Periodontal+Surgery+Options



**1. Free Connective Tissue Autografts:** The connective tissue autograft technique is based on the fact that the connective tissue carries the genetic message for the overlying epithelium to become keratinized. The advantage of this technique is that the donor tissue is obtained from the undersurface of the palatal flap, which is then sutured closed. This minimizes the patient's postoperative discomfort at the donor site. Another advantage of the free connective tissue autograph is that better esthetics can be achieved because the color of the grafted tissue matches the adjacent areas more closely. MT. 18 Takei, H., Azzi, R., & Han, T. (2006).Carranza (10th ed.) //Periodontal plastic and esthetic surgery //. St. Louis, MO: Saunders.

**2. Free Gingival Autograft:** This is used to create a widen zone of attached gingiva. Free gingival grafts effectively widen the attached gingiva. The placements of a gingival graft does not improve the status of the gingiva. The indication for a free gingival graft should be based on the presence of progressive gingival recession and inflammation. Free gingival grafts have been found to be useful for covering nonpathologic dehiscences and fenestrations. MC#3 Takei, H., Azzi, R., & Han, T. (2006).Carranza (10th ed.) //Periodontal plastic and esthetic surgery //. St. Louis, MO: Saunders.

**3. The main purpose of the gingival graft and the connective tissue graft are the same, which is to correct mucogingival defects, while the procedures differ. Our role as dental hygienists is to educate the patient on the outcomes of such procedures. TL #8** The connective tissue graft is more esthetically appeasing, with a more comfortable healing process (stitches instead of an open wound) when compared to the gingival graft. The patient should be given this information, as well as post-operative instructions.

**4. Periodontal surgery may be indicated in cases where clinical removal of irritants may not be possible. MW 19** In areas that are more periodontally involved or have local factors which make access difficult, it may be indicated that the patient have periodontal surgery in order to completely remove all irritants. Carranza's Clinical Periodontology mentions the following conditions that may warrant surgical intervention: irregular bony contours or deep craters, pockets that do not allow for complete access, grade II or III furcations, intrabony pockets particularly on the distal aspects of last molars, and areas of persistent inflammation that do not resolve with non-surgical therapy. The goal of periodontal surgery in these cases are for increased attachment and a better prognosis for these teeth. Drug Induce Gingival EnlargementDrug induced gingival growth may need surgical intervention. The medication that is inducing this change must be first considered and if the patient can stop or change medication. Second OHI must be stress because improper home care can induce gingival overgrowth if the irritant are not removed. Third if the first two options do not work the patient may need a gingivectomy or periodontal flap. SR14

**5. Reevaluation after Phase I therapy. GE#6.** There have been longitudinal studies that have indicated that all patient's should fist be treated with scaling and root planing and that a final decision should not be made for periodontal surgery until after a thorough evaluation of the effect of Phase I therapy.. According to Carranza the assessment is made no less that 1 to 3 months and sometimes as much as 9 months after the completion of Phase I therapy. During the re-evaluation the clinician should include re-probing the entire mouth, with re-checking of any residual calculus or other irritate factors along with all signs of persistent inflammation.

Takei, H., Azzi, R., & Han, T. (2006).Carranza (10th ed.) //Phase II periodontal therapy //. St. Louis, MO: Saunders.

====Periodontal disease often refers to bacterial plaque and infections around the gum and tooth root. It can happen around one or several teeth. In some cases, the gum tissue is damaged or shrinks. In advanced stages, surgery to generate new gum tissue and/or bone growth can be done. There are several techniques used to encourage new gum growth using donor tissue, man-made material, or tissue from the roof of the patient’s mouth. ====
 * 6. Soft Tissue Grafts can reduce patient sensitivity RK7**

====During periodontal surgery possible complications may include: Tooth sensitivity; Changes in gum appearance; Graft failure; Bleeding; Reaction to the sedation medicines; Infection; Swelling; Nausea and vomiting. Factors that may increase the risk of complications include: Smoking and other systemic conditions. ====

====A soft tissue graft is needed to: Cover tooth roots that are exposed, which can lead to bone loss; Reduce tooth sensitivity, and Even out gum tissue due to recession ==== ====During this procedure gum tissue is taken from the palate, with improvements in technique periodontitis are able to remove this tissue with significantly less post operative discomfort. The tissue is then secured over the exposed root and underneath the gum tissue in the area of the recession by placing the graft within the flap. By then repositioning the gum tissue from the flap over the exposed root and grafted tissue, the graft is further nourished and the root may be covered. ====

====In conclusion, a soft tissue graft can reduce further recession and bone loss. In some cases, it can cover exposed roots to protect them from decay. In addition soft tissue grafts may reduce tooth sensitivity and improve esthetics of your patient’s smile. ====

In many cases various procedures and techniques are combined to fulfill both objectives in one surgery. The purpose of surgical pocket therapy is to eliminate the pathological changes in the pocket walls, to create a stable and maintainable state for both the clinician and patient, and if possible, to promote regeneration.
 * 7. The surgical phase of periodontal therapy has the following main objectives: improvement of the prognosis of teeth and their replacements, and improvement of esthetics. CE5**

The papilla preservation flap technique is the best for grafting procedures due to the interdental papilla coverage of the area. Various types of grafting material may be utilized or combined from xenografts, allografts, autografts and nonbone grafting materials. Autografts will have a secondary surgical site that the patient will have to recover from. On advantage is the piece of mind that the patient is receiving their own bone for the grafting procedure. Advantages of other materials such as allografts(donated bone) and xenografts ( bovine bone) are the lack of the secondary site for healing. Properties of nonbone materials such as oral and bioactive glass include cementum, bone and collagen formation. The idea of combining materials is to enhance positive results. Selection of materials is done by the surgeon, but the patient may ask question of materials therefore it is important to have and understanding of the origin of each material.
 * 8.The use of various grafting materials are one way for restoring some periodontal osseous defects. KT4**

9. Most specialist prefer to perform the connective tissue graft compared to free gingival grafting due to esthetic reasons and success rate. LL#9.