Changes

Periodontal surgery is the term used for certain specific surgical techniques aimed at '''preserving the periodontium'''. Periodontal surgery techniques include closed curettage, gingivoplasty, various flap techniques, osseous surgery, guided tissue regeneration and, of course, implants. The techniques create accessibility for professional [[scaling and polishing]], and establish a gingival morphology that facilitates plaque control by home care regimes. Some techniques are aimed at regeneration of periodontal attachment lost, e.g. guided tissue regeneration.  

Periodontal surgery is the term used for certain specific surgical techniques aimed at '''preserving the periodontium'''. Periodontal surgery techniques include closed curettage, gingivoplasty, various flap techniques, osseous surgery, guided tissue regeneration and, of course, implants. The techniques create accessibility for professional [[scaling and polishing]], and establish a gingival morphology that facilitates plaque control by home care regimes. Some techniques are aimed at regeneration of periodontal attachment lost, e.g. guided tissue regeneration.  

Periodontal surgery is never first-line treatment for periodontal disease. Conservative management of periodontal disease (i.e. thorough supra- and subgingival scaling, rootplaning and polishing), in combination with daily meticulous home care, is always the first step. If a client cannot maintain good dental hygiene for their pet then, in the interest of the well being of the animal, there is no indication for periodontal surgery.

Periodontal surgery is never first-line treatment for [[Periodontal Disease|periodontal disease]]. Conservative management of periodontal disease (i.e. thorough supra- and subgingival scaling, rootplaning and polishing), in combination with [[Oral Hygiene - Small Animal|daily meticulous home care]], is always the first step. If a client cannot maintain good dental hygiene for their pet then, in the interest of the well being of the animal, there is no indication for periodontal surgery.

The main objective of periodontal surgery is to contribute to the preservation of the periodontium by facilitating plaque removal and plaque control. Periodontal surgery can help achieve this by:

The main objective of periodontal surgery is to contribute to the preservation of the periodontium by facilitating plaque removal and plaque control. Periodontal surgery can help achieve this by:

#Creating accessibility for professional scaling and root planing

#Creating accessibility for professional scaling and root planing

#Establishing a gingival morphology that facilitates plaque control by home care regimes

#Establishing a [[Gingiva|gingival]] morphology that facilitates plaque control by home care regimes

#In addition, periodontal surgery may aim to regenerate lost periodontal attachment  

#In addition, periodontal surgery may aim to regenerate lost periodontal attachment  

==Gingivoplasty==

==Gingivoplasty==

[[File:Gingivoplasty step 1.jpg|thumb|200px|right|Gingivoplasty - step 1]]

[[File:Gingivoplasty step 1.jpg|thumb|200px|right|Gingivoplasty - step 1]]

Gingivoplasty is the '''removal of gingival pockets''' by excision of the gingiva, or recontouring the gingiva to its proper anatomical form. It is indicated for the management of [[Gingival Hyperplasia|gingival hyperplasia]]. In this situation the excessive gingival tissue should be excised, leaving a normal depth of healthy gingiva.

Gingivoplasty is the '''removal of gingival pockets''' by excision of the gingiva, or recontouring the gingiva to its proper anatomical form. It is indicated for the management of [[Gingival Hyperplasia|gingival hyperplasia]]. In this situation the excessive gingival tissue should be excised, leaving a normal depth of healthy gingiva.

The procedure for gingivoplasty is as follows:

The procedure for gingivoplasty is as follows:

#Pocket depths are measured with a graduated [[Periodontal Probe|periodontal probe]]. The probe is withdrawn from the pocket and held against the outer surface of the gingiva to show the depth of the pocket and a bleeding point made. This is repeated along the circumference of the tooth.   

#Pocket depths are measured with a graduated [[Periodontal Probe|periodontal probe]]. The probe is withdrawn from the pocket and held against the outer surface of the gingiva to show the depth of the pocket and a bleeding point made. This is repeated along the circumference of the tooth.   

#A beveled incision, using either a scalpel blade (No. 11 or 15) or electrosurgery is made, joining the bleeding points and recreating the scalloped edge of the normal gingival anatomy. The beveled incision is directed towards the base of the pocket or to a level slightly coronal to the apical extension of the junctional epithelium. (Pic8) When using electrosurgery the operator should allow for a 1 mm slough postoperatively. The electrode should be activated at the minimal effective setting in cut mode and stroked across the gingiva at the required angle. The cut surface should be pink and not bleeding if the setting is correct. Blanched tissue indicates that the setting is too high and should be reduced. To avoid overheating the tooth the electrode should not be applied to the gingiva around the same tooth for more than 5 seconds.

#A beveled incision, using either a scalpel blade (No. 11 or 15) or electrosurgery is made, joining the bleeding points and recreating the scalloped edge of the normal gingival anatomy. The beveled incision is directed towards the base of the pocket or to a level slightly coronal to the apical extension of the junctional epithelium. When using electrosurgery the operator should allow for a 1 mm slough postoperatively. The electrode should be activated at the minimal effective setting in cut mode and stroked across the [[gingiva]] at the required angle. The cut surface should be pink and not bleeding if the setting is correct. Blanched tissue indicates that the setting is too high and should be reduced. To avoid overheating the tooth the electrode should not be applied to the gingiva around the same tooth for more than 5 seconds.

#The incised tissues are removed using  a curette or a scaler. Remaining tissue tags are cut with a curette or a pair of scissors.

#The incised tissues are removed using  a curette or a scaler. Remaining tissue tags are cut with a curette or a pair of scissors.

#Hemorrhage is controlled with gauze swabs and digital pressure. The crown and exposed root surfaces are then scaled and polished.

#Hemorrhage is controlled with gauze swabs and digital pressure. The crown and exposed root surfaces are then scaled and polished.