Three reasons for surgical pocket therapy
provide access to remove residual calculus
create a stable/maintainable state
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
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?
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
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?
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)
What is the difference between a full and partial thickness flap?
Full thickness includes 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
Two contraindications for OFD
Graftable vertical defects (regenerate instead)
Irregular bony architecture
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!
You're doing an APF. What type of incision and flap do you want?
Inverse bevel, full or partial thickness
There are many ways to do a gingivectomy, when it is done for esthetics what tool do you need?
What type of incision do you want to do for a gingivectomy if you have minimal keratinized gingiva?
What type of incision do you want to do for a gingivectomy if you have plenty of keratinized gingiva?
If you're doing an gingivectomy and using the external bevel incision is there need for sutures or flap?
For regenerative procedures what two types of incisions do you want? What kind of flap?
Sulcular and midcrestal, Full thickness
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