operational techniques in periodontology -...
TRANSCRIPT
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Operational techniques in
periodontology
Paul Nagy DMD
Department of Periodontology
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PERIODONTIUM
SUPPORTING TISSUES OF THE TEETH
1 . GINGIVA
2. CEMENTUM
3. PERIDONTAL (SHARPEY’S) LIGAMENTS
4. ALVEOLAR BONE
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DENTAL PLAQUE - CAUSATIVE FACTOR OF EVERY PERIODONTAL DISEASES
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MASSIVE SUPRAGINGIVAL DENTAL CALCULUS
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QUITE GOOD ORAL HYGIENE, BUT HUGE QUANTITY SUBGINGIVAL CALCULUS FORMATION
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Periodontitis
Gingivitis
Dental plakk
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GINGIVITIS:
DISEASE OF THE FREE GINGIVAL MARGIN
DEFENSIVE MECHANISMS AGAINST DENTAL PLAQUE
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PERIODONTITIS:
IRREVERSIBLE DERANGEMENT OF THE ATTACHING APPARATUS
RESULT OF THE INSUFFICIENT GINGIVAL IMMUN-DEFENSE
ATTACHEMENT-LOSS
TOOTH MOBILITY
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Periodontitis
Gingivitis
Dental plakk WHY DOES NOT EVERYBODY WITH POOR ORAL HYGIENE SUFFER FROM PERIODONTITIS???
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Periodontitis
Gingivitis
Dental plakk
Risk factors: • Genetics •Behavioural •Systemic conditions
Severe periodontitis
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ROBUST SUPRA- AND SUBGINGIVAL PLAQUE AND CALCULUS
THE SUBGINGIVAL PLAQUE EXISTS INDEPENDENTLY, CREATES A MASSIVE BIOFILM, WHICH CAN BE ELIMINATED ONLY BY MECHANICAL MEANS OF PROFESSIONAL CLAENING
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Progression: pocket formation, bone- and attachementloss
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SEVERE ALVEOLAR BONELOSS
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Cause related periodontal treatment: forgo the surgical therapy
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1. Resective period. surgery
2. Regenerative surgery
3. Mucogingival (perio plastic) surgery
Types of periodontal surgical
therapy, aims
Aims: • support cause relared period. treatment, thorough root surface debridement with visual controll • pocket depth reduction (establish complete inflammaton-free state) • regain attachment, improve prognosis of the teeth • gain a marginal gingiva and bone contour, which function and look like as the original • improve esthetics, (reduce cervical hypersensitivity)
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I. Resective period. surgical
techniques
• Gingivectomy (conventional, internal bevelled reversed)
• Apically transpositioned flap
• Modified- Widman flap
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I. Resective: Gingivectomy
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Internal bevelled reversed incision
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I. Resective: internal bevelled
reversed gingivectomy
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I. Resective: internal bevelled
reversed gingivectomy
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THE INCISION FOLLOWS THE ORIGINAL GINGIVAL CONTOUR AND WE CUT THROUGH THE PAPILLA INTERDENTALLY IN THE MIDDLE, TRY TO PRESERVE AS MUCH GINGIVAL TISSUES AS POSSIBLE TO GAIN A BETTER INTERDENTAL FLAP CLOSURE
I. Resective: pocket surgery with flaps!!
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I. Resective: apically
transpositioned flap
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APICALLY TRANSPOSITIONED FLAP AIMING POCKET DEPTH REDUCTION
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APICALLY TRANSPOSITIONED FLAP + OSTECTOMY
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I. Resective: modified-Widman flap
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I. Rezektív: modified-Widman flap
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I. Resective: modified-Widman flap
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II. Regenerative surgical techniques:
•GTR (guided tissue regeneration)= MEMBRANES
•Biological modifiers (ENAMEL MATRIX PROTEIN=Emdogain)
•Bone fillers
•Combined techniques
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II. Regenerative: GTR
Needleman IG, Worthington HV, Giedrys-Leeper E, Tucker RJ. Guided tissue regeneration for periodontal infra-bony defects. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD001724. Review.
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Preoperative clinical and radiological pictures
II. Regenerative: GTR
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The opened defekt
II. Regenerative: GTR
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Filling the defekt with bone filler and
cover it with a resorbable membrane
II. Regeneratív: GTR
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Wound closure
II. Regeneratív: GTR
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Radiolological result
preoperative -6 months postoperatively
II. Regeneratív: GTR
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II. Regenerative: Emdogain
(enamelmatrix protein)
Tonetti MS, Lang NP, Cortellini P, et al. Enamel
matrix proteins in the regenerative therapy of deep
intrabony defects. J Clin Periodontol 2002;29:317-
325.
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Preoperative clinical and radiological pictures
II. Regeneratív: Emdogain (zománcmártix protein)
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II. Regenerative: Emdogain (enamelmatrix protein)
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9th month result
II. Regeneratív: Emdogain (zománcmártix protein)
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II. Regenerative: Bone fillers
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II. Regenerative:Combination (Emdogain +
bone filler)
Preoperative clinical and radiological pictures
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II. Regenerative:Combination(Emdogain + bone filler)
Root surface modification with Emdogain and
filling the defect with mixed bone fillers
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II. Regenerative:Combination(Emdogain + bone filler)
Root surface modification with Emdogain and
filling the defect with mixed bone fillers
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6 months radiological result
II. Regenerative:Combination(Emdogain + bone filler)
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III. Mucogingival surgery
• Gingival recession’s coverage
• Narrow attached gingiva widening
• Negative papilla
• Gingival asymmetry
• Shallow vestibular fold
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Initial state
III. Mucogingival surgery: recession coverage
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Surgical planning: Incision line of the coronally advanced flap
Zucchelli G, De Sanctis M. The coronally advanced flap for the treatment of multiple recession defects: a modified surgical approach for the upper anterior teeth. J Int Acad Periodontol. 2007 Jul;9(3):96-103.
III. Mucogingival surgery: recession coverage
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Correction of overhanging margins, root planing, conditioning with EDTA
III. Mucogingival surgery: recession coverage
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Diagonal submarginal interdental incision, flap making, half-thickness flap preparation
III. Mucogingival surgery: recession coverage
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Connective tissue graft harvesting
Hürzeler, M. & Weng, D.: A single-incision technique to harvest subepithelial connective tissue graft from the palate. International Journal of Periodontics and Restorative Dentistry 1999 19: 279–287
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Deepithelialisation of th papillas, fixation of the graft, wound closure
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Initail and current sate
Initial Current
III. Mucogingival surgery: recession coverage
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Initial state
Aroca S, Keglevich T, Nikolidakis D, Gera I, Nagy K, Azzi R, Etienne D.: Treatment of class III multiple gingival recessions: a randomized-clinical trial. J Clin Periodontol. 2010 Jan;37(1):88-97.
III. Mucogingival surgery: recession coverage
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Root planing Conditioning (EDTA)
Coronally advanced modified tunnel technique
III. Mucogingival surgery: recession coverage
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Connective tissue graft harvesting from the palate
Hürzeler, M. & Weng, D.: A single-incision technique to harvest subepithelial connective tissue graft from the palate. International Journal of Periodontics and Restorative Dentistry 1999 19: 279–287
III. Mucogingival surgery: recession coverage
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Pulling in the graft under the tunnel flap
III. Mucogingival surgery: recession coverage
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Stabilize the tunnel flap coronally with sutures and applying Emdogain
III. Mucogingival surgery: recession coverage
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Pre- and postoperative pictures
III. Mucogingival surgery: recession coverage
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Thank You for Your attention
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