Complications ofPeriodontal Surgery      INDIAN DENTAL ACADEMY   Leader in Continuing Dental Education  www.indiandentalac...
POST OPERATIVE COMPLICATIONS Bleeding Infection Swelling Hypersensitivity Adverse tissue changes      www.indiandenta...
BLEEDING Periodontal Surgery can produce profuse  bleeding especially during initial incision  and flap reflection It di...
Bleeding … Intra operative bleeding can be managed by  aspiration Pressure applied with moist gauze is good  adjunct to ...
 Excessive hemorrhage after initial incision  and flap reflection may be caused by  laceration of venules, arterioles, or...
 In spite of all the care, bleeding may occur  because of anatomic variations. If a medium or large vessel is lacerated,...
 Excessive bleeding from a surgical wound  also may result from incisions across  capillary plexus Minor areas can be st...
   For slow, constant blood flow and oozing,    hemostasis may be achieved with    hemostatic agents.      Absorbable Ge...
 Absorbable Gelatin Sponge is a porous  matrix prepared from pork skin that helps  stabilize a normal blood clot The spo...
 Oxidized cellulose is a chemically modified  form of surgical gauze that forms an  artificial clot The material is fria...
 Oxidized regenerated cellulose is prepared  from cellulose by reaction with alkali to  form a chemically pure, more unif...
 Oxidized regenerated cellulose can be used  as a surface dressing because it does not  impair epithelialization and is b...
 Thrombin is a drug capable of hastening the  process of blood clotting. It is intended for topical use and is applied  ...
   Its imperative to recognize that excessive    bleeding may be caused by systemic    disorders, including platelet defi...
Sensitivity to Percussion Extension of inflammation to the  periodontal ligament may cause sensitivity  to percussion Gr...
 Particles of calculus that were overlooked  must be removed Relieving the occlusion is usually helpful Sensitivity may...
Swelling In the first 2 post op days, some patients  may report a soft, painless swelling of the  cheek in the surgical a...
 It generally subsides by the 4th post  operative day without necessitating removal  of the pack. If swelling persists o...
POST OPERATIVE PAIN Surgery done according to the standard  principles would produce only minor pain  and discomfort. On...
 Of those with pain only 20.1% took 5 or  more doses of analgesics Mucogingival procedures result in 6 times  more disco...
 A common source of post op pain is  overextension of the pack beyond MG  junction Overextended packs cause localized ar...
   Extensive and excessively prolonged    exposure and dryness of bone also induces    severe pain.        www.indiandent...
 For most of the patients, a preoperative dose  of Ibuprofen (600-800mg) followed by one  tablet TID for 24-48 hours is e...
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Complications of periodontal surgery /certified fixed orthodontic courses by Indian dental academy

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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.


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

  1. 1. Complications ofPeriodontal Surgery INDIAN DENTAL ACADEMY Leader in Continuing Dental Education www.indiandentalacademy.com
  2. 2. POST OPERATIVE COMPLICATIONS Bleeding Infection Swelling Hypersensitivity Adverse tissue changes www.indiandentalacademy.com
  3. 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 www.indiandentalacademy.com
  4. 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 www.indiandentalacademy.com
  5. 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 www.indiandentalacademy.com
  6. 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. www.indiandentalacademy.com
  7. 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 www.indiandentalacademy.com
  8. 8.  For slow, constant blood flow and oozing, hemostasis may be achieved with hemostatic agents.  Absorbable Gelatin Sponge  Oxidized cellulose  Oxidized regenerated cellulose  Thrombin www.indiandentalacademy.com
  9. 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 www.indiandentalacademy.com
  10. 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 www.indiandentalacademy.com
  11. 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. www.indiandentalacademy.com
  12. 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 www.indiandentalacademy.com
  13. 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. www.indiandentalacademy.com
  14. 14.  Its imperative to recognize that excessive bleeding may be caused by systemic disorders, including platelet deficiencies, coagulation defects, medications and hypertension etc. www.indiandentalacademy.com
  15. 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 www.indiandentalacademy.com
  16. 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. www.indiandentalacademy.com
  17. 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. www.indiandentalacademy.com
  18. 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. www.indiandentalacademy.com
  19. 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. www.indiandentalacademy.com
  20. 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. www.indiandentalacademy.com
  21. 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 www.indiandentalacademy.com
  22. 22.  Extensive and excessively prolonged exposure and dryness of bone also induces severe pain. www.indiandentalacademy.com
  23. 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 www.indiandentalacademy.com

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