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Objectives & Principles of Periodontal Surgery

Contributed by:

I.                    Rationale: provides access for cleaning.

A.     Deep Pockets-

B.     Complex Pockets- torturous, not just straight down, may twist.

C.     Furcations-

**** These are factors that make it difficult to clean****

II.                 Methods of Pocket Elimination

A.     Reattachment- get attachment level more coronal, associated with new PDL, new bone.

B.     Surgical-

C.     Apical displacement with flap surgery-

D.     Tooth removal- removal of part of tooth & root in multirooted teeth.

III.               Gingival Pockets

A.     Edematous- can shrink (SRP) and reduces pocket depth.

B.     Fibrotic- mre connective tissue, less likely to shrink after SRP, mre likely to need surgical intervention

IV.              Surgical Techniques

A.     Gingival Curettage- removes epithelial lining of pocket.

1.      Indications: edematous pocket, help reduce inflammation.

2.      Rationale: remove any barriers for healing, SRP then curettage (one in the same).

3.      Technique: Anesthesia, flip cutting edge of instrument so its on tissue. Not done anymore because some curettage happens with regular instrumentation.

B.     Gingivectomy- cutting off gingiva, cutting wall off.

1.      Indications: eliminating Suprabony fibrotic pockets.

2.      Contraindications: elimination of gingival enlargement, infraboney pockets/ need bone for surgery, mucogingival involvement (little or no attached gingiva)

C.     Gingivoplasty- done in absence of pockets, recontour gingiva, cosmetic procedure.

D.     Perio flap surgery- reflecting soft tissue away from tooth & bone so we can see/fix it.

E.      Osseous Surgery- have to lay flap (elevate flap) before we can do osseous surgery.

1. Additive- regeneration: less predictable. Grow Bone.

2. Subtractive- resective: cut bone to get rid of bony defect, reshaping bone so it looks normal.

F.      Mucogingival Surgery- not enough or no attached gingiva.

1.      Etiology of absent attached gingiva: recession, high frenum (muscle pulls).

G. Frenectomy- high frenum is cut.

 Disclaimer: These notes were copied and pasted from files sent to me by Andrea.  They have not been reviewed for errors. You are responsible for checking out the information to verify the accuracy. This site, Amy Nieves and Andrea are not responsible for typographical errors.