📌 POINTS TO PONDER
🔹Causes of excessive bleeding during surgery include laceration of large blood vessels, incomplete removal of granulation tissue, hypertensive patient, bleeding disorder patient and patient on anticoagulant therapy.
🔹 If the surrounding tissue blanches, however, the suture is too tight, which may cause necrosis because of poor vascularization.
🔹 Hemostasis should be achieved before, and not by, the application of a dressing. The only clear indication for a dressing is to achieve tissue stasis, such as with a free mucosal graft, or to protect a clot over bone in the interdental denudation technique. Application of dressing is a matter of individual preference.
🔹 The possible outcomes of surgical periodontal therapy are: Regeneration, new attachment, long junctional epithelium, root resorption or ankylosis and recurrence of pocket.
📣 Classification of periodontal surgery:
A. Pocket reduction surgery:
🔺Resective: Gingivectomy, apically displaced flap and undisplaced flap with or without osseous resection.
🔺Regenerative: Flaps with grafts and membranes.
B. Correction of anatomic/morphologic defects:
🔺Plastic surgery techniques to widen attached gingiva:
– Epithelial grafts
– Connective tissue grafts
🔺Esthetic surgery:
– Root coverage
– Recreation of gingival papillae
🔺Preprosthetic surgery techniques:
– Crown lengthening
– Ridge augmentation
– Vestibular deepening
🔺Placement of dental implants:
– With GBR
– Sinus grafts
📢 The Various Topical Hemostatic Agents are :
⭐ Agent Main constituent
🔸Avitene Collagen
🔸Collacote Collagen
🔸Collatape Collagen
🔸Collaplug Collagen
🔸Thrombinar Thrombin
🔸Thrombogen Thrombin
🔸Thrombostat Thrombin
🔸Gelfoam Gelatin
🔸Beriplast Fibrin
🔸Surgicel Cellulose
📌 VIVA VOCE
Q1. What are the critical zones in pocket surgery?
Ans. The critical zones in pocket surgery are as follows:
▪️ Zone 1 : Soft-tissue wall
▪️ Zone 2 : Tooth surface
▪️ Zone 3 : Bone
▪️ Zone 4 : Attached gingiva
Q2. What are the causes of excessive bleeding during surgery?
Ans. The causes of excessive bleeding during surgery are as follows:
▪️ Laceration of large blood vessels
▪️ Incomplete removal of granulation tissue
▪️ Hypertensive patient
▪️ Patient with bleeding disorder
▪️ Patient on anticoagulant therapy
Q3. Why increased mobility is seen immediately after surgical procedures in periodontally involved teeth?
Ans. These procedures often significantly disrupt/remove the gingival fiber groups which enables the gingiva to form a rigid cuff around the tooth that adds stability, especially when periodontal ligament and alveolar support is lost.
Q4. Who had put forward “No Pack Philosophy”?
Ans. Stahl had put forward “No Pack Philosophy” in 1969.
Q5. What are the complications that arise in the 1st postoperative week?
Ans. Complications that arise in the 1st postoperative week are as follows:
▪️ Persistent bleeding after surgery
▪️ Sensitivity to percussion
▪️ Swelling
▪️ Feeling of weakness
Q6. What are the complications that arise usually after 1st postoperative week?
Ans. Root sensitivity, tooth mobility and gingival recession are complications that arise usually after 1st postoperative week.
Q7. What is the average blood loss during periodontal surgical procedures?
Ans. According to Baab, average of 134 mL blood loss occurs during one sextant of periodontal surgery with wide variability of 16–592 mL.
Q8. How much time various periodontal tissues take to heal?
Ans. Healing rates of various periodontal tissues :
▪️ Junctional epithelium takes approximately 5 days to heal.
▪️ Sulcular epithelium takes approximately 7–10 days to heal.
▪️ Gingival surface epithelium takes approximately 10–14 days to heal.
▪️ Connective tissue takes approximately 21–28 days to heal.
▪️ Alveolar bone takes approximately 4–6 weeks to heal.
Q9. How many days before surgery the anticoagulant therapy or aspirin should be stopped?
Ans. 7–14 days before surgery anticoagulant therapy or aspirin should be stopped and can be restarted after 3–4 days of surgery; with the physician’s approval.
Q10. Which type of consent should be taken before surgery?
Ans. Both verbal and written consent.
📌 MULTIPLE CHOICE QUESTIONS MCQs
💡The purpose of placing sutures after periodontal flap surgery is to:
A. Hold the soft tissues in place
B. Protect the wound
C. Hold the soft tissues in place and maintain the blood clot
D. All of the above
Answer : D
💡Periosteal sutures in periodontal flaps is usually used in:
A. Coronally displaced flaps
B. Apically displaced flaps
C. Undisplaced flaps
D. None of the above
Answer : B
💡Following statement about suturing is true except:
A. Needle holder should grasp the needle approximately ¾th of the distance from point
B. Needle should enter the tissue perpendicular tothe surface
C. Needle should be passed through the tissue following curvature of the needle
D. Needle should be passed from thicker to the thinner side
Answer : D
💡Following statement about periodontal dressings are true except:
A. It protect wound area from irritants such as hot/spicy food
B. Enhances patient comfort
C. Eliminate pain
D. Helps to maintain the position of repositioned soft tissues
Answer : C
💡The most useful periodontal dressing in flap control in concave zones is
A. Cyanoacrylate
B. Collagen dressings
C. Methacrylic gel
D. None of the above
Answer : A
💡Which of the following is visible light cure periodontal dressing:
A. Barricaid
B. Coepak
C. Periocare
D. Periopac
Answer : A
💡The chemotherapeutic agents used for premedications are:
A. Tranquilizer
B. Antibiotics
C. Chlorhexidine gluconate mouthwash
D. Ibuprofen
E. All of the above
Answer : E
💡 Which of the following is an example of absorbable esuture material?
A. Silk
B. Propylene
C. Nylon
D. Gut
Answer : D