Periodontal Surgery – Specialized surgical instruments are utilized in periodontal surgery. Surgical instruments and materials may be classified in the following manner:
• Excisional and incisional instruments
• Surgical curettes and sickles
• Periosteal elevators
• Surgical chisels and hoes
• Surgical ifies
• Scissors and nippers
• Pocket-puncturing forceps
• Periodontal dressings
• Suture materials and needles.
EXCISIONAL AND INCISIONAL INSTRUMENT
These instruments are used for excision and incision of the gingival and related tissues during the periodontal surgery. Common excisional and incisional instruments include the following:
Periodontal Surgery Knives
The most common periodontal knife used for a gingivectomy is the Kirkland knife. It is a kidney- shaped knife with the entire outer border being the cutting edge. It is available in both single- ended and double-ended designs.
The Orban knife and the Merrifield knife are the most commonly used knives for interdental areas. These knives are spear-shaped and are available with single bends or two bends. They have a cutting edge on both sides of the blade and are available in both single-ended and double-ended designs.
The disposable Scalpel blades come in various shapes and sizes. The most commonly used scalpel blades are manufactured by Bard-Parker.
Electrosurgery is sometimes performed on soft tissue. The controlled high-frequency current that is used, exerts a hemostatic effect.
• Osseous resective Periodontal Surgery
• Periodontal Surgery regeneration procedures.
The choice of surgical techniques depends upon the periodontal condition of the patient and its severity.
Gingival curettage is the scraping and debridement of the soft tissue lining of a periodontal pocket. This procedure contributes to the healing process by removing tissue debris and bacterial penetration, and by eliminating barriers to new attachment or reattachment.
Gingivectomy is the excision of the gingival wall of a pocket (the entire free gingiva). The objective of a gingivectomy is pocket elimination through removal of the suprabony pocket or gingival pocket. This procedure also provides access to the tooth surface and promotes healing.
A gingivectomy is contraindicated in areas where there is not enough attached gingiva or if there are frenum attachment problems or other underlying bone problems that must be addressed.
Periodontal Surgery FLAP
Periodontal Surgery flap procedures involve surgical separation of a section of gingiva and/or mucosa from the underlying tissues in order to provide visibility of and access to the bone and/or root surface.
The objectives of Periodontal Surgery flap procedures are to provide access for root preparation, eliminate pockets that extend to or beyond the mucogingival junction, preserve or create an adequate zone of attached gingiva, and permit access to underlying bone for treatment of osseous defects.
Flap types. There are two types of flaps:
1. Full-thickness flap (also called a mucoperiosteal flap). All of the soft tissue (including the periosteum) is reflected to expose the underlying bone. This procedure is indicated for bone Periodontal Surgery.
2. Partial-thickness flap (also called a mucosal flap). The soft tissue is reflected, but a layer of soft tissue is left covering the bone. This procedure is done by sharp dissection with a surgical knife.
These procedures involve graft material being placed into a bony defect. There are several functions of the grafting materials.
• Osteoconduction. The graft acts as a pattern or trellis to assist in bone formation.
• Osteoinduction. The graft acts to induce (stimulate) new bone formation.
• Osteogenesis. The cells of the graft actually produce new bone.
There are several types of grafts:
• Free osseous autograft. Bone from elsewhere in the patient’s body (harvested from an area in the mouth or other body area such as the hip bone).
• Allo graft. Freezed-dried frozen bone from another individual.
• Alloplastic graft. Synthetic substances.
• Composite grafts. Combination of autograft material and either allograft or alloplastic material used as an extender.
The type of surgical intervention selected for mucogingival problems depends on the type of defect. The objectives for mucogingival Periodontal Surgery are to establish an adequate width or thickness of attached gingiva, eliminate pull on the free gingival margin by frena or muscle attachments, cover gingival clefts or recession, and establish new gingival attachment at a more coronal level.
Indications for mucogingival Periodontal Surgery include the following.
• Gingival recession
• Frenal pulls
• Exposed root surfaces
• Inadequate zone of attached gingiva.
For the successful and satisfactory completion of the Periodontal procedure, postoperative care is of utmost importance. Instructions should be given to the patient after Periodontal Surgery, which should include the following topics:
- Post operative discomfort.
- Periodontal dressings (how long they should remain on the area and what to do if they come off).
- No smoking (this slows down the healing).
- Oral hygiene instructions.
- Physical activity.
- Swelling and bleeding (what is normal and when to call).
- Medications (those given for pain, infection, or swelling).
- Patients should always be reminded to call the dental office if problems occur.
Most Common Problems
The most common problems occurring after periodontal surgery are:
• Persistent bleeding.
• Loose (or lost) dressings.
• Infection and swelling.
If everything goes fine the patient is called for postoperative visit one week after Periodontal Surgery. During that visit, the periodontal dressings are removed, sutures are removed, and the area is examined but not probed. Additional treatment is decided on a case-by-case basis. The patient is given instructions regarding proper oral hygiene methods.
It is very important that the patient must be motivated to maintain a high degree of oral hygiene for adequate plaque-control. One should always need to remind that the patient is the one who cares for his or her mouth on a daily basis, and no degree of professional care can make up for poor daily oral hygiene care.