PERIO SURGERIES: FLAPS AND GRAFTS

GINGIVECTOMY
 After gingivectomy, surface epithelium occurs in 7-14 days
 They heal by secondary intention, because there is no tissue approximating.
 INDICATIONS FOR GINGIVECTOMY:
o DIGE cases
o To eliminate suprabony pocket
o To remove pseudopocket,* in fibrous enlargement cases
o To eliminate gingival abscesses
o For suprabony pdl abscess !

 CONTRA INDICATIONS TO GINGIVECTOMY
o Anterior aesthetic zone.
o If there is defect in the alveolar bone!!!*
o Infrabony pockets
o Osseous reconstruction cases.*** (tricky one)

FLAP SURGERY
A portion of marginal periodontal tissue that has been surgically separated coronally from its underlying support and blood supply and attached apically by a pedicle of supporting vascular connective tissue

Perio surgery miscellaneous
 Wait 6 months after perio surgery for maturation of entire periodontium
 Periodontitis prognosis – depends on loss of clinical attachment QN
 Success of perio Rx – depends on good oral hygiene QN
 Best indication for successful perio Rx is --> NO bleeding on probing QN
 Indications : accessibility and visualization
 Best to access a bony defect
 After perio surgery, re-attachment happen as soon as in a week.
 evaluation of improved periodontal health: no bleeding on probing/ decreased plaque score attachment level***

FLAP DESIGN
 Wide base to ensure adequate blood supply.
 Most commonly used flap --> modified Widman flap