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Periodontics pt. 2 (Surgical Therapy (Goals of Management (Clean and…
Periodontics pt. 2
Surgical Therapy
Goals of Management
Clean and maintainable dentition, restorations, prostheses
Effective plaque control technique, routines
Elimination / control of systemic conditions, risk factors
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Techniques:
Resective approach
Pocket Elimination
- Gingivectomy
- Apically repositioned flap
Access Flap
- Modified Widman flap
- Kirkland flap
At 5 years post-intervention, the difference between modalities is for PD/CAL negligible (ie SRP < MWF < ARF)
- bone regeneration occurs indefects
- molar sites and furcations benefit from surgery
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Mucogingival Therapy
Definition:
correction of defects, morphology/position/amount of soft tissues and bone supporting teeth or implants
Examples of Mucogingival Therapy:
- Gingival augmentation
- Root coverage
- Correction of mucosal defects at implants
- Crown lengthening
- Gingival preservation at ectopic tooth eruption
- Removal of aberrant frenulum
- Prevention of RRR associated with extraction
- Augmentation of the edentulous ridge
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Surgical Techniques
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Mucograft
- 3D collagen matrix
- enhances the width of KT + recession coverage
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Biologic Width
Definition:
Functional unit consisting of the junctional epithelium, gingival sulcus, & connective tissue attachment
It is a relative constant (eruption/post eruption) and its damaged by restorative dentistry
- Deep caries
- Deep Crown preps
- Overhangs
- Fractures
- Perforations
- Transient Injuries (retraction cord, impressions, electro, scaling, probing)
After violation the new biologic width will be restore apically with bone loss and recession of attachement
Crown Lengthening
Indications
- Short clinical crown
- Poor retentive form
- Assist in developing the ferrule effect
- Caries that violate the biologic width
- Crown fracture
- External root resorption
- Subgingival restoration margins
- Gummy smile
- Perforations
Considerations
- Pt selection
- Crown to root ratio
- Furcation location
- Esthetics
- Anterior will cause loss of gingiva in the interproximal and make it more triangle
- Mobility
Techniques
- Gingivectomy (remove tissue)
- Biologic width not violated
- Removal of gingival tissue above base of pocket
- Apically Positioned Flap (moving tissue)
- pocket reduction/crown lengthening
- Elevated beyond MGJ
