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Gingivectomy is __________, and provides ___________.
- excision of the gingiva and the supporting tissue
- visibility and accessibility to the tooth and / or root surfaces
- Mostly done in ortho patients.
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Gingivectomy - Indication:
- Elimination of suprabony pockets
- Elimination of gingival enlargements
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Gingivectomy - Contraindications:
- The need for osseous surgery.
- Pocket base is apical to the MGJ.
- NOT for gaining access to the bone.
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Modified Widman Flap
- purpose is to provide access to root surface for debridement
- Doesn't go beyond MGJ
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Gingivectomy - Technique
- Mark external “pocket markers”
- Incisions with a Kirkland knife, apical to the marking points
- move coronally to a point between the base of the pocket & the crest of bone.
- Remove the excised pocket wall and examine the root surface.
- Remove any granulation tissue.
- Suture & / or cover with a periodontal pack.
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Gingivoplasty
- Similar to a gingivectomy, BUT only reshaping the gingiva to create a physiologic gingival contour.
- This is done in the absence of a pocket.
- No supporting tissue is removed.
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Gingivoplasty - Technique
- Periodontal knife
- Scapel
- Diamond burs
- To taper or contour the gingival margins
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Red complex
- • T forsynthia - gram negative rods
- • T denticola - spirochetes
- P. gingivalis
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Periodontal treatment options
- 1. Surgical intervention - removal of the offending tissue, repair of a defect
- 2. Chemotherapeutics/immunologic intervention - medically inducing the body to eliminate the diseased cells/genetically altering the host-response to an insult
- 3. Laser therapy – utilizing specific laser wavelengths for appropriate tissue wound healing modulation. LANAP (laser-assisted new attachment procedure)
- 4. Scaling and root planing - long junctional epithelium repair. 2 & 3 only work as adjunct of 4.
- RATE LIMITING STEP - calculus removal / SRP
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4 biggies on the market
- diode
- Nd:YAG - for perio
- erbium
- CO2
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Laser interaction with ANY living tissue is primarily determined by the:
- Specific Wavelength
- Tissue Composition
- Water Content
- Pigmentation or lack thereof
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Common use laser absorption targets..
- CW Carbon Dioxide (Far-infrared): Water, Collagen, Hydroxyapatite
- CW Diodes (Near infrared): Hemoglobin & soft tissue melting via heat conduction.
- ERYAG: Water and Hydroxyapatite
- CW: Continuous Wave
- Nd:YAG in pulses: Transparent to water and cell walls (i.e. Endothelial cells, macrophages); Highly absorbed in dark pigment (i.e. black pigmented gram negative anaerobes); Well absorbed in Hemoglobin -> hemostasis; Not well absorbed in CT.
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Total
Triclosan and fluoride toothpaste
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Listerine
Essential oils - menthol, eucalyptol, thymol
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Prohealth mouthrinse
Cetylpyridinium chloride (CPC), quaternary ammonium compound
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Prohealth toothpaste
stannous fluoride (causes staining) + anti-stain agent
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Peridex/Perioguard mouthrinse
Chlorhexidine mouth rinse
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PerioChip
Chlorhexidine chip
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Arestin microspheres
- Tiny round particles with minocycline
- Atridox - doxycycline gel, replaced by arestin
- Actisite - fiber w/ tetracycline
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Periostat
Low dose doxycycline tablets
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If there is crestal Lamina Dura present,
NO active disease.
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In the absence/diffuse of the crestal Lamina Dura,
there could be either Active or no Active disease.
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