General principles of periodontal surgery All surgical procedures should be carefully planned. The patient should be adequately prepared medically, psychologically, and practically for all aspects of the intervention. Surgical periodontal procedures are usually performed in the dental office. The following findings may indicate the need for a surgical phase of therapy: 1. Areas with irregular bony contours, deep craters, and other defects usually require surgical approach. 2. Pockets on teeth in which a complete removal of root irritants is not considered clinically possible may call for surgery. This occurs frequently in molar and premolar areas. 3. In cases of furcation involvement of grade II or III, a surgical approach ensures the removal of irritants; any necessary root resection or hemisection also requires surgical intervention. 4. Intrabony pockets on distal areas of last molars, frequently complicated by mucogingival problems, are usually unresponsive to nonsurgical methods. 5. Persistent inflammation in areas with moderate to deep pockets may require a surgical approach. In areas with shallow pockets or normal sulci, persistent inflammation may point to the presence of a mucogingival problem that needs a surgical solution. Patient Preparation Reevaluation after Phase I Therapy. Almost every patient undergoes the so-called initial or preparatory phase of therapy, which basically consists of thorough scaling and root planing and removing all irritants responsible for the periodontal inflammation. These procedures (1) eliminate some lesions entirely; (2) render the tissues more firm and consistent, thus permitting a more accurate and delicate surgery; and (3) acquaint the patient with the office and the operator and assistants, thereby reducing the patient’s apprehension and fear. Premedication For patients who are not medically compromised, the value of administering antibiotics routinely for periodontal surgery has not been clearly demonstrated. However, some studies have reported reduced postoperative complications, including reduced pain and swelling, when antibiotics are given before periodontal surgery and continued for 4 to 7 days after surgery. Smoking The deleterious effect of smoking on healing of periodontal wounds has been amply documented. Patients should be clearly informed of this fact and asked to quit or stop smoking for a minimum of 3 to 4 weeks after the procedure. For patients who are unwilling to follow this advice, an alternate treatment plan that does not include more sophisticated techniques (e.g., regenerative, mucogingival, esthetic) should be considered.

1. General Principles
Of Periodontal Surgery
AHMED A. ABDULWAHAB
UG:1330095

2. Indications
1. Areas with irregular bony contours.
2. Pockets on teeth in which a complete removal of root irritants is not considered clinically
possible.
3. Persistent inflammation in areas with moderate to deep pockets.
4. Furcation involvement
5. Intrabony pockets on distal areas of last molars.
Contraindications
1. Patient cooperation - Plaque control , Smoking
2. High bleeding score
3. Blood disorders
4. Poor prognosis teeth

3. Pre-Surgical Preparation of a Patient
1. Re-evaluation
2. Smoking
3. Pre-medication
4. Informed consent
5. Measures to prevent transmission of infection
6. Emergency equipment

4. During Periodontal Surgery
Instruments used in periodontal surgery
1. Excisional and incisional instruments
2. Surgical curettes and sickles
3. Periosteal elevators
4. Surgical chisels
5. Surgical files
6. Scissors
7. Hemostats and tissue forceps

5. During Periodontal Surgery
Procedures involved:
1. Tissue management
2. Scaling and root planing
3. Osseous recontouring
4. Haemostasis
5. Suturing
6. Periodontal dressing
7. Post-operative instruction & medication

6. During Periodontal Surgery
 Tissue management
Incision and/ or excision (atraumatic handling)
Flap elevation
Flap reflection

7. During Periodontal Surgery
Scaling and root debridement
Removal of adherent fibrous and granulomatous tissue
Scaling and root debridement to remove residual subgingival calculus

8. During Periodontal Surgery
Osseous recontouring
Osteoplasty
Removal of non-supporting bone
Ostectomy
Removal of supporting bone

9. During Periodontal Surgery
Haemostasis
Compression with damp gauze for at least 4 minutes
Administration of local anesthetic
Suturing
Periodontal dressing
Zinc oxide/ eugenol (Coe-pack)

10. Post operative instructions &
medications
Post operative pain control
Mefenamic acid, Ibuprofen
No brushing at the site of surgery
Rinse with 0.12%-0.2% CHX mouthwash
Sutures in the mouth

11. Post Surgery
o Review after 1 week and pack removal
o Debridement & post-operation complaints
o Post-operation review
o Maintenance every 2 weeks for 3 months