Corrective phase of periodontal therapy Surgical phase Dr

Corrective phase of periodontal therapy (Surgical phase) Dr. Kadhim Jawad 1

Surgical phase may include: 1 - Periodontal surgeries. 2 - Osseous surgery. 3 - Bone grafting. 4 - Mucogingival surgery. Dr. Kadhim Jawad 2

Objectives of P. S 1. Surgical elimination of periodontal pocket. 2. Access creation for proper scaling and root planning. 3. Establishing gingival morphology that facilitate the self performed plaque control measures. 4. May aim at the regeneration of periodontal attachment loss due to P. D. Dr. Kadhim Jawad 3

Types of periodontal surgery: A - Curettage. B - Gingivoplasty & gingivectomy. C - Surgical flaps. Dr. Kadhim Jawad 4

A –Curettage: It was extensively used in past to remove the lining of periodontal pockets but it is very difficult to be mastered & no longer be used nowadays. Dr. Kadhim Jawad 5

A –Curettage: Dr. Kadhim Jawad 6

B – Gingivoplasty. gingivectomy. Goldman gingivectomy procedure: Dr. Kadhim Jawad 7

GIVING LOCAL ANASTHETIC AGENT Dr. Kadhim Jawad 8

Determination of the bleeding points by using the pocket depth marker. Dr. Kadhim Jawad 9

Primary beveled incision, which carried out according to the bleeding points Dr. Kadhim Jawad 10

Secondary incision to separate the inter -proximal soft tissues form the interdental periodontium. Dr. Kadhim Jawad 11

Careful removal of the incised tissues Dr. Kadhim Jawad 12

Direct scaling & root planing Dr. Kadhim Jawad 13

Adjustment of the gingival contour Dr. Kadhim Jawad 14

Dressing of the wound for (7 - 10 days). Dr. Kadhim Jawad 15

Dressing removal & polishing. Dr. Kadhim Jawad 16

C - Flaps in periodontal surgery: 1 - Replaced flap. 2 - Repositioned flaps. 3 - Retromolar flap operation (Distal wedge). 4 - Modified widman flap. Dr. Kadhim Jawad 17

1 - Replaced flaps. They are called so because they are re- sutured in their original positions Dr. Kadhim Jawad 18

Initial incision through marginal gingiva Dr. Kadhim Jawad 19

Flap reflection , tissue removal & thorough scaling. Dr. Kadhim Jawad 20

The flap is sutured to its original position Dr. Kadhim Jawad 21

2 - Repositioned flaps Apically , Laterally & coronally Dr. Kadhim Jawad 22

Apically repositioned flap Dr. Kadhim Jawad 23

3 - Retromolar flap operation (Distal wedge) Dr. Kadhim Jawad 24

4 - Modified widman flap Dr. Kadhim Jawad 25

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2 - Osseous surgery They are either Osteoplasty as: 1 - Thinning of a thick osseous ledge. 2 - Establishing of a scalloped pattern of buccal or lingual surfaces of alveolar bone. 3 - Elimination of bone walls of a circumferencial osseous defect. Or Osteoectomy, which means removal of large amounts of bone. Dr. Kadhim Jawad 31

Osseous surgery carried out with special instruments: Dr. Kadhim Jawad 32

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3 - Bone grafting. Dr. Kadhim Jawad 35

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Sever bone loss adjacent to a tooth need to be a bridge abutment Dr. Kadhim Jawad 38

Harvesting bone by the hand trephine. Dr. Kadhim Jawad 39

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After seven months Dr. Kadhim Jawad 41

4 - Mucogingival surgeries we have two main types of muco gingival surgery: 1 - Vestibular extenuation procedures. 2 - Transplantation of gingiva & palatal mucosa that may be either, free gingival graft or pedicle graft e. g. laterally repositioned flap. Dr. Kadhim Jawad 42

1 - Vestibular extenuation procedures. Dr. Kadhim Jawad 43

2 - Transplantation of gingiva & palatal mucosa Dr. Kadhim Jawad 44

Instruments for gingival grafts hand mucotomes Dr. Kadhim Jawad 45

Instruments for gingival grafts motor-driven mucotomes Dr. Kadhim Jawad 46

Graft harvesting Dr. Kadhim Jawad 47

Graft in its recipient site with or without suturing Dr. Kadhim Jawad 48

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Suturing in Periodontology: 1 - Interrupted inter dental suture. 2 - Suspensory suture. 3 - Continuous. Dr. Kadhim Jawad 50

Periodontal dressing: used for: 1 - To protect the wound during healing. 2 - T o maintain close adaptation of the flap to the underlying bone. 3 - To provide more patient comfort. 4 - To prevent post operative bleeding. 5 - To prevent formation of excessive granulation tissues. Dr. Kadhim Jawad 51

Types of dressing: Euginol dressing: contains ZOE powder base with euginol liquid. e. g. Wonder pack. Non euginol dressing : supplied in two tubes or ready made jars. e. g. Coe- pak & Peripac. Dr. Kadhim Jawad 52

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