Periodontal surgery

Last updated

Periodontal surgery is a form of dental surgery that prevents or corrects anatomical, traumatic, developmental, or plaque-induced defects in the bone, gingiva, or alveolar mucosa. [1] The objectives of this surgery include accessibility of instruments to root surface, elimination of inflammation, creation of an oral environment for plaque control, periodontal diseases control, oral hygiene maintenance, maintain proper embrasure space, address gingiva-alveolar mucosa problems, and esthetic improvement. [1] The surgical procedures include crown lengthening, frenectomy, and mucogingival flap surgery. [2] [3] [4]

Contents

Indications

Contraindications

Some contraindications include: [2] [5]

Considerations

Surgical procedures

Crown lengthening  

Crown lengthening is a technique for increasing crown height of teeth by flap surgery with or without bone surgery. [3] There are two main types:

  1. Aesthetic crown lengthening which is performed when a “gummy” smile is an issue for the patient [3]
  2. Functional crown lengthening is used to make an unrestorable tooth restorable. For example, a tooth with caries that extends below the gums may undergo crown lengthening so that the caries is no longer below the gums and a crown may be placed. [3]

Contraindications

Untreated or unstable gum disease (periodontal disease) and gingival phenotype [4]

Considerations

  • Strategic value of tooth
  • Crown/root ratio that will remain following surgery
  • Aesthetics will be affected such as longer clinical crowns and loss of interdental papillae leading to “black triangles”
  • It can result in exposure of furcations
  • Mobility of teeth
  • Post-op sensitivity due to root dentine exposure
  • Patient may need long-term treatment until gingival margin stabilised (3–6 months).
  • Patient must also be made aware prior to surgery that relapse is possible

Method

There are three main methods for surgical crown lengthening: [6]

  • Gingivectomy
  • Apically repositioned flap (APF) surgery
  • Apically repositioned flap (APF) with osseous reduction (osteoplasty/ostectomy)

Frenectomy

Frenectomy is indicated by thick, prominent muscle attachments known as fraena or a frenum with close attachment to the gum margin. Thick frenum attachment or close attachment to gum margin can contribute to increased plaque accumulation, persistent inflammation, muscular pull on gum and affect gum contour. [6]

Usual sites for frenectomy are buccal regions of upper and lower incisors, upper canines and premolars. Frenectomy is rarely required for lingual sites. [6]

Procedure

Frenectomy procedure consists of: [6]

  • Cutting the attachment of the frenum to the gums
  • Administering local anaesthetic
  • Stretching the lip and gripping the frenum with forceps
  • Cutting through base of frenum on both sides of forceps
  • Incision on alveolar side near to bone leaving the periosteum intact.
  • Removal of the frenal tissue and suturing the edges of the wound closely with resorbable sutures
  • Placing Swabs over the wound
  • The patient is instructed to rinse twice daily with chlorohexidine mouthwash.

Mucogingival flap surgery

Mucogingival surgery is a procedure where the gums are separated from teeth and temporarily folded back to allow the dentist to directly view and reach root surface of the tooth and bone. It is used for crown lengthening surgery. It also, if required, can be used for guided tissue regeneration [2] or open flap debridement (OFD) to treat gum disease (periodontitis/periodontal disease). The presence of bacteria, in the form of dental plaque/tartar/calculus on the root of a tooth, can cause inflammation of the gums resulting in gum disease. This can lead to bone loss around the affected teeth and if left untreated, lead to tooth loss. [7] When a tooth has very deep periodontal pockets it may not be possible to fully remove the dental plaque/tartar/calculus from the tooth’s root surface with scaling alone. In open flap debridement (OFD) the gum is peeled back to make it possible for the dentist to see and ensure full removal of tartar/calculus from these difficult to access areas. [7] Teeth with furcation defects as a result of gum recession may require open flap debridement (OFD) as these areas can be very difficult to clean. [7]

Mucogingival flaps thickness

Full thickness flap involves incision down to bone. Using blunt dissection, the flap is raised from bone. Full thickness flap is a simple procedure which provides access to root surface and bone. The procedure leaves minimal post-operative discomfort. It provides limited mobility of flap and is unsuitable for grafting. [6] [2]

Split thickness flap involves sharp cutting of tissues and leaving the underlying periosteum intact. The procedure prevents exposure dehiscence and allows good blood supply for grafting. It does not provide access to underlying bone or root surface and results in greater post-operative discomfort. [6]

Related Research Articles

<span class="mw-page-title-main">Periodontal disease</span> Medical condition

Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen and red and may bleed. It is considered the main cause of tooth loss for adults worldwide. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out. Bad breath may also occur.

<span class="mw-page-title-main">Gums</span> Human mouth anatomy

The gums or gingiva consist of the mucosal tissue that lies over the mandible and maxilla inside the mouth. Gum health and disease can have an effect on general health.

<span class="mw-page-title-main">Dental surgery</span>

Dental surgery is any of a number of medical procedures that involve artificially modifying dentition; in other words, surgery of the teeth, gums and jaw bones.

Periodontology or periodontics is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament. A periodontist is a dentist that specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants.

<span class="mw-page-title-main">Veterinary dentistry</span> Branch of veterinary medicine

Veterinary dentistry is the field of dentistry applied to the care of animals. It is the art and science of prevention, diagnosis, and treatment of conditions, diseases, and disorders of the oral cavity, the maxillofacial region, and its associated structures as it relates to animals.

<span class="mw-page-title-main">Gingival recession</span>

Gingival recession, also known as gum recession and receding gums, is the exposure in the roots of the teeth caused by a loss of gum tissue and/or retraction of the gingival margin from the crown of the teeth. Gum recession is a common problem in adults over the age of 40, but it may also occur starting in adolescence, or around the age of 10. It may exist with or without concomitant decrease in crown-to-root ratio.

<span class="mw-page-title-main">Crown lengthening</span>

Crown lengthening is a surgical procedure performed by a dentist, or more frequently a periodontist, where more tooth is exposed by removing some of the gingival margin (gum) and supporting bone. Crown lengthening can also be achieved orthodontically by extruding the tooth.

<span class="mw-page-title-main">Gingival and periodontal pocket</span>

Gingival and periodontal pockets are dental terms indicating the presence of an abnormal depth of the gingival sulcus near the point at which the gingival tissue contacts the tooth.

<span class="mw-page-title-main">Scaling and root planing</span> Dental procedure

Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is a procedure involving removal of dental plaque and calculus and then smoothing, or planing, of the (exposed) surfaces of the roots, removing cementum or dentine that is impregnated with calculus, toxins, or microorganisms, the agents that cause inflammation. It is a part of non-surgical periodontal therapy. This helps to establish a periodontium that is in remission of periodontal disease. Periodontal scalers and periodontal curettes are some of the tools involved.

Gingivectomy is a dental procedure in which a dentist or oral surgeon cuts away part of the gums in the mouth.

A gum lift is a cosmetic dental procedure that raises and sculpts the gum line. This procedure involves reshaping the tissue and/or underlying bones to create the appearance of longer or symmetrical teeth, thereby making the smile more aesthetically pleasing. This procedure is typically done to reduce excessively gummy smiles or to balance out an asymmetrical gum line. The procedure, also known as crown-lengthening, has historically been used to treat gum disease. It is only within the past three to five years that dentists have commonly used this procedure for aesthetic purposes. The practice of cosmetic gum lifts was first developed in the late 1980s, but there were few oral surgeons and dental practitioners available to perform the procedures. Gum lifts can also include bone shaping to reduce the prominence of the upper jaw and even out the tooth and gum ratio. This method provides permanent results, while simple gum contouring may result in relapse or regrowth of the gingiva.

Guided bone regeneration (GBR) and guided tissue regeneration (GTR) are dental surgical procedures that use barrier membranes to direct the growth of new bone and gingival tissue at sites with insufficient volumes or dimensions of bone or gingiva for proper function, esthetics or prosthetic restoration. Guided bone regeneration typically refers to ridge augmentation or bone regenerative procedures; guided tissue regeneration typically refers to regeneration of periodontal attachment.

<span class="mw-page-title-main">Gingivitis</span> Inflammation of the gums

Gingivitis is a non-destructive disease that causes inflammation of the gums. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms that is attached to tooth surfaces, termed plaque-induced gingivitis. Most forms of gingivitis are plaque-induced.

<span class="mw-page-title-main">Debridement (dental)</span> Removal of plaque and calculus from teeth

In dentistry, debridement refers to the removal by dental cleaning of accumulations of plaque and calculus (tartar) in order to maintain dental health. Debridement may be performed using ultrasonic instruments, which fracture the calculus, thereby facilitating its removal, as well as hand tools, including periodontal scaler and curettes, or through the use of chemicals such as hydrogen peroxide.

Chronic periodontitis is one of the seven categories of periodontitis as defined by the American Academy of Periodontology 1999 classification system. Chronic periodontitis is a common disease of the oral cavity consisting of chronic inflammation of the periodontal tissues that is caused by the accumulation of profuse amounts of dental plaque. Periodontitis initially begins as gingivitis and can progress onto chronic and subsequent aggressive periodontitis according to the 1999 classification.

Aggressive periodontitis describes a type of periodontal disease and includes two of the seven classifications of periodontitis as defined by the 1999 classification system:

  1. Localized aggressive periodontitis (LAP)
  2. Generalized aggressive periodontitis (GAP)

Hereditary gingival fibromatosis (HGF), also known as idiopathic gingival hyperplasia, is a rare condition of gingival overgrowth. HGF is characterized as a benign, slowly progressive, nonhemorrhagic, fibrous enlargement of keratinized gingiva. It can cover teeth in various degrees, and can lead to aesthetic disfigurement. Fibrous enlargement is most common in areas of maxillary and mandibular tissues of both arches in the mouth. Phenotype and genotype frequency of HGF is 1:175,000 where males and females are equally affected but the cause is not entirely known. It mainly exists as an isolated abnormality but can also be associated with a multi-system syndrome.

In the dental specialty of endodontics, periradicular surgery is surgery to the external root surface. Examples of periradicular surgery include apicoectomy, root resection, repair of root perforation or resorption defects, removal of broken fragments of the tooth or a filling material, and exploratory surgery to look for root fractures.

<span class="mw-page-title-main">Gingival grafting</span>

Gingival grafting, also called gum grafting or periodontal plastic surgery, is a generic term for the performance of any of a number of periodontal surgical procedures in which the gum tissue is grafted. The aim may be to cover exposed root surfaces or merely to augment the band of keratinized tissue.

References

  1. 1 2 3 4 5 6 7 8 Kripal K, Chandrashekar BM, Anuroopa P, Rajan S, Sirajuddin S, Prabhu SS, Kumuda MN, Apine A (December 2014). "Practical periodontal surgery: an overview". Journal of Evolution of Medical and Dental Sciences. 3 (66): 14398–410.
  2. 1 2 3 4 Clerehugh V, Tugnait A, Genco RJ (2009). Periodontology at a glance. Chichester, U.K.: Wiley-Blackwell. ISBN   978-1-4051-2383-9. OCLC   280355497.
  3. 1 2 3 4 Bateman GJ, Saha S, Pearson D (2008-07-02). "Contemporary periodontal surgery: 1. Surgical principles". Dental Update. 35 (6): 411–3. doi:10.12968/denu.2008.35.6.411. PMID   18717104.
  4. 1 2 Rose LF (2004). Periodontics : medicine, surgery, and implants. St. Louis, Mo.: Mosby. ISBN   0-8016-7978-8. OCLC   53052024.
  5. ↑ Clinical problem solving in periodontology & implantology. Hughes, Francis J. Edinburgh: Churchill Livingstone. 2013. ISBN   978-0-7020-3740-5. OCLC   767256486.{{cite book}}: CS1 maint: others (link)
  6. 1 2 3 4 5 6 Bateman G, Saha S, Chapple IL (2007). Contemporary periodontal surgery : an illustrated guide to the art behind the science. London: Quintessence. ISBN   978-1-85097-123-8. OCLC   165411636.
  7. 1 2 3 Del Fabbro M, Karanxha L, Panda S, Bucchi C, Nadathur Doraiswamy J, Sankari M, et al. (November 2018). "Autologous platelet concentrates for treating periodontal infrabony defects". The Cochrane Database of Systematic Reviews. 11: CD011423. doi:10.1002/14651858.cd011423.pub2. PMC   6517213 . PMID   30484284.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.