Transcript General Principles of Periodontal Surgery

General Principles of
Periodontal Surgery
Dr. Mohamed Elewa
Management of Postoperative Pain
A common source of postoperative pain is
overextension of the periodontal pack onto the soft
tissue beyond the mucogingival junction or onto the
frena.
Overextended packs cause localized areas of edema,
usually noticed 1 to 2 days after surgery.
Removal of excess pack is followed by resolution in
about 24 hours.
Extensive and excessively prolonged exposure and
dryness of bone also induce severe pain.
For most healthy patients
Preoperative dose of ibuprofen (600 to 800 mg)
followed by one tablet every 8 hours for 24 to 48 hours
is very effective in reducing discomfort after
periodontal therapy. Patients are advised to continue
taking ibuprofen or change to acetaminophen if
needed
If pain persists, acetaminophen plus codeine can be
prescribed.
Caution should be used in prescribing Ibuprofen to
patients with hypertension controlled by
medications because it can interfere with the
effectiveness of the medication.
When severe postoperative pain is
present
The patient should be seen at the office on an emergency
basis.
The area is anesthetized by infiltration or topically, the
pack is removed, and the wound is examined.
Postoperative pain related to infection
is accompanied by a- localized lymphadenopathy &
b- Slight elevation in temperature
It should be treated with systemic antibiotics and
analgesics
Treatment of Sensitive Roots.
Common problem in periodontal practice.
It may occur spontaneously when
1-the root becomes exposed as a result of gingival recession or pocket
formation, or
2-After scaling and root planing and surgical procedures.
It is manifested as pain induced by cold or hot temperature, more
commonly cold; by citrus fruits or sweets; or by contact with a
toothbrush or a dental instrument.
Factor for reducing or eliminating hypersensitivity
is adequate plaque control.
The patient should be informed about the possibility of root
hypersensitivity before treatment is undertaken.
DESENSITIZING AGENTS
The following information on how to deal with the
problem should also be given to the patient:
1. Hypersensitivity appears as a result of the exposure of
dentin, which can be corrected if calculus and plaque and
their products will be removed.
2. Hypersensitivity slowly disappears over a few weeks.
3. Plaque control is important for the reduction of
hypersensitivity.
4. Desensitizing agents do not produce immediate relief.
They have to be used for several days or even weeks to
produce results.
DESENSITIZING AGENTS
Desensitizing agents can be applied by the patient at home or
by the dentist or hygienist in the dental office.
The most likely mechanism of action
is the reduction in the diameter of the dentinal tubules so as to
limit the displacement of fluid in them.
According to Trowbridge and Silver, this can be attained by
1) Formation of a smear layer produced by burnishing the
exposed surface,
2) Topical application of agents that form insoluble precipitates
within the tubules,
3) Impregnation of tubules with plastic resins, or
4) Sealing of the tubules with plastic resins
Agents used by the Patient
The most common agents used by the patient for oral hygiene
are dentifrices.
Although many dentifrice products contain fluoride,
additional active ingredients for desensitization are strontium
chloride, potassium nitrate and sodium citrate.
The following dentifrices have been approved by the
American Dental Association for desensitizing purposes:
Sensodyne, and Thermodent, which contain strontium
chloride Crest Sensitivity Protection, Denquel, and Promise,
which contain potassium nitrate
and Protect,which contains sodium citrate.
Fluoride rinsing solutions and gels can also be used after the
usual plaque control procedures
Patients should be aware that several factors must be considered
in the treatment of tooth hypersensitivity, including:the history and severity of the problem as well as the physical
findings of the tooth or teeth involved.
A proper diagnosis is required before any treatment can be
initiated so that pathologic causes of pain (caries, cracked tooth,
pulpitis) can be ruled out before treating hypersensitivity.
Desensitizing agents act via the precipitation of crystalline
salts on the dentin surface,which block dentinal tubules.
Patients must be aware that their use will not prove to be
effective unless used continuously for a period of at least 2 weeks.
Agents used in the Dental Office
These products and treatments aim to decrease hypersensitivity via
blocking dentinal tubules with either a crystalline salt precipitation or
an applied coating (varnish or bonding agent) on the root surface in
an attempt to occlude the dentinal tubules.
Fluoride solutions and pastes historically have been the agents of
choice. In addition to their antisensitivity properties, they have the
advantage of anticaries activity, which is particularly important
for patients with a tendency to develop root caries.
However, certain agents such as chlorhexidine, decrease the ability of
fluoride to bind with calcium on the root surfaces.
Thus it is important to advise patients not to rinse or eat for 1
hour after a desensitizing treatment.
A newer method of treatment for hypersensitive dentin
is the use of varnishes or dentin bonding agents
to occlude dentinal tubules.
Newer restorative materials,such as and glass-ionomer cements
dentine bonding agents, are still under investigation, but
when the tooth needs recontouring or difficult cases do not
respond to other treatments, the dentist may choose to use a
restorative material.
Resin primers alone could be promising, but the effects are not
permanent and investigations are ongoing
Recently,
attempts have been made to improve the success and
longevity of these treatments using lasers.
Low-level laser "melting" of the dentin surface
appears to seal dentinal tubules without damage to
the pulp.
Nd:YAG laser has been used to coagulate fluoride
varnish on root surfaces