Clinical


Fig 8 Reduction of osseous defect allows flap adaptation


Fig 13 Bone and membrane in place in GTR site


Fig 14 Surgical access to furcation for calculus removal


Continued »


a provisional flap design to allow for several possible scenarios at the time of surgery. It is absolutely essential to have


Fig 9 Upper premolar bony defect


radiographs that clearly show the apices of all the teeth in the surgical field before contemplating surgery. Bone loss to the apex of a tooth in the surgical field is never something you want to encounter for the first time at the time of surgery, although it happens on occasion even with the best preparation in the world.


Fig 10 GTR procedure with bone and membrane in situ


Conclusions This short review merely scratches the surface of the decision making process in the use of surgical therapy to treat periodontal diseases. However, it is important to ensure that before contemplating the use of a surgical technique, the operator must evaluate carefully what they wish to achieve from the procedure. Is it for access to an area that cannot be reached non-surgically, for example, within a furcation region (Fig 14)? Or, is it to reduce the pocket depths as much as possible (e.g. flap and osseous surgery)? The notion of surgery to address a


particular pocket depth is over- simplistic, and ignores the bony


Fig 11 A quadrant suitable for a combination approach REFERENCES


• Badersten A, Nilveus R, Egelberg J. Effect of non surgical periodontal therapy. II Severely advanced periodontitis. J Clin Periodontol. 1984 Jan; 11(1):63-76


Fig 12


GTRin one region, but osseous surgery more posteriorly


• Claffey N, Nylund K, Kiger R, Garrett S, Egelberg J. Diagnostic predictability of scores of plaque, bleeding, suppuration, and probing depth for probing attachment loss, three-and-a years of observation following initial


periodontal therapy. J Clin Periodontol. 1990 Feb; 17(2):108-14 • Kaigler D, Cirelli JA, Giannobile WV. Growth factor delivery for oral and periodontal tissue engineering. Expert Opin Drug Deliv. 2006 September;3(5): 647-662 • Pihlstrom BL, Ortiz-Campos C, McHugh RB. A randomised four-year study of periodontal therapy. J Periodontol. 1981 May;52(5): 227-42


Ireland’s Dental magazine 25


anatomy, the attachment level, the local anatomy, and the prognosis of the tooth. It is important to have a clear objective before we enter into an invasive technique, and to ask ourselves what we hope to achieve by the procedure. Periodontal surgery is a fantas-


tically successful treatment modality when used appropriately. Not only is it more relevant than ever (as patients keep their teeth for longer), but it is an exciting field in terms of development. Even as you read this there are new


materials, at advanced stages of development, that will revolutionise periodontal surgery and grafting technology. The use of integrated human growth factors, and the careful orchestration of biological repair and regeneration mechanisms are already a reality (Kaigler et al 2006). It looks like another update in periodontal surgery is only around the corner.


® Dr. Barry Dace and Dr. Rachel Doody are both Masters of Science graduates of the Advanced Education Programme in Periodontics at the University of Minnesota, USA, and are currently in practice limited to periodontics and implant dentistry in Blackrock, Co Dublin. For further information and events at their practice, please visit www.number16.ie


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