The document outlines the general principles and indications for periodontal surgery, such as addressing irregular bony contours and persistent inflammation. It discusses contraindications, pre-surgical preparations, and necessary surgical instruments, as well as specific procedures including tissue management and osseous recontouring. Post-operative care instructions are also provided, emphasizing pain control and maintenance follow-ups.

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