Periodontal surgery is a form of dental surgery that prevents or corrects anatomical, traumatic, developmental, or plaque-induced defects in the bone, gingiva, or alveolar mucosa.[1] The objectives of this surgery include accessibility of instruments to the root surface, elimination of inflammation, creation of an oral environment for plaque control, periodontal disease control, oral hygiene maintenance, maintaining proper embrasure space, addressing gingiva–alveolar mucosa problems, and esthetic improvement.[1] Surgical procedures include crown lengthening, frenectomy, and mucogingival flap surgery.[2][3][4]
Some contraindications include:[2][5]
Crown lengthening is a technique for increasing crown height of teeth by flap surgery with or without bone surgery.[3] There are two main types:
Untreated or unstable gum disease (periodontal disease) and gingival phenotype[4]
There are three main methods for surgical crown lengthening:[6]
Frenectomy is indicated by thick, prominent muscle attachments known as fraena or a frenum with close attachment to the gum margin. Thick frenum attachment or close attachment to gum margin can contribute to increased plaque accumulation, persistent inflammation, muscular pull on gum and affect gum contour.[6]
Usual sites for frenectomy are buccal regions of upper and lower incisors, upper canines and premolars. Frenectomy is rarely required for lingual sites.[6]
Frenectomy consists of:[6]
Mucogingival surgery is a procedure where the gums are separated from teeth and temporarily folded back to allow the dentist to directly view and reach root surface of the tooth and bone. It is used for crown lengthening surgery. It also, if required, can be used for guided tissue regeneration[2]oropen flap debridement (OFD) to treat gum disease (periodontitis/periodontal disease). The presence of bacteria, in the form of dental plaque/tartar/calculus on the root of a tooth, can cause inflammation of the gums resulting in gum disease. This can lead to bone loss around the affected teeth and if left untreated, lead to tooth loss.[7] When a tooth has very deep periodontal pockets it may not be possible to fully remove the dental plaque/tartar/calculus from the tooth's root surface with scaling alone. In open flap debridement (OFD) the gum is peeled back to make it possible for the dentist to see and ensure full removal of tartar/calculus from these difficult to access areas.[7] Teeth with furcation defects as a result of gum recession may require open flap debridement (OFD) as these areas can be very difficult to clean.[7]
Full thickness flap involves incision down to bone. Using blunt dissection, the flap is raised from bone. Full thickness flap is a simple procedure which provides access to root surface and bone. The procedure leaves minimal post-operative discomfort. It provides limited mobility of flap and is unsuitable for grafting.[6][2]
Split thickness flap involves sharp cutting of tissues and leaving the underlying periosteum intact. The procedure prevents exposure dehiscence and allows good blood supply for grafting. It does not provide access to underlying bone or root surface and results in greater post-operative discomfort.[6]
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