PERIODONTAL SURGERY: Dr. Kristina Corazon L.
Robles
PROTOCOL & ARMAMENTARIUM MScD Periodontology and Implant Dentistry
CEU GRADUATE SCHOOL
MAIN OBJECTIVES OF
PERIODONTAL SURGERY
1. to contribute to the longterm preservation of the periodontium through
facilitating plaque removal and infection control by:
Creating accessibility for proper professional scaling and root planning
Establishing a gingival morphology which facilitates selfperformed
infection control
2. to regenerate the periodontal attachment lost due to destructive disease
INDICATIONS FOR SURGICAL TREATMENT
1. Impaired access for scaling and root planing
(+) Inflammation
(+) BOP on subgingival area
6 mm Probing depth
The presence of subgingival
deposits should be suspected
INDICATIONS FOR SURGICAL TREATMENT
If not resolved by repeated
subgingival instrumentation,
surgical treatment should be
performed to expose the root
surfaces for proper cleaning.
INDICATIONS FOR SURGICAL TREATMENT
2. Impaired access for selfperformed plaque control
Pronounced gingival hyperplasia and presence of gingival craters
GOALS OF THE TREATMENT
1. No sub or supragingival dental deposits
2. No pathologic pockets (no BOP to the bottom of the pockets)
3. No plaqueretaining aberrations of gingival morphology
4. No plaqueretaining parts of restorations in relation to the
gingival margin.
INDICATIONS FOR PERIODONTAL SURGERY
1. Accessibility for proper root debridement
2. Establishment of a morphology of the dentogingival area conducive to infection
control
3. Pocket depth reduction
4. Correction of gross gingival aberrations
5. Shift of the gingival margin to a position apical to plaqueretaining restorations
6. Facilitation of proper restorative therapy
7. Aesthetics
CONTRAINDICATIONS FOR PERIODONTAL
SURGERY
1. Patient non-cooperation
Optimal post-operative infection
control is decisive for the success of the
treatment.
A patient who fails to cooperate during
the causerelated phase of therapy
should not be exposed to surgery
CONTRAINDICATIONS FOR PERIODONTAL
SURGERY
2. Smoking - less resolution of probing pocket depth, smaller
improvement in clinical attachment, and less bone regeneration
might occur in smokers than in nonsmokers
CONTRAINDICATIONS FOR PERIODONTAL
SURGERY
2. General health conditions - reevaluate the patients
medical history before any surgical intervention. Consultation
with the patients physician should also be considered
LOCAL ANESTHESIA IN PERIODONTAL SURGERY
Anesthetics from the chemical group amino amides
- lidocaine, mepivacaine, prilocaine, and articaine
- More potent, less allergenic
- GOLD STANDARD
TECHNIQUES
Anesthesia for periodontal surgery is obtained by nerve block and/or by local
infiltration.
Local infiltration may have a greatly decreased rate of success ( tissue pH tends to
be low in inflamed areas and anesthetic solutions are less potent at low pH)
In cases of flap surgery, complete anesthesia must be attained before commencing
the operation, as it may be difficult to supplement the anesthesia after the bone
surface has been exposed.
LOCAL ANESTHESIA IN THE MANDIBLE
LOCAL ANESTHESIA IN THE MAXILLA
INSTRUMENTS USED IN PERIODONTAL SURGERY
Incision and excision (periodontal knives)
Deflection and readaptation of mucosal flaps (periosteal elevators)
Removal of adherent fibrous and granulomatous tissue (soft tissue rongeurs and
tissue scissors)
Scaling and root planing (scalers and curettes)
Removal of bone tissue (bone rongeurs, chisels, and files)
Root sectioning (burs)
Suturing (sutures and needle holders, suture scissors)
Application of wound dressing (plastic instruments).
Standard Instrument Tray
Mouth mirrors
Dental anesthetic syringe
Graduated periodontal
probe/explorer
Handles for disposable surgical
blades (e.g. Bard
ParkerR handle)
Mucoperiosteal elevator and
tissue retractor
Scalers and curettes
Cotton pliers
Tissue pliers (ad modum Ewald)
Tissue scissors
Needle holder
Suture scissors
Plastic instrument
Hemostat
Burs
PERIODONTAL PROBE
Williams Graduated CPITN UNC-15 Goldman Fox Naber
GRACEY CURETTES
SURGICAL INSTRUMENTS
KNIVES fixed blade versions
Kirkland 15/16
Orban
Waerhaug 1/2
SURGICAL INSTRUMENTS
KNIVES Disposable blades
No. 11, No. 12, No. 12D, No. 15, and No. 15C. Universal 360 handle
SURGICAL INSTRUMENTS
Scalers and curettes
Curette SG 215/16C Syntette
Sickle 215216 Syntette
minicurette SG 215/16MC
SURGICAL INSTRUMENTS
Set Of Burs Useful In
Periodontal Surgery
The rotating finegrained diamond stones may
be used for debridement of infrabony
defects.
The round burs are used for bone
recontouring.
ULTRASONIC DEVICE
INSTRUMENTS FOR BONE REMOVAL
Instruments Used For Bone Recontouring
Bone chisels Ochsenbein No.
1 and 2 (Kirkland 13K/13KL)
Bone chisel Ochsenbein No. 3
Schluger curved file No. 9/10.
INSTRUMENTS
FOR HANDLING FLAPS
Periosteal Elevators -
For Optimal Visibility
INSTRUMENTS FOR HANDLING FLAPS
RETRACTORS
TISSUE FORCEPS
ADDITIONAL EQUIPMENT
Sterile Physiologic Saline
For rinsing and moistening the field of operation;
For cooling when burs are employed
ADDITIONAL EQUIPMENT
Aspirator Tip
- Visibility in the field of
operation
OPERATOR
PROPER SURGICAL ATTIRE
PATIENT
STERILITY and PROTECTION
SOURCE
THANK YOU!
