Flap op

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Flap op

  1. 1. periodontal surgery
  2. 2. 影響結果的幾個 factor-5
  3. 3. And in flap curettage without a barrier membrane, sufficient width of keratinized gingiva is necessary
  4. 4. evidence-1 Becker
  5. 5. evidence-2 Rosling
  6. 6. tx effect analysi s
  7. 7. RADIOGRAPHIC OUTCOME infrabony component depth reduction after tx depth < 2mm ratio angle change smoker 0.07 8% +1 non-smoker 0.92 39% +9
  8. 8. discussion Isidor et al. (1985) the 13 sites treated with NSPT was almost identical to the one in the present study (3.4 versus 3.2 mm in 7mm PPD) the CAL reduction was inferior (1.6 versus 2.3 mm). the radiographic bone level was essentially unchanged following nonsurgical therapy
  9. 9. present sdudy Isidor 1985 Renvert 1985 > 7mm CAL gain 3.2 3.4 PPD reduction 2.3 1.6 radiogaphic 0.69 non Bone gain 1.2 0.3 probing bone gain
  10. 10. Additional analysis /mm total OFD & MWF PPF MPPT & PPPF SPPF MMIST CALbasline 8.75 8.91 9.5 7.7 9.4 9.6 CAL 1.65 1.57 1.3 1.62 2.48 4.1 PPD 6.74 6.56 7.3 7.1 8.02 7.5 PPD 2.8 2.77 2 2.69 3.59 4.4 REC 1.26 1.35 0.7 1.03 1.31 -0.3 4.4 4.25 4.3 4.35 3.1 gain reduction increase residua l pocket
  11. 11. 14 -235 /mm total 1 -10 OFD & MWF PPF 2 -34 4 -187 MPPT & PPPF SPPF 1 -15 MMIST CALbasline 8.75 8.91 9.5 7.7 9.4 9.6 CAL 1.65 1.57 1.3 1.62 2.48 4.1 PPD 6.74 6.56 7.3 7.1 8.02 7.5 PPD 2.8 2.77 2 2.69 3.59 4.4 REC 1.26 1.35 0.7 1.03 1.31 -0.3 4.4 4.25 4.3 4.35 3.1 gain reduction increase residua l pocket
  12. 12. Additional analysis /mm total OFD & MWF PPF MPPT & PPPF SPPF MMIST CALbasline 8.75 8.91 9.5 7.7 9.4 9.6 CAL 1.65 1.57 1.3 1.62 2.48 4.1 PPD 6.74 6.56 7.3 7.1 8.02 7.5 PPD 2.8 2.77 2 2.69 3.59 4.4 REC 1.26 1.35 0.7 1.03 1.31 -0.3 4.4 4.25 4.3 4.35 3.1 gain reduction increase residua l pocket
  13. 13. Additional analysis /mm total OFD & MWF PPF MPPT & PPPF SPPF MMIST CALbasline 8.75 8.91 9.5 7.7 9.4 9.6 CAL 1.65 1.57 1.3 1.62 2.48 4.1 PPD 6.74 6.56 7.3 7.1 8.02 7.5 PPD 2.8 2.77 2 2.69 3.59 4.4 REC 1.26 1.35 0.7 1.03 1.31 -0.3 4.4 4.25 4.3 4.35 3.1 gain reduction increase residua l pocket
  14. 14. Additional analysis /mm total OFD & MWF PPF MPPT & PPPF SPPF MMIST CALbasline 8.75 8.91 9.5 7.7 9.4 9.6 CAL 1.65 1.57 1.3 1.62 2.48 4.1 PPD 6.74 6.56 7.3 7.1 8.02 7.5 PPD 2.8 2.77 2 2.69 3.59 4.4 REC 1.26 1.35 0.7 1.03 1.31 -0.3 4.4 4.25 4.3 4.35 3.1 gain reduction increase residua l pocket
  15. 15. JP 1998.Laurell303--313
  16. 16. OFD pocket reduction OFD with bone graft GTR limited limited prominant CAL gain 1.5mm 2.1mm 4.2mm bone fill 1.1 2.1mm 3.2mm crest resorption re-entry procedures also demonstrated a eresiai ré sorption that in general averaged 1 mm no significant correlation between defect depth and CAL gain following OFD Bone fill showed a statistically significant, correlation to defect depth
  17. 17. open flap
  18. 18. open flap + bone graft
  19. 19. GT R
  20. 20. furcation
  21. 21. MIST
  22. 22. main objectives of the MIST (1) reduce surgical trauma (2) increase flap/wound stability (3) allow stable primary closure of the wound (4) reduce surgical chair time (5) minimize patient discomfort and side effects.
  23. 23. MIST Flap elevation * The SPPF was performed whenever the width of the inter-dental space was 2mm or narrower, MPPT was applied at inter-dental sites wider than 2 mm. The inter-dental incision (SPPF or MPPT) was extended to the buccal and lingual aspects of the two teeth adjacent to the defect. These incisions were strictly intra-sulcular to preserve all the height and width of the gingiva, and their mesio-distal extension was kept at a minimum to allow the corono-apical elevation of a very small full-thickness flap with the objective to expose just 1–2mm of the defect-associated residual bone crest. vertical- releasing incisions were always kept very short and within the attached gingiva (never involving the muco-gingival junction) The overall aim of this approach was to avoid using vertical incisions whenever possible or to reduce at minimum their number and extent when there was a clear indication for them. Periosteal incisions were never performed. JCP 2007.Cortellini.
  24. 24. Maurizio S. Tonetti
  25. 25. Maurizio S. Tonetti
  26. 26. Maurizio S. Tonetti
  27. 27. Maurizio S. Tonetti
  28. 28. Maurizio S. Tonetti
  29. 29. In order to increase surgical effectiveness, the use of operating microscopes and microsurgical instruments has been suggested (Cortellini & Tonetti 2001, 2005)
  30. 30. Defect anatomy Presence of at least one tooth with probing pocket depth (PPD) and CAL loss of at least 5mm associated with an intrabony defect of at least 3mm involving predominantly the interdental space of the tooth. Teeth that presented a detectable buccal and/or a lingual intrabony component were excluded
  31. 31. JCP 2009.Cortellini.
  32. 32. JCP 2009.Cortellini.
  33. 33. JCP 2009.Cortellini.
  34. 34. The supracrestal interdental tissues, therefore (i) remained attached to the root cement of the crest-associated tooth with its supracrestal fibres, (ii) maintained continuity with the palatal tissue (iii) were not elevated or displaced JCP 2009.Cortellini.
  35. 35. JCP 2009.Cortellini.
  36. 36. At the end of instrumentation, EDTA was applied on the root surface for 2 min. and then the defect area was carefully rinsed with saline. Before the application of EMD, a single modified internal mattress suture was positioned at the defect-associated interdental area (6-0 PTFE Goretex). or 7-0 e- The suture was left loose. JCP 2009.Cortellini.

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