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RINCIPLES
F PERIODONTAL
URGERY
Rikko Hudyono
Unsoed-2015
OUTLINE
Outpatient surgery
Hospital Periodontal
Surgery
OUTPATIENT SURGERY
1. Patient Preparation
2. Emergency Equipment
3. Measures to prevent transmission
of infection
4. Sedation and anaesthesia
5. Tissue management
6. Scaling and Root Planning
7. Hemostasis
8. Periodontal Dressing
9. Post-operative procedures
1. PATIENT PREPARATION
KNOW
YOUR
PATIENT
KNOW
YOUR
PATIENT
1. PATIENT PREPARATION
Patient overall health status
Know your operation site.
Re-evaluation after phase I Therapy
Premedication
Smoking
Informed Consent
1. PATIENT
PREPARATION
1. PATIENT
PREPARATION
1. PATIENT
PREPARATION
1. PATIENT
PREPARATION
Premedication
Reduce anxiety see Sedation
Prophylactic antibiotic
Especially for patient with medically
compromised patient
It is supposed to have greater
success rate for the new attachment
or any tissue engineering procedure
1. PATIENT
PREPARATION
Premedication
NSAIDs (Ibuprofen,
Methampyron & Diazepam,
Mefenamic acid)
Corticosteroid
(Dexamethasone, Methyl
Prednisolon)
Mouthwashes (Chlorhexidine,
Chlorine Dioxine, Hyaluronic
Acid, Aloe Vera, warm brine)
1. PATIENT
PREPARATION
Smoking
The deleterious eff ects of
smoking had been well
documented
Patient should be informed of
this fact and asked to quit
smoking 3-4 weeks after the
procedure
1. PATIENT
PREPARATION
Smoking
1. PATIENT
PREPARATION
Informed Consent
Patient should be informed at
the initial visit about the
diagnosis, prognosis, and
diff erent possible treatment,
with their expected results,
and all pros and contras of
each approach.
1. PATIENT
PREPARATION
2. EMERGENCY
EQUIPMENTS
The operator, all assistants, and offi ce personnel
should be trained to handle all the possible
emergencies that may arise. Drugs and equipment for
emergency use should be readily available at all
times.
BASIC LIFE SUPPORT
Respiratory Equipments
Circulatory Equipments
2.
EMERGENCY
EQUIPMENTS
Medicaments
Ephinephrine
Glucocorticoids (Prednisone)
Morphine or its derivatives
Infusion solutions
Inhaled short-action beta-2
mimetic
Nitroglycerin
etc
2.
EMERGENCY
EQUIPMENTS
3. MEASURES TO PREVENT
TRANSMISSION OF
INFECTION
Universal Precaution
Sterilization
Disposal
4. SEDATION &
ANESTHESIA
SEDATION
4. SEDATION
&
ANESTHESIA
5. TISSUE
MANAGEMENT
1. Operate gently and carefully .
2. Observe the patient at all times .
3. Be certain the instruments are
sharp .
7. HEMOSTASIS
Clear visualization of the surgical site
is HALF WAY of success
Be sure no bleeding disorders. It is
imperative to recognize that excessive
bleeding may be caused by systemic
disorders
Be familiar with your surgical site
Good aspiration with continuous suctioning
Ice-moist sterile gauze
Absorbable gelatin sponge
8. PERIODONTAL DRESSINGS
Noneugenol Packs
Based on reaction of fatty acid and metallic oxide
Other non eugenol packs include cyanocrylates, tissue
conditioners (methacrylate gel), zinc oxide and glycol
alcohol
Kegunaan Periodontal
Pack
Melindungi luka dari gesekan
sehingga dapat membantu
penyembuhan
Mengurangi perdarahan dengan
menjaga bekuan darah tetap di
tempatnya
Mengurangi kegoyangan gigi
Menjaga posisi fl ap secara
mekanis
Memberi bentuk pada jaringan
baru
8.
PERIODONTAL
DRESSINGS
CHARACTERICS OF PERIODONTAL
PACK
Nontoxic or nonirritating to the
tissue
Conveniently prepared, placed and
removed with minimal discomfort to
patient
Should maintain adhesion to itself
and to the teeth, kept in place
mechanically by interlocking in
interdental spaces
8.
PERIODONTAL
DRESSINGS
8.
PERIODONTAL
DRESSINGS
Retention of Packs
Mechanical interlocking of interdental spaces
Antibacterial properties
May be enhanced by incorporating
antibiotics in pack
Allergy
So far, contact allergy with eugenol and
resin had been reported
8.
PERIODONTAL
DRESSINGS
PERIODONTAL
DRESSINGS
8.
PERIODONTAL
DRESSINGS
8.
PERIODONTAL
DRESSINGS
2-3
8.
PERIODONTAL
DRESSINGS
8.
PERIODONTAL
DRESSINGS
9. POST OPERATIVE
PROCEDURES
9. POST- OP
PROCEDURES
FINDINGS ON PACK
(after 1 week)
If a gingivectomy has been performed,
the cut surface is covered with a friable
meshwork of new epithelium, which
should not be disturbed.
After a fl ap operation, the areas
corresponding to the incisions are
epithelialized but may bleed readily
when touched; they should not be
disturbed. Pockets should not be probed.
The facial and lingual mucosa may be
covered with a grayish yellow or white
granular layer of food debris that has
seeped under the pack.
9. POST- OP
PROCEDURES
Mouthcare
Patient is advised to keep area clean, as
plaque and food accumulation may
impair healing
Soft toothbrushes and light water
irrigation are advised. Rinsing with
chlorhexidine
Bleeding is normal, and will subside as
healing progresses
9. POST- OP
PROCEDURES
Management of Post-op
Pain
Minor pain and discomfort are normal
following periodontal surgery
Common source of post operative pain
is overextension of periodontal pack
For healthy patient, NSAIDs prescribed
is eff ective to reduce post operative
pain
Antibiotics may be prescribed if postoperative pain is related to infection,
which is usually accompanied by
lymphadenopathy, and slight elevation
of body temperature
9. POST- OP
PROCEDURES
Treatment of
Hypersensitivity
At home
Dentrifi ces containing strontium
chloride, potassium nitrate, and sodium
citrate
In offi ce
These products and treatments aim to
decrease hypersensitivity by blocking
dentinal tubules with either a crystalline
salt precipitation or an applied coating
(varnish or bonding agent) on the root
surface
9. POST- OP
PROCEDURES
HOSPITAL PERIODONTAL
SURGERY
Ordinarily, periodontal surgery is an offi ce
procedure performed in quadrants or sextants,
usually at biweekly or longer intervals.
Indications for hospital periodontal surgery
include
optimal control and management of
apprehension
convenience for individuals who cannot
endure multiple visits to complete surgical
treatment
patient protection.
SURGICAL INSTRUMENT
1 Excisional and incisional instruments
2 Surgical curettes and sickles
3 Periosteal elevators
4 Surgical chisels
5 Surgical files
6 Scissors
7 Hemostats and tissue forceps
PERIOSTEAL ELEVATORS
SURGICAL CHISELS
SURGICAL FILES