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.