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

Complications of
Periodontal Surgery

INDIAN DENTAL ACADEMY
Leader in Continuing Dental Education

www.indiandentalacademy.com

POST OPERATIVE COMPLICATIONS

 Bleeding
 Infection
 Swelling
 Hypersensitivity
 Adverse tissue changes


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


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


 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


 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.


 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


 For slow, constant blood flow and oozing,
hemostasis may be achieved with
hemostatic agents.
 Absorbable Gelatin Sponge

 Oxidized cellulose

 Oxidized regenerated cellulose

 Thrombin


 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


 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


 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.

 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


 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.


 Its imperative to recognize that excessive
bleeding may be caused by systemic
disorders, including platelet deficiencies,
coagulation defects, medications and
hypertension etc.


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

 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.


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.


 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.

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.


 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.


 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


 Extensive and excessively prolonged
exposure and dryness of bone also induces
severe pain.


 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


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

Recommended

Recommended

More Related Content

What's hot

What's hot (19)

Viewers also liked

Viewers also liked (14)

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

Similar to Complications of periodontal surgery /certified fixed orthodontic courses by Indian dental academy (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

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