Dentist Bangladesh February 17, 3 Comments. All rights reserved. Powered by Dentist BD. Note: dentistbd. Scaling, Root Planing, and Curettage Section 2. Basic Surgical Modalities 5.
Gingivectomy 6. Mucogingival Surgery 7. Palatal Flaps 8. Osseous Surgery 9. Resective Osseous Surgery Sanders MD. Read Sylvia Full Download - by A. Bullen Series Full Download - by. Download Mirror Preview. Leave a Reply Cancel reply. Tuberosity b. Retromolar area Open Procedures. Gingivectomy 2. Full- or partial-thickness flap a. Apically positioned flap b. Unpositioned flap c. Modified flap d. Modified Widman flap 2.
Distal wedge procedure 3. Palatal flap Open Procedures. Gingivectomy a. Rotary abrasives b. Interproximal denudation c. Intrabony pocket procedure 2. Partial thickness 2.
Frenectomy or frenotomy 3. Modified Widman flap. Increasing Dimension of Exisiting Attached Gingiva. Mucosal stripping 2. Periosteal separation 3. Laterally positioned flap pedicle a. Partial thickness c. Periosteally stimulated d. Papillary flaps a. Double papillae b. Rotated papillae c.
Horizontal papillae 5. Edlan-Mejchar, subperiosteal vestibular extension operation, or double lateral bridging flap 6. Free soft tissue autografts a. Partial thickness b. Full thickness 7. Connective tissue autograft 8. Subepithelial connective tissue graft. Laterally positioned flaps 2. Double-papillae flaps 3. Coronally positioned flaps 4. Periosteally stimulated flaps 5. Semilunar flap 6. Rotated or transpositional pedicle flap Free Soft Tissue Autografts.
Full thickness 2. Partial thickness Subepithelial Connective Tissue Graft. Acellular Dermal Matrix Grafts. Guided Tissue Regeneration. Nonresorbable 2. Pouch procedure 2. Pediculated connective tissue graft 4. Onlay interpositional graft 5. Interpositional graft. Outline of basic incisions. A, Curettage incision and removal of an inflamed inner pocket wall. B, Gingivectomy incision and subsequent removal of excised tissue note that the incision is above the mucogingival junction [mgj].
C, Sulcular a and crestal b incisions for full-thickness mucoperiosteal flaps. D, Partial-thickness incisions for partial-thickness flaps. E, Modified flap incisions for ledge-and-wedge techniques. Variables Healing Time requirement for completion of procedure Reattachment Degree of difficulty Bleeding postoperatively Visibility for osseous surgery Ability to treat irregularities and defects Preservation of keratinized gingiva.
Medications should be carefully noted, and medical consultations and preoperative laboratory work should be performed where indicated. It is important to note that the medical history consists of a review of drug abuse, transfusion, and alternative lifestyles in attempting to determine the risk of acquired immune deficiency syndrome AIDS or human immunodeficiency virus HIV.
This should be combined with a thorough oral examination eg, ulcers, candidiasis, hairy leukoplakia. Basic procedure a. Socket filler b. Patient cooperation Cardiovascular disease a. Uncontrolled hypertension b. Myocardial infarction d. Anticoagulant therapy e.
Rheumatic endocarditis, congenital heart lesions, and heart vascular implants Organ transplants Blood disorders Hormonal disorders a. Uncontrolled diabetes b. Adrenal dysfunction Hematologic disorders a. Epilepsy Smoking—more a limiting factor than a contraindication.
Note: No periodontal surgery should be undertaken on a medically compromised patient without a recent physical evaluation and clearance by a physician. A complete medical history should be taken and any underlying systemic disorders or problems ie, hypertension, diabetes, or.
Note: The best protection against AIDS and hepatitis is a proper barrier technique and sterilization at all times. Blood pressure should be recorded. Surgical therapy should be considered only after adequate control, scaling, root planing, and all necessary restorative, prosthetic, endodontic, orthodontic, and occlusal stabilization and splinting procedures have been completed and the case has been reevaluated.
Without proper plaque control, there is no need for surgery. A surgical consent form should be completed in all cases, and periodontal documentation including tissue quality, pocket depths, radiographs, and models is a must. Procedural selection should be based on the following: a. Simplicity b. Predictability c. Efficiency d.
Mucogingival considerations e. Underlying osseous topography f. Anatomic and physical limitations eg, small mouth, gagging, mental foramen g. Age and systemic factors eg, cardiac arrhythmias and murmurs, diabetes, history of radiation treatment, hypothyroidism, hyperthyroidism 2. All incisions should be clear, smooth, and denifite. Indecision usually results in an uneven, ragged incision, which requires more healing time.
All flaps should be designed for maximum use and retention of keratinized gingival tissue so as to maintain a functional zone of attached keratinized gingiva and prevent needless secondary procedures. The flap design should allow for adequate access and visibility. Involvement of adjacent noninvolved areas should be avoided. The flap design should prevent unnecessary bone exposure, with resultant possible loss and dehiscence or fenestration formation.
Where possible, primary intention procedures are preferred to those of secondary intention. The base of a flap should be as wide as the coronal aspect to allow for adequate vascularity. Tissue tags should be removed to allow for rapid healing and prevent regrowth of granulation tissue. Adequate flap stabilization is necessary to prevent displacement, unnecessary bleeding, hematoma formation, bone exposure, and possible infection. Healing Degree of difficulty Pocket elimination Osseous surgery, resective or inductive Periosteal retention Relocation of frenum Widen zone of keratinized gingiva Increase in attached keratinized gingiva Combine with other mucogingival procedures Suture variability Presence of a thin periodontium—dehiscence or fenestration Bleeding and tissue trauma.
Scaling and root planing for removal of calculus, plaque, cementum Curettage of inner inflamed wall of pocket. Mark pocket with probe Scallop internal beveled incision to base of pocket Remove incised epithelium and granulation tissue Root plane Position flap and suture to presurgical level. Primary incision 0. Sulcularly, crestally, or labially positioned inverse beveled incision to bone Flap completed, reflected off bone Flap is apically positioned and sutured.
Crestal incision with blade parallel to long axis of tooth Flap raised by sharp dissection Periosteum retained over bone Flap is apically positioned at or below alveolar crest. Color atlas of periodontics. Louis: Mosby-Year Book; A surgical suture is one that approximates the adjacent cut surfaces or compresses blood vessels to stop bleeding. Suturing is performed to. Provide an adequate tension of wound closure without dead space but loose enough to obviate tissue ischemia and necrosis Maintain hemostasis Permit primary-intention healing Provide support for tissue margins until they have healed and the support is no longer needed Reduce postoperative pain Prevent bone exposure resulting in delayed healing and unnecessary resorption Permit proper flap position.
Suture Material Surgical sutures have been used to close wounds since prehistoric times 50,—30, BC gave us the first written description of their use dating back as early as 4, BC Macht and Krizek, Many materials have been used throughout the centuries, such as gold, silver, hemp, fascia, hair, linen, and bark.
Yet none have provided all of the desired characteristics. Silk and synthetic sutures are employed most often.
Gut sutures are used only when retrieval is difficult when securing grafts and in younger patients. The limited physical characteristics of gut sutures do not warrant their routine use. When using gut plain or chromic sutures, it is often advantageous to soak the package in warm water for a half-hour and to pull gently but firmly on the suture when opened. This will remove the kinks and straighten the suture.
Finally, lubricating the suture lightly with petrolatum or sterile bone wax will prevent brittleness. Note: This is not. Gore-Tex Flagstaff, Arizona and coated Vicryl sutures are recommended for guided tissue regeneration procedures. The following qualities of the ideal suture material are compiled from Postlethwait , Varma and colleagues , and Ethicon :.
Pliability, for ease of handling Knot security Sterilizability Appropriate elasticity Nonreactivity Adequate tensile strength for wound healing Chemical biodegradability as opposed to foreign body breakdown. With the possible exception of coated Vicryl Ethicon, Somerville, New Jersey , none of the sutures available today meet these criteria.
Table lists the various materials—natural, synthetic, absorbable digested by body enzymes or hydrolyzed , and nonabsorbable—available for periodontal use. Table outlines the charateristics and applications of resorbable and nonresorbable sutures. The ideal material for these procedures is expanded polytetrafluoroethylene ePTFE. Surgical Procedure a. Failure is generally the result of untying owing to knot slippage or breakage. Since the knot strength is always less than the tensile strength of the material, when force is applied, the site of disruption is always the knot Worsfield, ; Thacker and colleagues, This is because shear forces produced in the knot lead to breakage.
Knot slippage or security is a function of the coefficient of friction within the knot Price, ; Hermann, This is determined by the nature of the material, suture diameter, and type of knot. Monofilament and coated sutures Teflon, silicon have a low coefficient of friction and a high degree of slippage; braided and twisted sutures such as uncoated Dacron and catgut. Natural protein fiber of raw silk treated with silicon protein or wax Long-chain aliphatic polymers Nylon 6 or nylon 6. Collagen from healthy mammals treated with chromic salts Copolymer of lactide and glycolide coated with polyglactin and calcium stearate.
Skin closure Mucosal surfaces Cardiovascular, plastic, general surgery General, plastic, cardiovascular, skin surgery All types of soft tissue approximation and cardiovascular surgery Soft tissue closure.
Subepithelial mucosal surfaces Vessel ligation All types of general closure Subepithelial sutures Mucosal surfaces Vessel ligation Absorbable suture with extended wound support Mucosal surfaces. Absorbable; should not be used where extended approximation of tissues under stress is required Should not be used in patients with known sensitivities or allergies to collagen or chromium.
Periodontology, dental implant and oral surgery, especially when performing guided tissue and bone regenerative techniques. Silverstein L, Periodontology and dental implant surgery, extraction sites Periodontology, dental implant and oral surgery Dental implant and oral surgery.
Used to resist muscle pull, closely adapt flaps to bone and either teeth or dental implants Can also be used to apically or coronally position flaps Used to resist muscle pull, closely adapt flaps to bone and either teeth or dental implants Can also be used to apically or coronally position flaps Used to resist muscle pull, closely adapt flaps to bone and either teeth or dental implants Can also be used to apically or coronally position flaps Used to resist muscle pull, closely adapt flaps to bone, regenerative barriers, and dental implants, along with maintaining approximation of flap edges.
Used when a flap has been elevated on only one side Used in anterior mandible or posterior region to resist muscle pull.
It is interesting to note that basic suture silk, although extremely user friendly, is distinctly inferior in terms of strength and knot security compared with other materials Hermann, It also shows a high degree of tissue reaction Postlethwait, ; Taylor, , and the addition of wax or silicon to reduce the tissue reaction and prevent wicking further diminishes knot security Hermann, Knot selection is the last of the variables and the one over which surgeons have the most influence.
Knot security has been found to vary greatly among clinicians, and even the security of knots tied by the same clinician varies at different times Hermann, A sutured knot has three components Figure Thacker and colleagues, : 1.
In Figure , we see the four knots most commonly used in periodontal surgery. In a study, Thacker found that the granny knot was the least secure, always requiring more throws or ties to achieve the same knot strength as the square or surgical knot. For materials with a high degree of slippage monofilament or coated sutures , flat and square throws were recommended, with all additional throws being squared. Cutting the ears of the suture too short is contraindicated when slippage is great because the knot will come untied if the slippage exceeds the length of the ears.
Loosely tied knots were shown to have the highest degree of slippage, whereas in tight knots, slippage was not a significant factor. Knot anatomy. A, Various knot components prior to completion. B, Completed knot anatomy. Maintain adequate traction on one end while tying to avoid loosening the first loop. The surgeons knot and square knot strength, although generally not needing more than two throws, will have increased strength with an additional throw. Granny knots and coated and monofilament sutures require additional throws for knot security and to prevent slippage.
Coated Vicryl will hold with four throws—two full square knots. Sutures should be removed as atraumatically and cleanly as possible. Ethicon recom-. Principles of Suturing Ethicon recommends the following principles for knot tying: 1.
The completed knot must be tight, firm, and tied so that slippage will not occur. To avoid wicking of bacteria, knots should not be placed in incision lines. Knots should be small and the ends cut short 2—3 mm. Avoid excessive tension to finer-gauge materials because breakage may occur. Avoid using a jerking motion, which may break the suture.
Avoid crushing or crimping of suture materials by not using hemostats or needle holders on them except on the free end for tying. Do not tie the suture too tightly because tissue necrosis may occur. Knot tension should not produce tissue blanching. Recommend Documents. Atlas of periodontal surgery. A colour atlas of periodontal surgery. Cosmetic surgery. Analysis of completed reconstructive cosmetic surgery interface fellowships in the UK. Plastic and reconstructive breast surgery.BC Decker Inc P. BoxL. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. Box Lewiston, NY Tel: ; Fax: ; E-mail: info bcdecker. Notice: The authors and publisher have made opi nail polish sale free shipping effort to ensure that the patient care recommended herein, including choice of drugs and drug dosages, is in accord with the accepted standard and practice at the time of publication. However, since research and regulation constantly change clinical standards, the reader is urged to check the product atlas of cosmetic and reconstructive periodontal surgery free download sheet included in the package of each drug, which includes recommended doses, warnings, and contraindications. This is particularly important with new or infrequently used drugs. Any treatment regimen, particularly one involving medication, involves inherent risk that must be weighed on a caseby-case basis against the benefits anticipated. The reader is cautioned that the purpose of this atlas of cosmetic and reconstructive periodontal surgery free download is to inform and enlighten; the information contained herein is not intended as, and should not be employed as, a substitute for individual diagnosis and treatment. Contributors Arun K. Tibbits, DDS. Contents Preface. Surgical Basics. Sutures and Suturing. Scaling, Root Planing, and Atlas of cosmetic and reconstructive periodontal surgery free download. Mucogingival Surgery. Palatal Flaps. Cosmetic Treatment of Maxillary Anterior Teeth. Resective Osseous Surgery. Inductive Osseous Surgery. Visual Perception. You can publish your book online for free in a few minutes! Atlas of Cosmetic and Reconstructive Periodontal Surgery: 3rd Edition. Published. St Louis, MO, Mosby, , pages, illustrated This classic text continues to provide the latest information on the diagnosis and Download PDF. 77KB Sizes. Atlas of Cosmetic and Reconstructive Periodontal Surgery, 3rd Edition. By Dental Education / July 20, Download · Mirror · Preview. Author: Edward. Atlas of Cosmetic and Reconstructive Periodontal Surgery 3/E: Medicine Get your Kindle here, or download a FREE Kindle Reading App. Title: Atlas of cosmetic and reconstructive periodontal surgery 3rd edition Rotated or transpositional pedicle flap Free Soft Tissue Autografts. Nov 10, - Download the Medical Book: Atlas of Cosmetic and Reconstructive Periodontal Surgery 3rd Edition PDF For Free. This Website we Provide. Atlas of Cosmetic and Reconstructive Periodontal Surgery 3rd Download This PDF Reconstructive Periodontal Surgery 3rd Edition PDF Free, download, Edward S. Cohen, Free, PDF, Periodontology Books Download. Purchase Atlas of Cosmetic and Reconstructive Periodontal Surgery - 3rd Edition. Print Book. ISBN Free global shipping. No minimum order. [PDF-Download] Atlas of Cosmetic and Reconstructive Periodontal Surgery PDF Online - by Edward S. Cohen. [PDF-Download] Bat Boy: The Musical PDF. Used to resist muscle pull, closely adapt flaps to bone and either teeth or dental implants Can also be used to apically or coronally position flaps Used to resist muscle pull, closely adapt flaps to bone and either teeth or dental implants Can also be used to apically or coronally position flaps Used to resist muscle pull, closely adapt flaps to bone and either teeth or dental implants Can also be used to apically or coronally position flaps Used to resist muscle pull, closely adapt flaps to bone, regenerative barriers, and dental implants, along with maintaining approximation of flap edges. When the base of the pocket is reached, the tissue is marked Figure D. Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein, including choice of drugs and drug dosages, is in accord with the accepted standard and practice at the time of publication. This is tied off and should stabilize the body of the flap. This technique requires an adequate zone of attached keratinized gingiva and is used primarily on the palate, on enlarged tissue, or in areas in which limited access may prevent a primary inverse-beveled incision Figure E. Digital pressure to support the gingival tissue enhances the cutting efficiency of the curet. Note that the incisal papilla ip is outlined or avoided in this area. The modern periodontal paradigm is predicated on papillary preservation maintainable on gingival esthetics and the interrelationship of the lip, gingival, and occlusal lines. High plaque Unfavorable systemic factors 1. A periodontal dressing is now placed interproximally, without being forced.