Clinical
A longer tooth, W
Contemporary periodontal surgery by Dr. Barry Dace BDS BSc MFDS RCSEd MSand Dr. Rachel Doody BA BDentSc MFD RCSI MS
hen you hear the term periodontal surgery, what do you think of? Is it cutting off tissue
(gingivectomy), or flap surgery, or is it bone regeneration? Do you think of long teeth and aesthetic complications? What you first think of is probably
driven by when or where you’ve graduated, or by personal experience of some of your own patients. In this short article, we hope to provide you with an update of the currently used surgical techniques for treatment of periodontal diseases, as well as an explanation of when and where each might be used.
The question of pocket depth A question often asked is: ‘What pocket depths should I do surgery on?’ However, this question over- simplifies the issue. There are many
factors to take into account before we consider using periodontal surgery. While it is true that deeper pockets are more likely to experience progressive disease (Claffey et al 1990), there is no pocket depth for which conventional non-surgical therapy won’t show some degree of success (Badersten et al 1984) provided the teeth have a reasonable initial prognosis. However, the important questions are: 1. Whether surgical therapy is likely to result in additional benefit beyond non-surgical therapy? But, perhaps even more importantly: 2. “Am I going to improve the prognosis of these teeth by doing this surgical procedure?” If the answers to these particular questions are uncertain, then periodontal surgery is generally not indicated, and either a more conservative approach, or extraction, is advisable. It is absolutely essential
to ask yourself these questions before you embark on surgical treatment.
Non-surgical periodontal therapy For the vast majority of patients, and teeth, non-surgical therapy is the gold standard and surgical therapy will not improve results further than that achievable with subgingival scaling and root surface debridement. Indeed, for shallow pockets, surgical therapy will cause a loss of attachment and aesthetic complications. Of course, non-surgical therapy does
have limitations, and we know from large prospective studies (Pihlstrom et al 1981), that the expected pocket depth reductions and clinical attachment level gains after scaling and root planing are fairly predictable. We cannot therefore expect our 8mm pocket to become a 3 or 4mm pocket on average – this is the exception. So, knowing these figures, if it’s
pocket depth reduction that is the goal in a certain case, then surgical therapy may be employed. Of course, pocket depth reduction is only one of the desirable outcomes of perio- dontal surgery, and the decision
Fig 1
Minimal reflection approach (modified Widman flap)
Fig 2 Access surgery for open flap debridement Fig 3
Both buccal and palatal flaps are required for access surgery
a tooth nolo
20 Ireland’s Dental magazine
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