apically Positioned Flap with

Osseous RecontouringCrown Lengthening

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Root Amputation or Hemisection

Root amputation Severe bone loss,

furcation involvement,

decay, fractured root

Hemisection

Sufficient bone around

remaining root(s)

Requires endodontic tx

prior to surgery

Regeneration

Restore periodontal tissueslost through disease

Formation of new alveolarbone, cementum, and PDL

Bone grafting

Guided tissue regeneration

Bone Grafting

Types

Autograft

Allograft

Xenograft

Alloplast

Guided Tissue Regeneration

Barrier Membrane

Allows proliferation of

primary healing cells from

Emdogain

Enamel matrix protein(porcine)

alveolar bone and PDL,

rather than growth of

epithelium from gingiva

Barrier Membrane with Bone Graft

Ridge Augmentation

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Bone Graft and GTR Mucogingival Surgery

Periodontal plastic

surgery

Augment width and

gingiva

Correct recession

Frenectomy

Free Gingival Graft

Donor tissue usually from

palate

re c a e ea ng

Tissue color may not

match

Painful healing of donor

site

Subepithelial Connective Tissue

(SECT)

Procedure of choice for rootcoverage

Trans lants sube ithelial connectivetissue

Donor site closed with sutures

Tissue color and texture better whenhealed

SECT Lasers in Periodontal Surgery

What were your

findings?

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References

AAP Position Paper: Guidelines for Periodontal Therapy, 2001.Retrieved from http://www.perio.org/resources-products/pdf/33-therapy.pdf.

AAP Position Paper: Periodontal Regeneration, 2005. Retrievedfrom http://www.perio.org/resources-products/pdf/50-regeneration.pdf.

AAP Commissioned Review: Lasers in Periodontics, 2006.Retrieved from http://www.perio.org/resources-products/pdf/lr-lasers.pdf

Nield-Gehrig, J.S., & Willmann, D.E., (2008). Foundations ofPeriodontics for the Dental Hygienist, 2nd Ed 313-338.

Weinberg, M.A. et al, (2006). Comprehensive Periodontics for theDental Hygienist, 2nd Ed., 437-485.