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Pericoronitis is defined as inflammation of the oral soft tissues surrounding the crown of a partially erupted tooth. its treatment- operculectomy i.e. removal of the inflammed operculum

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  1. 1. PERICORONITIS Achi joshi SAIMS, Indore 1
  2. 2. PERICORONITIS • Pericoronitis is defined as inflammation of the oral soft tissues surrounding the crown of a partially erupted tooth. • The major cause is the microbial flora that develops in the distally located pseudopocket. • The term pericoronitis was first introduced to dental literature by Bloch in 1921. 2
  3. 3. CLINICAL FEATURES • Red, swollen, suppurating lesion that is exquisitely tender with radiating pain to ear, throat and floor of mouth. The diagnosis of pericoronitis is mainly clinical with three distinct diagnostic categories recognised: 1) Acute pericoronitis, 2) Sub-acute pericoronitis, and 3) Chronic pericoronitis. These classifications are empirically derived based on how individual cases arbitrarily fall into the three distinct clinical categories. 3
  4. 4. 1. Acute Pericoronitis: Trismus, pain, dysphagia, extraoral swelling, malaise, halitosis, pus discharge, sore throat, and anorexia. Pain may disturb sleep, lymphadenitis involving the deep cervical lymph nodes may be present. 4
  5. 5. 5 2. Subacute Pericoronitis: Pain, dysphagia, intraoral swelling, halitosis, pus discharge, sore throat. Associated pain is most often described as continuous, dull, and is occasionally sharp or throbbing. Unlike acute attacks, radiation of painful symptoms into adjacent muscles is rare. The individual does not have limited mouth opening. This is a distinguishing feature from acute pericoronitis (Nigerian Journal of Clinical Practice, 2014 )
  6. 6. 3. Chronic pericoronitis: It is diagnosed based on a history of temporary dull aching low grade pain that typically lasts only 1-2 days. Signs include palpable non-tender submandibular lymph nodes and macerated buccal tissue consistent with cheek biting. 6
  7. 7. COMPLICATIONS 1. Pericoronal abscess 2. It may spreads posteriorly in orophrengeal area. 3. Dysphagia 4. Involvement of lymph nodes- posterior and deep cervical. 5. Peritonsillar abscess. 6. Ludwigs angina 7
  9. 9. INDICATIONS OF OPERCULECTOMY 1. Availability of space for eruption of lll molar 2. Presence and proper alignment of antagonist tooth 3. Proper alignment of impacted lll molar in the arch. 4. Angulation of impacted mandibular lll molar in relation to long axis of second molar : vertical angulation is favourable. 5. Position/ depth of third molar in mandible. 6. Prosthetic consideration: Requirement of third molar as an abutment for fixed prosthesis. 7. Socio-economic reasons/ patient not willing for extraction. 9
  10. 10. PROCEDURE Operculectomy Scalpel Laser Electrocautry 10
  11. 11. SCALPEL 11 Operculum covering the occlusal surface of molar- lateral and occlusal view. Complete removal of the operculum clearing the occlusal surface
  12. 12. 12 •Incisions distal to molar should follow the area with greatest amount of attached gingiva. •It may be directed disto- lingually or disto-facially
  13. 13. Advantages • Cost effective • Better healing at initial level is due to primary healing by suturing. Disadvantages • Bleeding at surgical site. • Post- operative pain. • Local anesthesia required • Suturing • Swelling ,scarring • Multiple visits of patient 13
  14. 14. ELECTROCAUTRY 14 • Electrosurgery involves the intentional passage of high frequency waveforms or currents, through the tissues of the body to achieve a controllable surgical effect. • The passage of current into tissue cause cellular fluid to turn into steam, bursting cell wall and disrupting the structure. • The electro-surgery has significant advantages over steel scalpel based on incision time, blood loss, early post-operative pain and analgesia. (Kearns et al, sumit M, k kaur, 2011)
  15. 15. 15 1. Loop electrode is used in a range of 1.5 to 7.5 mHz in a continuous brushing method.
  16. 16. Advantages • Blood less field. • Less post operative pain. • sufficient tissue shaping ability. Disadvantages • Unpleasant odor. • May cause damage to bone . 16
  17. 17. LASER 17
  18. 18. Advantages • Better patient co-operation. • Bloodless surgical and post- surgical event; • Sterilization of the wound site. • Minimal swelling • Less scar formation. • Less or no postsurgical pain Disadvantages • Expensive equipments required. • Charring and carbonization created by laser may interfere with initial healing. 18
  19. 19. DISTAL MOLAR SURGERY • Treatment of periodontal pockets on the distal surface of terminal molars is often complicated by the presence of bulbous fibrous tissue over the maxillary tuberosity or prominent retromolar pads in the mandible. •Operations for this purpose were described by Robinson in 1966 19
  20. 20. • The procedure allows treatment of irregular osseous defects and access to maxillary distal furcation area. OBJECTIVES : • Eliminate periodontal pocket. • Maintain and preserve attached gingiva. • Make area accessible for instrumentation. 20
  21. 21. Factors that determine the flap design of a wedge procedure 1. Size and shape. 2. Thickness of soft tissue. 3. Difficulty of access. 4. Band of attached gingiva of the abutment tooth. 5. Depth of periodontal pocket and degree of osseous defect on the edentulous side of the abutment. 6. Clinical crown length required as an abutment for restorative/prosthetic treatment. 21
  22. 22. 22
  23. 23. FLAP DESIGN OF THE WEDGE PROCEDURE 1. TRIANGULAR DISTAL WEDGE Requires adequate zone of keratinized tissue and can be used in a very short or small tuberosity. 23 Outline of the incision Cross- sectional view- removal of the wedge.
  24. 24. 24 Undermining of incision to thin the tissue. Reflection of flaps for osseous correction Sutures placed to close the flap
  25. 25. SQUARE , PARALLEL DISTAL WEDGE • Indicated when tuberosity is longer. • Allows conservation of keratinized tissue • Provides greater access to tissues. 25 Cross- sectional view- proper blade angulations. Outline of the incision
  26. 26. 26 Flap reflection and tissue is removed osseous correction Sutures placed to close the flap
  27. 27. REFERENCES 1. Carranza. Clinical periodontology. 10th edition. 2. Edward cohen. Atlas of cosmetic and reconstructive periodontal surgery. 87-102. 3. N. Sato. Atlas of periodontal surgery. 4. Sumit Malhotra, Kamaljeet Kaur. Electro-surgery versus Conventional Surgery for Excision of Pericoronal flaps. Indian J Stomatol 2012;3(4):236-40. 27
  28. 28. 28 THANK YOU