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Complications of periodontal surgery /certified fixed orthodontic courses by Indian dental academy


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Welcome to Indian Dental Academy …

Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients

State of the art comprehensive training-Faculty of world wide repute &Very affordable.

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  • 1. Complications ofPeriodontal Surgery INDIAN DENTAL ACADEMY Leader in Continuing Dental Education
  • 2. POST OPERATIVE COMPLICATIONS Bleeding Infection Swelling Hypersensitivity Adverse tissue changes
  • 3. BLEEDING Periodontal Surgery can produce profuse bleeding especially during initial incision and flap reflection It disappears or subsides after flap reflection and removal of granulation tissue
  • 4. Bleeding … Intra operative bleeding can be managed by aspiration Pressure applied with moist gauze is good adjunct to control site specific bleeding If not controlled by this means, indicates a more serious problem
  • 5.  Excessive hemorrhage after initial incision and flap reflection may be caused by laceration of venules, arterioles, or larger vessels. The laceration of medium or large vessels is rare because highly vasularised anatomic areas are avoided in incision and flap design
  • 6.  In spite of all the care, bleeding may occur because of anatomic variations. If a medium or large vessel is lacerated, a suture around the bleeding end may be necessary to control hemorrhage.
  • 7.  Excessive bleeding from a surgical wound also may result from incisions across capillary plexus Minor areas can be stopped by applying cold pressure for several minutes Also LA with vasoconstrictor may be useful This action is short lived and should not be relied on for long term hemostasis
  • 8.  For slow, constant blood flow and oozing, hemostasis may be achieved with hemostatic agents.  Absorbable Gelatin Sponge  Oxidized cellulose  Oxidized regenerated cellulose  Thrombin
  • 9.  Absorbable Gelatin Sponge is a porous matrix prepared from pork skin that helps stabilize a normal blood clot The sponge can be cut to the desired dimensions and either sutured or positioned within the wound. It is absorbed in 4 to 6 weeks
  • 10.  Oxidized cellulose is a chemically modified form of surgical gauze that forms an artificial clot The material is friable and can be difficult to keep in place It absorbs in 1 to 6 weeks
  • 11.  Oxidized regenerated cellulose is prepared from cellulose by reaction with alkali to form a chemically pure, more uniform structure than Oxidized cellulose. The material is prepared in a cloth or thin gauze form that can be cut to the desired size and sutured or layered on the bleeding surface.
  • 12.  Oxidized regenerated cellulose can be used as a surface dressing because it does not impair epithelialization and is bactericidal to many Gram +ve and Gram –ve organisms both aerobic and anaerobic. Caution should be used when wounds are infected or have an increased potential to be infected ( immunocompromised) because absorbable hemostatic agents can serve as a nidus for infection
  • 13.  Thrombin is a drug capable of hastening the process of blood clotting. It is intended for topical use and is applied as a liquid or powder. Thrombin should never be injected into tissues because it can cause serious, even fatal intravascular coagulation.
  • 14.  Its imperative to recognize that excessive bleeding may be caused by systemic disorders, including platelet deficiencies, coagulation defects, medications and hypertension etc.
  • 15. Sensitivity to Percussion Extension of inflammation to the periodontal ligament may cause sensitivity to percussion Gradually diminishing severity is a favorable sign Pack should be removed and gingiva checked for irritation or infection which should be cleaned or incised to provide drainage
  • 16.  Particles of calculus that were overlooked must be removed Relieving the occlusion is usually helpful Sensitivity may also be caused by excess pack interfering in occlusion. Removal of excess usually corrects the condition.
  • 17. Swelling In the first 2 post op days, some patients may report a soft, painless swelling of the cheek in the surgical area. Lymph node enlargement may occur and temperature may be slightly elevated. This results from a localized inflammatory reaction to the procedure.
  • 18.  It generally subsides by the 4th post operative day without necessitating removal of the pack. If swelling persists or becomes worse or is associated with increased pain, amoxycillin 500mg TID for a week. Also moist heat application by the patient over the area intermittently.
  • 19. POST OPERATIVE PAIN Surgery done according to the standard principles would produce only minor pain and discomfort. One study of 304 consecutive periodontal surgical intervention revealed that 51.3% had minimal or no pain. 4.6% reported severe pain.
  • 20.  Of those with pain only 20.1% took 5 or more doses of analgesics Mucogingival procedures result in 6 times more discomfort and osseous surgery 3.5 times more discomfort than plastic gingival surgery.
  • 21.  A common source of post op pain is overextension of the pack beyond MG junction Overextended packs cause localized areas of edema noticed 1-2 days after surgery. Removal of excess pack is followed by resolution in about 24 hours
  • 22.  Extensive and excessively prolonged exposure and dryness of bone also induces severe pain.
  • 23.  For most of the patients, a preoperative dose of Ibuprofen (600-800mg) followed by one tablet TID for 24-48 hours is effective in reducing the pain and discomfort. Pain related to infection is accompanied by localized lymphadenopathy and a slight elevation in temperature. It should be treated with systemic antibiotics and analgesics