BDS11001 Basic periodontal surgery(1).pdf

BDS11001 Indications for surgerybasic periodontal surgery Phase I therapy Phase I periodontal treatment therapy • Oral hygiene • Debridement • Systemic antibiotics • Occlusal bite adjustment • Disease re-evaluation Periodontitis Disease Infection Inflammation Dysbiosis Where do antibioti...

BDS11001 Indications for surgerybasic periodontal surgery Phase I therapy Phase I periodontal treatment therapy • Oral hygiene • Debridement • Systemic antibiotics • Occlusal bite adjustment • Disease re-evaluation Periodontitis Disease Infection Inflammation Dysbiosis Where do antibiotics fit into this new concept of periodontitis? Antibiotics in periodontics Aside from age, medical condition, and allergies close attention should be paid to the following • Local factors: The conditions prevailing at the site of infection greatly such as presence of pus and secretions, necrotic material and foreign body, low pH. • Organism related considerations: The most probable pathogen must be considered and treatment chosen accordingly. • Drug factors: Specific properties of antibiotics like spectrum of activity (narrow/broad), type of activity (bactericidal/bacteristatic), sensitivity of the organism relative toxicity, must all be considered. Antibiotics in periodontics • High doses for a short duration • Antibiotic loading dose. Without a loading dose, it takes 6-12 hours to achieve maximum therapeutic blood level • Frequent dosing intervals are important to maintain relatively constant blood levels • Duration of therapy. It is determined by subsidence of the symptoms of disease Antibiotics in periodontics Why give antibiotics? • Impaired host defense. In an individual with normal host defense, nonsurgical treatment may achieve the desired effect, and cure the disease. • Intensive therapy with drugs is imperative in those with impaired host defense. Antibiotics in periodontics • Tetracycline • Doxycycline • Metronidazole • Clindamycin • Amoxicillin + Clavulanic acid • Azithromycin • Metronidazole + Amoxicillin • Spiramycin Surgical periodontal therapy Phase II therapy Why surgical therapy? • Addresses the limitations of non-surgical therapy • Direct and stimulate the body’s natural healing ability • Build lost tissue Objectives of periodontal surgery • To arrest the progression of periodontal disease and prevent disease recurrence. • To attempt regeneration of periodontal tissues destroyed due to disease • To address irregular bone defects, that allow disease persistence Indications for periodontal surgery • Access for root debridement • Irregular bone defects • Reduction of the depth of periodontal pocket • Correction of mucogingival deficiencies or defects • Creation of a favorable restorative environment • Regenerative procedures • Furcation involvement Periodontal surgeries • Resective procedures • Periodontal regenerative procedures • Periodontal plastic surgery • Preprosthetic surgical procedures. • Surgical procedures for placement of implants and treatment of periimplant disease. Contraindications for periodontal surgery • Inadequate plaque control • Uncontrolled medical conditions • Anatomic limitations • Concern for cosmetic consequences Principals of periodontal surgery • Patient preparation • Emergency equipment • Sedation and anesthesia • Tissue management • Hemostasis Surgical Armamentarium Instruments used in periodontal surgery: I.Periodontal knives • Kirkland knife • Orban knife • Buck Knife • Knives cutting edge along entire periphery of the blade. • Knives have fixed blades that require frequent resharpening II:Surgical blades :15, 15C, 11,12D Primary incision Microsurgical blades III:Surgical handles IV:Periosteal elevators and tissue forceps Tissue manipulation V:Scissors Trimming Curved vs Straight VI:Needle holders and sutures Tissue closure Suturing needles: The shape • Straight and curved • Curved needles can be 1/2, 3/8, 1/4, 1/8 of the circle. • 3/8 is most commonly used • • 1/2 circle needle in more restricted areas Surgical sutures • Natural • Synthetic • Absorbable • Nonabsorbable • Monofilament • Multifilament Surgical pocket therapy Gingivectomy • As •our knowledge of wound healing and the underlying biological processes progressed, so have the treatment modalities. • Flap procedure • Some techniques are still in use but the aim of their use have evolved. • Osteoplasty and ostectomy • We no longer use gingivectomies for pocket therapy Gingivectomy • It is the oldest surgical approach in periodontal therapy • It is defined as “the excision of the soft tissue wall of a pathologic periodontal pocket”. • The technique has evolved from starting point to the way it is applied today. Access flap procedures Types of access flaps Based on post surgical flap position • Nondisplaced flap, where the flap is returned to its original position • Displaced flap, where the flap is displaced coronally, apically laterally to its original position Apically repositioned flap Modified Widman flap • Is a surgical procedure aimed at exposing the root surfaces for meticulous instrumentation and for removal of the pocket lining. • Aimed at maximum healing in areas of previous periodontal pockets with minimum loss of periodontal tissues during and after surgery. It is not aimed at surgical elimination of the pocket walls Osteoplasty • It’s a plastic procedure where nonsupporting bone is reshaped to achieved improved and more physiologic architecture • It includes procedures like grooving or festooning Ostectomy • It is plastic removal of radicular and interradicular supporting bone to eliminate osseous deformities Periodontal surgery Before attempting periodontal surgery it is imperative to consider • The hoped for outcome • The alternative treatment options • The pros and cons of surgery • The technical limitations Surgical treatment • Surgical treatment aims at the restoration of the original structure, properties, and function of these tissues. It is the ideal and desired outcome of periodontal therapy. • Altered healing often disturbs the normal restoration of the periodontium and as a result different clinically compromised outcomes can be identified. What do you now know? Objectives of periodontal surgery • To arrest the progression of periodontal disease and prevent disease recurrence. • To attempt regeneration of periodontal tissues destroyed due to disease • To address irregular bone defects, that allow disease persistence Reading material • Carranza`s clinical periodontology, Newman, Takei, Klokkevold, Carranza (Chapter 53) • Clinical periodontology and implant dentistry, Jan Lindhe and Niklaus P. Lang, volume 2 (chapter 39) • Periodontology by Herbert F. Wolf and Thomas M. Hassell (page 295302)