Escolar Documentos
Profissional Documentos
Cultura Documentos
periodontal surgery
Pocket reduction
- Enhance maintenance by patient and therapist
- Improve long term stability
Patient convenience
Operation
Patient preparation*
RIGHT
ANGLE
INCISION
SULCULAR INCISION
INTERNAL BEVEL
INCISION
Flap preparation
Partial thickness*
Flap design
Based on the principle of maintaining an optimal blood
supply to the tissue
2 basic flap designs
– those with vertical releasing incisions
- without vertical releasing incisions
Alterations in gingival circulation resulting from various
periodontal flap designs were studied in humans, the
major blood supply to flap was found to exist at its base
traveling in apical coronal direction
Monsel’s solution
Ferric sulphate 20% ferric Astringent and
subsulfate protein precipitate
sealing blood
vessels ; irratating
to wound
Bone wax
Bone wax, Pressed into
semisynthetic nutient canal
bees wax and mechanical plug
isopropyl palmiate
Post operative bleeding – direct pressure on the flaps for
5 min , if bleeding persists use of hemostatic agents
Suturing materials and techniques
A suture is a strand of material used to ligate blood
vessels and to approximate tissues together
Absorbable
Non – absorbable
Monofilamentous
Multifilamentous
Natural
Synthetic
Absorbable suture
Studies
Disadv- expensive
Suture material Indication
Non absorbable Generalized purpose used in
1) Surgical silk keratinized tissue
2) expanded polytetra-
fluoroethylene GTR
Absorbable
Catgut:-
1) Surgical gut (plain)
2) Surgical gut (chromic) General purpose (gingiva
Synthetic fiber:- and mucosa)
1) Polyglactin 910 (coated
vicryl)
2) Polyglecaprone
(monocryl)
Multi filament versus monofilament
Several filaments ,twisted Single strand of material
or braided together
The eye
- Closed or swaged
- Shape of the eye round, oblong or square
- Eyed needles g traumatic needles
- Swaged suture g Atraumatic needles
The body
Widest point of the needle and is referred to as grasping
area
Cross – sectional configuration of the body may be
round, oval, side flattened rectangular, triangular or
trapezoidal
Point
Or the tip can be conventional or reverse cutting
The tip can be cutting, round or blunt
They are triangular in cross- section
Suturing
1) Maintains Hemostasis
2) Permits healing by primary intention
3) Reduces postoperative pain
4) Permits proper flap position
5) Prevents bone exposure resulting in delayed healing
and unnecessary resorption
Principles of suturing
Suture techniques
1) Interrupted Closure of vertical releasing
incisions and interproximal
areas replaced and coronally
positioned flap closure
2) Sling
Allows separate facial or
lingual flap positioning in
isolated areas
5) External mattress
Reduces amount of suture
under the flap, allows papilla
closure over osseous grafts
without the suture running
through the graft , enhances
positioning of papilla
6) Vertical Narrower interdental spaces
Uses
1) To protect wound post surgically
2) To obtain and maintain a close adaptation of the
mucosal flaps to the underlying bone (especially when
a flap has been apical repositioned)
3) For comfort of patient
Properties of periodontal dressings
- Zinc oxide packs mixed with eugenol or non eugenol liquids on wax
paper pad with wooden spatula or tongue depressor. Powder is
gradually incorporated into liquid, until thick paste formed
- 2-3 min paste looses tackiness, 3-5 min can be handled and
molded. Remains workable 15-30 min
The mix than rolled into 2 straight strips
End of 1 strip is rolled and bent to hook shaped to fit around the
distal surface remainder brought over facial surface and nicely
adapted to gingival margin area and interproximal area