What is the defining characteristic of an absolute contraindication for periodontal surgery, as opposed to a relative contraindication?
An absolute contraindication is a situation that makes a particular treatment absolutely inadvisable.
List three patient factors that could affect the outcomes of non-surgical periodontal treatment.
Patient factors include:
* oral hygiene
* smoking
* systemic disease
* compliance
* obesity/diet
* stress
* microbiology
What probing depth criteria might lead a clinician to consider periodontal surgery?
Surgery is considered when probing depths are:
* 7mm or greater
* 4-5 sites/mouth with 5-6mm pocket depths and BOP
* 1-2 sites per quadrant with 5-6mm pocket depths and BOP
What are the two main elements of the rationale for performing periodontal surgery?
The rationale of periodontal surgery is:
* accessibility
* visibility
What is the ultimate goal in periodontics regarding tissues lost due to disease?
The ultimate goal is to be able to regenerate periodontal tissues that were damaged by disease. The objectives for periodontal regeneration are to form:
* new cementum
* new functionally aligned periodontal ligament fibers
* new alveolar bone
List four specific indications for periodontal flap surgery.
Indications include:
* intra-bony defects
* irregular bony contours
* deep craters
* Grade II or III furcation involvement
* root resection/hemisection
* persistent inflammation in areas with moderate to deep pockets
Why is uncontrolled hypertension listed as a systemic condition that can be a relative contraindication for periodontal surgery?
A patient with uncontrolled severe hypertension would not be a candidate for periodontal surgery as long as the blood pressure remained severely elevated.
Why is a high risk for dental caries a relative contraindication for some types of periodontal surgery?
Some types of periodontal surgery result in exposure of portions of tooth roots. If the patient has uncontrolled dental caries risk, performing surgery that increases root exposure may be unwise due to the potentially devastating effect of root caries.
What three broad categories of surgical interventions are available?
The categories are:
* Access flap periodontal surgery
* Resective periodontal surgery
* Regenerative periodontal surgery
What is the formal definition of Guided Tissue Regeneration (GTR)?
GTR is the use of a barrier membrane, placed at the site of the defect to prevent ingress of certain cell types into the defect during healing, thereby allowing preferential colonization of the defect with progenitor cells derived from the PDL.
What is the primary objective of access flap surgery?
The main objective is to allow access to debride root surfaces.
What is the key disadvantage of the Modified Widman flap?
It is not indicated if osseous surgery is planned and cannot be used for full pocket removal.
What post-operative instruction regarding rinsing should patients follow in the first 24 hours after surgery?
Patients should not vigorously rinse or spit within the first 24 hours.
Why is compliance with self-performed oral hygiene so crucial prior to and following surgical periodontal treatment?
Proof-of-principle studies pointed to the negative effects (clinical attachment loss) of performing periodontal surgery in subjects with inadequate plaque control. The level of plaque control affects healing outcomes. Plaque scores smaller than 20%-25% have been consistently associated with better surgical outcomes.
When assessing the suitability of root resection as a treatment modality, what prognostic factors must be considered regarding the root structure?
Factors include:
* length of root trunk
* divergence between root cones
* length and shape of root cones
* fusion between roots
What is the procedure known as odontoplasty?
Odontoplasty is the reshaping of the tooth, such as enamel pearl smoothing.
What specific tissues must form for a procedure to meet the definition of periodontal regeneration?
Regeneration requires the reconstitution of:
* new cementum
* new functionally aligned periodontal ligament fibers
* new alveolar bone
What is the generally recommended interval for Supportive Periodontal Care (SPC) after periodontal surgery?
SPC every 3 months may be sufficient to control periodontitis progression after periodontal surgery. The recommended interval ranges from 2-4 times per year.
