Periodontal Surgery and GTR

Post operative care for periodontal surgery is important. The wound may be , this keeps the wound , controls , and maintains approximation of flaps or grafts.

The patient should be given post-operative advice in both and forms. In the first 24 hours;
- Avoid vigorous of mouth
- Avoid excessive or alcohol
- Prescribe
- at the surgical site is normal
- If bleeding lasts more than minutes seek help

After 24 hours;
- Rinse around site with mouthwash twice daily
- Clean other teeth as as possible to the surgical site

The goals of periodontal surgery include:

Thorough and smoothing of surfaces with vision
Reduce plaque areas, for example
Eliminate and pocket activity
Enhance of periodontal tissues
Create physiologic of marginal tissues and muco-gingival border

Gingivectomy is an example of periodontal surgery. It can be used for gingival , and over bony pockets. It can periodontal pockets and achieve good soft tissue .

An incision is made with a degree bevel angled towards the of the pocket. The incision is made totally within the gingiva. Following removal of gingival tissue, the root surfaces are and the gingival surface may be contoured ()

A periodontal may be placed over the wound for 7-14 days while it heals by intention.

Gingivectomy must not be carried out where the attached gingiva is , there are -bony pockets, or there is a need for recontouring.

Patients may experience post operative or recession, which in turn can predispose them to , caries, or poor .

Fully reflected flaps have the following advantages:

They give good of the surgical site - which aids decisions about recontouring, resection, the need for
incisions allow the flap to the replaced apically

Apically repositioned flaps are carried out in the following way:

1. A , inverse bevel incision is made - this releases epithelium and connective tissue from the flap
2. relieving incisions are made
3. incisions are made
4. The flap is
5. The separated pocket linings and connective tissue collar is
6. The are derided
7. The flap is replaced and sutured
8. A is placed, and the patient is booked in for after being given operative advice.

occasionally, but rarely, is indicated to remove non-supporting bone and improve bone architecture

A classic distal wedge excision is an example of periodontal surgery. It pockets distal to the last standing tooth/ standing teeth.

Classic distal wedge excision technique;
1. Incisions are made in a wedge that meets at the of the pocket
2. The second incisions and thin the buccal and lingual flaps
3. The flaps are and sutured, thus eliminating the pocket

A modified distal wedge excision is an example of a periodontal surgery to pockets.

The procedure is as follows:
1. shaped inverse bevel incision is made from the mid- surface to the mid- surface of the tooth. Then an incision is made
2. Wedge shaped incisions are made distally
3. a perpendicular incision is made
4. incisions are made to the flap and for reflection - the soft tissue is freed from the bone.
5. Flaps are
6. Coagulum fills the bony
7. Redundant tissue is removed with or electrosurgery - gingivectomy

Partially reflected flaps are an example of periodontal surgery. The aim is to the periodontal pocket with loss of tissue, not necessarily to pockets. They allow access to clean surfaces. The may also promote bony in the defect with some crystal resorption and an overall resultant in defect size. These procedures heal with long .

Partially reflected flaps to not go beyond the mucogingival line

A Modified Widman flap is carried out in the following way:

1. An inverse incision is made up to mm from the margin buccally and palatally to separate the pocket and inflamed connective from the flap
2. Intra- incisions are made, then a incision made to separate supracrestal pocket tissue
3. A thickness flap is reflected, but not beyond the line
4. Root surfaces are debrided with vision, and curettes used to tissue from interdental
5. Osseous defects are
6. Flaps are replaced over bone and teeth, and sutured. Ideally they should completely cover bone

Modified widman flaps are useful in segments where is important as they preserve soft and coverage. They do not pockets but pocket depths and heal by long , which is stable.

However, they can be highly sensitive and depend on the patient's potential. There is no attachment and may leave interdental craters.

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

GTR is carried out by placing a that excludes the oral cells and gingival connective tissue from and bone. This creates a around the cleaned root surface. This space is with cells that mature to form new ligament fibres which insert into . GTR can be used for bony pockets, or walled defects, defects and recession defects.

Types of bone grafts can include:

grafts - from the same individual
grafts - from the same species
grafts - from different species
bone substitutes