Periodontal Surgery and GTR

Gingivectomy is an example of what type of procedure?

The biological width is...

True or false: periodontal surgery is more effective than non surgical therapy for pockets less than 6mm

Check all the contraindications for periodontal therapy

Post operative care for periodontal surgery is important. The wound may be [blank_start]dressed[blank_end], this keeps the wound [blank_start]clean[blank_end], controls [blank_start]bleeding[blank_end], and maintains [blank_start]close[blank_end] approximation of flaps or grafts. The patient should be given post-operative advice in both [blank_start]verbal[blank_end] and [blank_start]written[blank_end] forms. In the first 24 hours; - Avoid vigorous [blank_start]rinsing[blank_end] of mouth - Avoid excessive [blank_start]exercise[blank_end] or alcohol - Prescribe [blank_start]analgesia[blank_end] - [blank_start]oozing[blank_end] at the surgical site is normal - If bleeding lasts more than [blank_start]20[blank_end] minutes seek help After 24 hours; - Rinse around site with [blank_start]chlorhexidine[blank_end] mouthwash twice daily - Clean other teeth as [blank_start]close[blank_end] as possible to the surgical site

The goals of periodontal surgery include: Thorough [blank_start]cleaning[blank_end] and smoothing of [blank_start]root[blank_end] surfaces with [blank_start]direct[blank_end] vision Reduce plaque [blank_start]retentive[blank_end] areas, for example [blank_start]pockets[blank_end] Eliminate [blank_start]inflammation[blank_end] and pocket activity Enhance [blank_start]regeneration[blank_end] of periodontal tissues Create physiologic [blank_start]morphology[blank_end] of marginal tissues and muco-gingival border

Examples of surgery for root coverage include...

Which procedure leaves soft tissue at the original level it was before surgery?

True or false? Modified Widman Flaps have no relieving incisions

True or false? Repair procedures result in replacement of lost periodontal ligament attachment

Gingivectomy is an example of [blank_start]resective[blank_end] periodontal surgery. It can be used for gingival [blank_start]enlargement[blank_end], and over [blank_start]supra[blank_end] bony pockets. It can [blank_start]eliminate[blank_end] periodontal pockets and achieve good soft tissue [blank_start]morphology[blank_end]. An incision is made with a [blank_start]45[blank_end] degree bevel angled towards the [blank_start]base[blank_end] of the pocket. The incision is made totally within the [blank_start]attached[blank_end] gingiva. Following removal of gingival tissue, the root surfaces are [blank_start]planed[blank_end] and the gingival surface may be contoured ([blank_start]gingivoplasty[blank_end]) A periodontal [blank_start]pack[blank_end] may be placed over the wound for 7-14 days while it heals by [blank_start]secondary[blank_end] intention. Gingivectomy must not be carried out where the attached gingiva is [blank_start]narrow[blank_end], there are [blank_start]infra[blank_end]-bony pockets, or there is a need for [blank_start]osseous[blank_end] recontouring. Patients may experience post operative [blank_start]pain[blank_end] or recession, which in turn can predispose them to [blank_start]sensitivity[blank_end], [blank_start]root[blank_end] caries, or poor [blank_start]aesthetics[blank_end].

Which of the following is a fully reflected flap?

Fully reflected flaps have the following advantages: They give good [blank_start]vision[blank_end] of the surgical site - which aids decisions about [blank_start]osseous[blank_end] recontouring, [blank_start]root[blank_end] resection, the need for [blank_start]grafts[blank_end] [blank_start]Vertical[blank_end] incisions allow the flap to the replaced apically

Apically repositioned flaps are carried out in the following way: 1. A [blank_start]scalloped[blank_end], inverse bevel incision is made - this releases [blank_start]pocket[blank_end] epithelium and [blank_start]inflamed[blank_end] connective tissue from the flap 2. [blank_start]Vertical[blank_end] relieving incisions are made 3. [blank_start]Intracrevicular[blank_end] incisions are made 4. The flap is [blank_start]reflected[blank_end] 5. The separated pocket linings and connective tissue collar is [blank_start]removed[blank_end] 6. The [blank_start]roots[blank_end] are derided 7. The flap is replaced [blank_start]apically[blank_end] and sutured 8. A [blank_start]dressing[blank_end] is placed, and the patient is booked in for [blank_start]review[blank_end] after being given [blank_start]post[blank_end] operative advice. occasionally, but rarely, [blank_start]osteoplasty[blank_end] is indicated to remove non-supporting bone and improve bone architecture

True or false; apically repositioned flaps have better aesthetics and post operative sensitivity than Modified Widman Flaps

True or false: Apically repositioned flaps are an example of resective periodontal surgery

Select the advantages of apically repositioned flaps

Select the indications for apically repositioned flaps

A classic distal wedge excision is an example of [blank_start]resective[blank_end] periodontal surgery. It [blank_start]eliminates[blank_end] pockets distal to the last standing tooth/[blank_start]lone[blank_end] standing teeth. Classic distal wedge excision technique; 1. Incisions are made in a [blank_start]triangular[blank_end] wedge that meets at the [blank_start]base[blank_end] of the pocket 2. The second incisions [blank_start]undermine[blank_end] and thin the buccal and lingual flaps 3. The flaps are [blank_start]repositioned[blank_end] and sutured, thus eliminating the pocket

A modified distal wedge excision is an example of a [blank_start]resective[blank_end] periodontal surgery to [blank_start]eliminate[blank_end] pockets. The procedure is as follows: 1. [blank_start]Crescent[blank_end] shaped inverse bevel incision is made from the mid-[blank_start]buccal[blank_end] surface to the mid-[blank_start]palatal[blank_end] surface of the tooth. Then an [blank_start]intracrevicular[blank_end] incision is made 2. Wedge shaped [blank_start]parallel[blank_end] incisions are made distally 3. a perpendicular incision is made 4. [blank_start]Undermining[blank_end] incisions are made to [blank_start]thin[blank_end] the flap and for reflection - the soft tissue [blank_start]wedge[blank_end] is freed from the bone. 5. Flaps are [blank_start]sutured[blank_end] 6. Coagulum fills the bony [blank_start]crater[blank_end] 7. Redundant tissue is removed with [blank_start]scalpel[blank_end] or electrosurgery - [blank_start]contouring[blank_end] gingivectomy

Surgical removal of all or part of the root of a multi-rooted tooth is an example of...

Hemisection differs from root resection in what way?

Reparative surgical techniques include

Partially reflected flaps are an example of [blank_start]reparative[blank_end] periodontal surgery. The aim is to [blank_start]heal[blank_end] the periodontal pocket with [blank_start]minimal[blank_end] loss of tissue, not necessarily to [blank_start]eliminate[blank_end] pockets. They allow access to clean [blank_start]root[blank_end] surfaces. The may also promote bony [blank_start]infill[blank_end] in the defect with some crystal resorption and an overall resultant [blank_start]reduction[blank_end] in defect size. These procedures heal with long [blank_start]junctional[blank_end] [blank_start]epithelium[blank_end]. Partially reflected flaps to not go beyond the mucogingival line

A modified widman flap is an example of a...

A Modified Widman flap is carried out in the following way: 1. An inverse [blank_start]bevel[blank_end] incision is made up to [blank_start]1[blank_end]mm from the [blank_start]gingival[blank_end] margin buccally and palatally to separate the pocket [blank_start]epithelium[blank_end] and inflamed connective [blank_start]tissue[blank_end] from the flap 2. Intra-[blank_start]crevicular[blank_end] incisions are made, then a [blank_start]horizontal[blank_end] incision made to separate supracrestal pocket tissue 3. A [blank_start]full[blank_end] thickness flap is reflected, but not beyond the [blank_start]mucogingival[blank_end] line 4. Root surfaces are debrided with [blank_start]direct[blank_end] vision, and curettes used to [blank_start]remove[blank_end] tissue from interdental [blank_start]craters[blank_end] 5. Osseous defects are [blank_start]curetted[blank_end] 6. Flaps are replaced over bone and teeth, and sutured. Ideally they should completely cover [blank_start]interdental[blank_end] bone

Select all the indications for partially reflected flaps

Modified widman flaps are useful in [blank_start]anterior[blank_end] segments where [blank_start]aesthetics[blank_end] is important as they preserve soft [blank_start]tissue[blank_end] and [blank_start]root[blank_end] coverage. They do not [blank_start]eliminate[blank_end] pockets but [blank_start]reduce[blank_end] pocket depths and heal by long [blank_start]junctional epithelium[blank_end], which is stable. However, they can be highly [blank_start]technique[blank_end] sensitive and depend on the patient's [blank_start]healing[blank_end] potential. There is no [blank_start]new[blank_end] attachment and may leave interdental craters.

Select all the non-resorbable membranes for GTR

Enamel matrix derivative, GTR, grafting techniques, are all examples of what type of periodontal surgery?

Conventional flap therapy results in [blank_start]apical[blank_end] migration of epithelial cells and healing by long [blank_start]junctional[blank_end] [blank_start]epithelium[blank_end] attaching on to root surface. This does not mimic the original [blank_start]periodontal[blank_end] attachment. Guided tissue regeneration aims to reorganise migration of cells so cells from the [blank_start]periodontal[blank_end] [blank_start]ligament[blank_end] are able to [blank_start]proliferate[blank_end] into a healing site, resulting in a reformed periodontium rather than a repaired one.

True or false: GTR can be used for 1 walled bony defects

True or false: GTR can be used for recession defects

True or false: GTR can be used to aid implant placement

GTR is carried out by placing a [blank_start]membrane[blank_end] that excludes the oral [blank_start]epithelial[blank_end] cells and gingival connective tissue from [blank_start]tooth[blank_end] and bone. This creates a [blank_start]space[blank_end] around the cleaned root surface. This space is [blank_start]repopulated[blank_end] with cells that mature to form new [blank_start]periodontal[blank_end] ligament fibres which insert into [blank_start]bone[blank_end]. GTR can be used for [blank_start]infra[blank_end] bony pockets, [blank_start]2[blank_end] or [blank_start]3[blank_end] walled defects, [blank_start]furcation[blank_end] defects and recession defects.

Types of bone grafts can include: [blank_start]Auto[blank_end]grafts - from the same individual [blank_start]Allo[blank_end]grafts - from the same species [blank_start]Xeno[blank_end]grafts - from different species [blank_start]Synthetic[blank_end] bone substitutes

An infra-bony pocket base is...

Supra bony pockets are an example of

Choose the 2 walled defect

Choose the F1 furcation defect

A "B" furcation defect has...

Which of the following is a contraindication for hemisection

A "tunnel" preparation can be provided for treatment of...

True or false: peri-implant mucositis is an irreversible condition

You should carry out pocket depth charting around an implant

True or false: peri-implantitis has no associated bone loss

True or false; you must never probe around an implant as this can damage the connective tissue

True or false: implants should be cleaned with the same instruments as you would clean a natural tooth

Peri-implantitis can be treated with non surgical periodontal therapy