Periodontal

Surgery
Surgical Procedures
• Gingivectomy
• Periodontal Flaps
• Osseous Contouring
• Bone Grafts
• Laterally Sliding Flap
• Free gingival Graft
Periodontal Flaps
• Increase access to root
• Reduce pocket depth
• Expose area for regeneration
• Crown lengthening
Horizontal Incision
VS
Vertical Incision
Incision Design
• Internal bevel
scalloped
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
1 of 16
Internal Bevel Scalloped
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
2 of 16
Correct
Incorrect
Vertical Incision
Vertical Releasing Incision
Bard Parker with
1. #15 Blade
2. #11 Blade
3. #12 Blade
4. #12B Blade
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
3 of 16
Full Thickness Flap
VS
Partial Thickness Flap
Full-Thickness Flap
Partial Thickness Flap
Full-Thickness (Mucoperiosteal Flap) Partial Thickness Flap
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
4 of 16
Full-Thickness Flap
6 months Post FTF - Bone Loss on Premolar
Conventional Flap Technique
Sulcular Incision
Repositioned Flap
VS
Apically Positioned
Flap
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
5 of 16
Apically Positioned Flap
Flap
Indications
Probing Beyond Mucogingival Junction
Surgical Crown Lengthening
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
6 of 16
Biologic Width
Restorative margin cannot
be placed closer than 2 mm
to crestal bone or will
disrupt attachment structure
Biologic Width
Expose 3-4 mm of tooth
coronal to bone during
surgery to accommodate 2
mm biologic width
Surgical Crown Lengthening
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
7 of 16
Primary Incision (Internal Bevel)
Primary Incision Primary Incision
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
8 of 16
Primary Incision - Flap Reflected
Secondary Incision
Buck or Orban Knives
Remove Interproximal Tissue
Full Thickness Flap Reflected Full Thickness Flap Reflected
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
9 of 16
Suturing Suturing
Interrupted Sutures
Interrupted Sutures
Coe Pack Placed
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
10 of 16
Dressing Removal Times
General Guidelines
Minimum - 3 to 4 days
Maximum - 7 to 10 days
Post-Surgical Hemorrhage
• Pressure
• Remove pack, sutures, clot
• Identify source/stop
bleeding
Chlorhexidine Rinses 4 Weeks Postoperative
Free Gingival
Grafting
Recession, no attached gingiva
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
11 of 16
Incision Partial Thickness Flap
Remove Keratinized Epithelium
Suture Alveolar Mucosa
Tin Foil Template on Donor Site
Donor Site Incision - Palate
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
12 of 16
Suture to Reflect Graft
Free Gingival Graft
Place Graft on Recipient Site
Place Coe Pack over Recipient Site
Donor Surgical Site
Coe Pack over Donor Site
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
13 of 16
10 Days Post Surgery Six Weeks Post Surgery
Pain
Management
A Flexible Analgesic Strategy
If aspirin-like drugs are indicated
Mild Pain 200 to 400 mg ibuprofen or 650 mg aspirin
Inadequate pain relief
600 to 800 mg ibuprofen
Inadequate pain relief
Moderate Pain
400 mg ibuprofen plus non-narcotic/narcotic
combination analgesic equivalent to 60 mg
codeine
Inadequate pain relief
Severe Pain
600 to 800 mg ibuprofen plus non-narcotic
combination analgesic equivalent to 10
oxycocodone
A Flexible Analgesic Strategy
If aspirin-like drugs are contraindicated
Mild Pain 650 to 1000 mg acetaminophen
Inadequate pain relief
Mod Pain
600 to 1000 mg acetaminophen and narcotic
equivalent to 60 mg codeine or hydrocodone
Inadequate pain relief
Severe Pain
1000 mg acetaminophen and narcotic equivalent
to 10 mg oxycocodone
Distal Wedge
Procedures
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
14 of 16
Types of
Incision
Design for
Distal
Wedge
Surgical
Procedures
Types of
Incision
Design for
Distal
Wedges
Surgical
Procedures
Distal - 2nd Molar - 7 mm Pocket
Distal Wedge - Diverging Incisions
Full-Thickness Flap Reflected
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
15 of 16
Flap Approximation
Flap Sutured
7 Days Post Surgery
Distal
Pocket
Elimination
Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota
16 of 16