Surgical treatment of periodontal

Periodontal surgery aimed at recruiting gum on the root surface and reducing the height of bags after
conservative treatment has been exhausted medical and hygiene, which led to the elimination of
inflammation.Preoperative will be a scaling thorough supra and subgingival followed by polishing of the root surface, scooping
cementum necrotic and dentine decrepit, cleaning tooth root control of the plaque, along with antimicrobial treatment, local
antiseptic and treatment of immune-stimulating treatment system diseases , indication for surgery is the remaining teeth bag
and suppuration. The indication for surgery is the remaining teeth bag and suppuration. It aims recruitment gum
removal bags periodontal alveolar bone modeling, reducing excess gum. To reduce excess gum and gum pockets
may be used substances cauterize or electrocautery. Among the chemical substances were used: acid: sulfuric
acid, chromic acid, trichloroacetic acid;base: Na or K hydroxide.

General principles of periodontal surgery

1. Interventions are ambulatory.
2. Consultation of the patient is mandatory.
3. There will be laboratory - ESR, blood counts, urine analysis, blood sugar, TS, TC, etc.
4. Correction system disorders that may influence the postoperative.
5. Preoperative therapy - administering preoperative medication, supportive care, sedatives and
tranquilizers for patients with emotional or neurodegenerative disorders.
6. The Cabinet of dentistry must be properly equipped
7. Delivery of the necessary tools.

Preparing the patient and the surgical field. Anesthesia: Plex, truncal peripheral Combined General. Surgery:
access, incision, bucking, take off; removing excess gum; altered tissue removal: curettage bag, root and
bone. Drug treatment of wound and wound toilet. Wound protection: suture periodontal dressing.Postoperative
treatment to cure: 6-7 days dressing is maintained; after 7 days heals and remove the wires. It aims oral
hygiene. Postoperative can be favorable or complications can occur: bleeding immediate or delayed; infection -
septic processes; tooth pain or spontaneous percussion; swelling, hematoma surgery.

Methods and techniques of periodontal surgery

1. Curettage gingival and subgingival curettage gingival

1.1 It aims curettage gingival wall of the periodontal pocket, while cleaning the tooth root which constitutes
the basic operation.

1.2 It aims subgingival curettage curettage of granulation tissue in the bottom of the bag, below the epithelial
insertion, below the bone crest. The aim is reacolarea gum curettage of the tooth root surface.After
curettage, blood clots will be held will be converted into tissue supporting the tooth and will regenerate
epithelia. Curettage curette is done, scaling tools, Mills. Use and caustic and ultrasonic instruments (there are
reservations about ultrasonic scaling). Subgingival curettage can be done: in the closed field - blind on blind; in
the open - with microincizii longitudinal and highlight the field.

2.Gingivectomy
Gingivectomy consists of excision margins gum, the external walls of the bag; It may be followed by curettage
of granulation tissue and bone modeling. It is indicated in bags that do not yield false after conservative
treatment or hypertrophic gums and / or hyperplastic. It will follow during the operation: highlighting
subgingival plaque and subgingival scaling; reducing false bag and plaque; supraalveolare removing gum
abscesses. No intervention in symptomatic hypertrophic gingivitis. It must be taken into account aesthetic
considerations that may change the surgical technique.Gingivectomy runs with ordinary knife, electric knife,
electrocoagulation, laser, chemical and milling turbine under running water.

3.Flap surgery
Flap surgery was imagined by Neuman in 1912 Widman Cieszinsky in 1914 and 1918. The purpose of the
operation is to allow better access and visibility sufficient to eliminate pathological periodontal pocket tissues
and efficient cleaning and correct the root surface .

The flap is the portion resulting from cutting the gum and gum off her.Sectioning can only mucosally or to the
alveolar bone. Practiced: - mucosal flap - off only interested in the mucosal; - Mucoperiostal flap - is off the
mucosa together with the periosteum.

The flap should have a broad enough base to ensure irrigation of blood. Flap surgery was imagined by Neuman
in 1912 Widman Cieszinsky in 1914 and 1918. The purpose of the operation is to allow better access and
visibility sufficient to eliminate pathological periodontal pocket tissues and efficient cleaning and correct the
root surface .

The flap is the portion resulting from cutting the gum and gum off her.Sectioning can only mucosally or to the
alveolar bone. Practiced: - mucosal flap - off only interested in the mucosal; - Mucoperiostal flap - is off the
mucosa together with the periosteum. The flap should have a broad enough base to ensure irrigation of blood.

3.1The operative technique

3.1.1 The incision lines are oblique incision line parallel to the gingival margin to reach, pointing toward the tip
of alveolar bone scalpel; Pinked line can be straight or with or without suppression suppression gingival papillae
papillae; crevicular incision line at the bottom of gingival sulcus to the alveolar ridge; horizontal incision line
that was cut sectioning the gumline and the gum base insertion; one or two vertical incisions so mobile that
form the gum flap; usually they are only vestibular palatal and lingual is just taking off. It is good to observe
vertical incision interdental papilla as vascular pedicle is the papilla; for palatal flap - horizontal incisions are
made in the same way; missing vertical incision. It aims excision gumline showing epithelial damage and
granulation tissue. The takeoff flap - is made with straight or lenticular decolatoare. The flap once obtained,
binds with a wire and keep away with a clamp. removing the gum - are commonly used tools scaling. removal of
granulation tissue and cleaning the tooth root (root planing) is made with curette instruments Gracey,
scraping, milling.

3.1.2 Curettage of alveolar bone, osteitis eliminate areas and leveling bone spurs. WC wound, hemostasis,
wound control, suture, ligature interdental dressing. Wound dressing.

3.2 Flap surgery mucoperiostal partially reflected (Modified Widman Flap - 1974 -
Ramfjord and WISS), it is essentially a gingival curettage operation with
microlambouri.

Practiced three incisions: the first incision parallel to 1-2 mm alveolar crest of the gingival margin to the
bone; The second incision is at the bottom of the gingival sulcus (sulcus) to bone; The third incision is
horizontal. The difference with the classic method is that two of sulcus incision is made by lifting the flap.

The incision can go to the bone, making muco-periosteal flap or be more superficial and skewed toward the
tooth, creating a mucosal flap. In addition, the incision may be placed higher apical or not, depending on the
depth of the pockets and the necessity of excision. The remaining edges are sutured gums healthy by allowing
reacolarea interdental ligatures. Pathological tissues are removed in the same way.

4. Bone surgery
Friedmann in 1955, specifies two types of alveolar bone surgery: shaping addition (osteoplasty); modeling
resection (osteotomy). It is considered that the horizontal resorption of the alveolar bone could be caused by
plaque, while vertical resorption were due to occlusal trauma. Bone surgery aims to achieve a positive bone
morphology with minimal bone loss.Positive alveolar bone morphology assumed labial edge of the bone socket
placed higher than the apical edge interdental (septum alveolar bone). When interdental septa are located
apical than labial edge of the socket bone morphology socket is negative.

Bone remodeling is done only in the operation flap and shaping bone or bone addition. Clinical examination is
completed by radiographs. Bone bags with one wall is resolved, usually by osteotomy and palpation of bone is
transgingival dental probe (prick gum and bone). Exostozele is chiureteaz or resected with chisels,
cutters. Obtain usually bone regeneration.

5. Surgery grafts used in addition

5.1 Autoimplante bone - addition to surgery may be used: autoimplante jaw bone or autoimplante extraorale. -
Curd bone - is prepared from the patient's blood and bone milling (Robinson 1969); - Implant bone marrow
(hiatal 1971) is harvested from the maxillary tuberosity or toothless alveolar crest bone or adjacent. It is the
best method. - Autoimplantele bone marrow extraorale;autoimplantul iliac bone.

5.2 Homoimplante (cadaver), irradiated or frozen.Xenoimplante bone - preserved bone, cartilage, tricalcium
phosphate, apatite, bone mineral (Osipov), bone lyophilized powder coral and others.

6. Treatment.
Furcaie injuries (between the roots of molars) can be superficial or without radiological changes can destroy
the septum interradicular. - Supraalveolare furcaie lesions treated by curettage and gingivectomy gum. -
Furcaie lesions with destruction of bone flap is resolved by gingivectomy.

7.Guided tissue regeneration

During the intervention connective tissue - bone - aims to isolate the islands of epithelial tissue epithelial cells
do not proliferate in the bone and prevent bone regeneration; to this end use of the barrier membrane. The
membranes can be: nerezorbabile (Gore Tex) ethylene; rezorbabile, collagen, dura mater.Nerezorbabile
membranes must be removed after 5 weeks after surgery.

8.Mucogingival surgery procedures

8.1. Increasing the height of the adherent gum - free gingival graft addition - autografts; - Movements of the
coronary gum gum free and adherent to cover the root surface.
8.2. Gingival autograft - gingiva excision is practiced bounding bag (area acceptor), is preparing the bed for
graft, graft is taken from the donor area, and secured on the bed in the acceptor. Fenestration - pathological
gums are deleted from the bag flap is taken from the apical and moving toward the gingival margin
coronal; epithelisant will bare bone surgery.
8.3 The repositioning of gingival flap apical - comes down to apex gum, increasing the clinical crown. Coverage
of denuded package is done for aesthetic reasons: pedicle graft; graft with two flaps; repositioned flap - side
apical pedicle. Repositioning frenurilor - is by frenctomie techniques, frenotomie, frenoplastie.Gingival
inflammatory pseudo-tumor surgery - excision is practiced type gingivectomy.

8.4. In recent retro- molar surgery is often hypertrophied gums and bone bags or false, requiring excision
gum. The incision is triangular with distal tip. Recognizes two incisions oblique ridge and third vertically in the
bottom of the sulcus. It makes excision, curettage and suture clean the tooth root.