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How can you tell an "Active pocket"

attachment/bone loss & spontaneous bleeding

Three reasons for surgical pocket therapy

provide access to remove residual calculus
create a stable/maintainable state
promote regeneration

What is the most important factor for determining if a pocket is progressive?

Level of attachment! (We want to examine he apical displacement of attachment and not the increase in PD)

When should you never perform perio surgery?

When the gums are highly inflamed OR when the periodontitis is minimal. (moderate and up is ok)

What are the 4 critical zones of pocket therapy?

Soft tissue wall
Tooth surface
Underlying bone
attached gingiva

List two disadvantages of non-surgical therapy

Incomplete root preparation, root damage from over instrumentation, time consuming and limited access/regen (any 2)

The indications for periodontal surgery are (5)

1 Areas with irregular bony contours
2 pockets that do not allow adequate debridement
3 Grade 2 or 3 furcation involvement
4 Intrabony pockets distal to terminal molars
5 Persistent inflammation in areas of moderate to deep pockets

When planning an incision on narrow attached gingiva, which incision type should be used?

internal bevel

When planning an incision on wide attached gingiva, which incision type should be used?

Collar of tissue

T/F the routine use of prophylactic antibiotics in healthy patients is not warranted when grafting

True

T/F Ibuprofen before an appointment is an okay idea

True

What should your patient do before the appointment?

Rinse with peridex

Your patient quits smoking before your gum surgery. When can he smoke again?

4 weeks.

T/F Anticoagulants and hypertension are contraindications to perio surgery

True

What is in the historical periodontal dressing pack?

ZoE

What is in a non eugenol pack?

Coe

What is the fungicide inside the CoE Pak?

Bithionol

What is the antibiotic in the CoE-pak?

Chlorothymol

T/F the coe-pak contains coconut

True

A Schluger isn't a pistol it's a ....

bone file

T/F Horizontal defects are conducive to regeneration

False. Use resective

Speaking of horizontal incisions, when would you use an external bevel

Gingivectomy

When would you use an internal bevel

Modified Widman

What does an internal bevel incision do?

Removes pocket epithelium

When would you use a sulcular incision?

Extractions

What instrument would you use to do a horizontal collar releasing incision?

Surgical curette or Orban

You're exploring the edentulous ridge of a patient looking for bony defects. What incision do you use?

Midcrestal

You're starting a vertical incision. Where do you make your cut?

Made at the line angle of the tooth (NOT mid papilla or mid tooth)

T/F envelope flaps have vertical release?

FALSE

What instrument is used for a full thickness flap?

Periosteal elevator

What is the difference between a full and partial thickness flap?

Full thickness includes the periosteum

T/F use a #15 blade if you want to do a partial thickness flap

True

What is 1 advantage of a partial thickness flap

it is more moveable without the periosteum

When might you do an apically positioned flap?

Resective surgery for pocket reduction, crown lengthening.

Two objectives of osseous surgery

Reduce perio pocket depth
Produce gingival morphology that mimics normal to facilitate OH

Three indications for Osseous surgery

Reduction of ledges, exotoses and tori
Reduction of SHALLOW bony defects
Enhance flap placement and adaptation
Increase clinical crown length

If designing a flap in a deep palatal vault, where do you make your incision?

At the level of the base of the pocket

If designing a flap in a shallow palatal vault, where do you make your incision?

Close to the gingival margin

Recession in the anterior sextant creates what

Black triangles

The shape of the interdental radicular bone of anterior teeth is

Convex

The average distance from CEJ to furcation on maxillary molars ranges from

3.6-4.8mm

What type of incision is done for open flap debridement?

Sulcular incision

For open flap debridement, do you need a full or partial thickness flap?

Full thickness

Which procedure "buy's time" for a tooth with poor prognosis and horizontal bone loss?

OFD

Two contraindications for OFD

Graftable vertical defects (regenerate instead)
Irregular bony architecture

T/F one disadvantage of OFD is that it often results in incomplete pocket removal

True

In OFD you don't touch the bone. If there is a bony defect left after you do an OFD, what happens during healing?

Recession or pocket formation!

What is the purpose of a modified widman flap

Expose the interdental tooth surface

You're doing an APF. What type of incision and flap do you want?

Inverse bevel, full or partial thickness

Which flap procedure eliminates or reduces pockets?

APF and distal wedge

There are many ways to do a gingivectomy, when it is done for esthetics what tool do you need?

A blade

What type of incision do you want to do for a gingivectomy if you have minimal keratinized gingiva?

Internal bevel

What type of incision do you want to do for a gingivectomy if you have plenty of keratinized gingiva?

External bevel

If you're doing an gingivectomy and using the external bevel incision is there need for sutures or flap?

No

When is healing for a gingivectomy completed

5-14 days

For regenerative procedures what two types of incisions do you want? What kind of flap?

Sulcular and midcrestal, Full thickness

Extensive ________ may compromise tooth support

Ostectomy

Extensive _________ may cause dehiscence

Osteoplasty

What four factors govern the quantity of supporting bone removed by ostectomy

Depth of defect
M-D width of interproximal area
A/P tooth location
Thickness of alveolar bone

T/F After osseous surgery, shallow pockets may have attachment LOSS while modest pockets will have attachment GAIN

True

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