Periodontal Surgery

1. GENERAL PRINCIPLES OF
PERIODONTAL SURGERY

2. The word surgery by definition is “ the act and art of treating
injuries or diseases by manual operation”
The term periodontal surgery is applied to surgical
manipulation of periodontal soft tissues and bone and not to
the accompanying scaling and root planing of teeth.

3. OBJECTIVES OF SURGICAL TREATMENT
The main objective is to contribute to the long term
preservation of the periodontium by:
I. Creating accessibility for professional scaling
and root planing
II. Establishing a gingival morphology which
facilitates plaque control
III. Regeneration of periodontal attachment lost due
to destructive disease

4. Indications for surgical treatment
I. Accessibility for proper scaling and root planing
II. Establishment of a morphology of dento-gingival
area conducive to plaque control
III. Pocket depth reduction
IV. Correction of gross gingival aberrations
V. Shift of the gingival margin to a postion apical to
plaque retaining restorations
VI. Facilitate proper restorative therapy

5. FACTORS AFFECTING SURGICAL OUTCOME
1. POOR PATIENT COOPERATION
2.CARDIOVASCULAR DISEASE
ARTERIAL HYPERTENSION
ANGINA PECTORIS
MYOCARDIAL INFARCTION
RHEUMATIC ENDOCARDITIS,CONGENITAL
HEART LESIONS&HEART/VASCULAR IMPLANTS
ANTICOAGULANT TREATMENT
3. ORGAN TRANSPLANTATION

6. 4. BLOOD DISORDERS
5. HORMONAL DISORDERS
DIABETES MELLITUS
ADRENAL FUNCTION
6. NEUROLOGIC DISORDERS
MULTIPLE SCLEROSIS&PARKINSON’S DISEASE
EPILEPSY
7. SMOKING

7. PREPARING FORPERIODONTAL SURGERY

8. PRE-OPERATIVE EXAMINATION
Physical evaluation consists of the following
three components
Medical history
Physical examination
MONITOR VITAL SIGNS
VISUAL INSPECTION
FUNCTION & LABORATORY TESTS

9. Physical status classification system
In 1962 the American Society of Anesthesiologists
adopted what is now commonly referred to a the
ASA Physical Status Classification System. It
represents a method of estimating the the medical
risk presented by a patient undergoing a surgical
procedure.

10. The Classification System follows
ASA I: A patient without systemic disease; a normal,
healthy patient
ASA II: A patient with mild systemic disease
ASA III: A patient with severe systemic disease that
limits activity but is not incapacitating
ASA IV: A patient with incapacitating systemic
disease that is a constant threat to life
ASA V: A moribund patent not expected to survive 24
hours with or without operation
ASA E: Emergency operation

11. STRESS REDUCTION PROTOCOL (ASA I )
 Recognition of anxiety
 Premedication on night before dental appointment
& immediately before dental appointment as needed
 Appointment scheduled in morning
 Minimize waiting time
 Psychosedation during therapy
 Adequate pain control during therapy
 Post operative anxiety/pain control

12. STRESS REDUCTION PROTOCOL: MEDICAL RISK
PATIENT (ASA II,III,IV)
1. Recognition of medical risk
2. Medical consultation before dental therapy
3. Appointment scheduled in morning
4. Preoperative and post operative vital signs
monitored
5. Psychosedation during therapy as needed
6. Adequate pain control during therapy

13. PREPARATION OF THE PATIENT
All surgical procedures should be very
carefully planned. The patient should be
adequately prepared medically,
psychologically and practically for all aspect
of the intervention

14. REVALUATION AFTER PHASE I THERAPY
Every patient undergoes the initial phase of therapy which
consists of thorough scaling and root planing to:
Eliminate some lesions
Render the tissues more firm and consistent
Acquaint the patient with the office and the
operator.
The revaluation phase consists of reprobing and re-
examining all the pertinent findings that previously
indicated the need for the surgical procedure.

15. PRESURGICAL CHARTING
Is done 1 week before surgery.This
includes:
Psychological preparation
Premedication
Nutritional regime
Recording blood pressure

16. PREMEDICATION
PROPHYLACTIC ANTIBIOTICS
Are administered for:
1. Medically compromised patients
2. Risk of Infective Endocarditis
3.Bone-grafting procedures

17.  The value of administering antibiotics routinely for
periodontal surgery had not been clearly
demonstrated
However a few studies
 Ariaudo – The efficacy of antibiotics in periodontal
surgery.
 Dall and Strahan – A clinical evalution of the
benefits of a course of oral penicillin following
periodontal surgery.
 Kole and Wade – Penicillin control of swelling &
pain after periodontal osseous surgery.
 Pendrill & Reddy – The use of prophylactic
pencillin in periodontal surgery.

18. STANDARD REGIMEN
AMOXICILLIN 3.0g ORALLY 1 hr BEFORE
PROCEDURE
& 1.5g 6 hrs AFTER INITIAL DOSE
PATIENTS ALLERGIC TO PENICILLIN
ERYTHROMYCIN STEARATE 1.0g ORALLY 2hrs
BEFORE PROCEDURE,AND HALF THE DOSE 6HRS
AFTER INITIAL DOSE
PARENTERAL ADMINISTRATION FOR PATIENTS
UNABLE TO TAKE ORAL MEDICATIONS-AMPICILLIN
2.0g 30 min BEFORE PROCEDURE,1.0g 6hrs AFTER
INITIAL DOSE
PATIENTS ALLERGIC TO PENICILLIN-CLINDAMYCIN
300mgIV 30 min BEFORE,AND 150mg 6hrs AFTER
INITIAL DOSE

19. ANTIANXIETY & SEDATION
Apprehensive and neurotic patients require
management with antianxiety or sedative/hypnotic
agents.
Commonly used oral antianxiety agents
DRUG
ALPRAZOLAM
DIAZEPAM
LORAZEPAM
TRIAZOLAM
DOSAGE (mg)
0.25-0.5
2-10
1-4
0.125-0.5

20. SETUP FOR PERIODONTAL SURGERY

21. INSTRUMENTS AND MATERIAL USED IN
PERIODONTAL SURGERY
Periodontal surgical instruments are classified as
follows
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

22. GENERAL CONSIDERATIONS
1. The set of instruments should have a
comparatively simple design
2. The number and variety of instruments should be
kept to a minimum
3. The instruments should be stored in sterile ready-
to- use packs or trays
4. The instruments should be in good working
conditions

23. Excisional and Incisional Instruments
Periodontal knives
The Kirkland knife is representative of knives
commonly used for gingivectomy. These knives can
be obtained as either double ended or single ended
instruments. The entire periphery of these kidney
shaped knives is the cutting edge.
Interdental knives
The Orban knife # 1-2 and the Merrifield knife
#1,2,3,4 are examples of knives used for interdental
areas. These spear shaped knives have cutting edges
on both sides of the blades.

24. GINGIVECTOMY KNIFES DISPOSABLE BLADES

25. Surgical Blades
The most commonly used blades are #12D,15 &
15C. The 12D blade is a beak shaped blade with
cutting edges on both sides to engage narrow
restricted areas. The #15 blade is used for thinning
flaps and for all-around use. The #15C blade, a
narrower version of the #15 blade, is useful for
making the initial, scalloping type incision.

26. SURGICAL CURETTES AND SICKLES
Larger and heavier curettes and sickles are needed
during surgery for the removal of granulation tissue,
fibrous interdental tissues & tenacious subgingival
deposits. The Kramer curette #1,2,3 and the
Kirkland surgical instruments are heavy curettes, the
Ball Scaler # B2-B3 is a heavy sickle.
PERIOSTEAL ELEVATORS
These instruments are necessary to reflect and
move the flap after the incision has been made. The
symbol #24G and the Goldman-Fox #14 are well
designed elevators.

27. SURGICAL CHISELS AND HOES
Chisel and Hoes are used for removing and reshaping
bone. The surgical Hoes has a flattened, fishtail-shaped
blade with a pronounced convexity in its terminal portion.
The Hoe is used for detaching pocket walls after
gingivectomy incision and for smoothing root and bone
surface.
The Ochsenbein #1-2 is a useful chisel with a semi-
circular indentation on both side of the shank to engage
around the tooth and into the interdental area.

28. SURGICAL FILES
They are used to smooth rough bony ledges and
to remove all areas of bone. Schluger and
Sugarman files are used with a push and pull
stroke in the interdental areas.
Scissors and Nippers
Used for removing tabs of tissue, trimming the
margin of flaps, enlarging incision in abscesses,
and removing muscle attachments. The Goldman-
Fox #16 with a curved bevelled blade and
serrations are used.

29. SCALERS & CURETTES CHISELS

30. The Instruments included in a standard tray
1. Mouth Mirrors
2. Graduated Periodontal Probe/Explorer
3. Handles for disposable surgical blades
4. Mucoperiosteal elevator and tissue retractor
5. Scalers & Curettes
6. Cotton Pliers
7. Tissue Pliers
8. Tissue Scissors

31. 9.Needle Holder
10.Suture Scissors
11.Plastic Instrument
12.Hemostat
13.Burs
Additional equipment may include-
1. Syringe for local anesthesia
2. Syringe for irrigation
3. Aspirator tip
4. Physiologic saline
5. Surgical gloves, mask & Surgeon’s hood
6. Drapings for the patient

32. STANDARD INSTRUMENT TRAY

33. SUTURE NEEDLES & MATERIALS
Atraumatic suture needles of the 3/8 inch or ½
inch semicircular reverse cutting or conventional
cutting are used for periodontal surgery.For fibrous
thick gingival tissues,a 3/0 black braided silk suture
is used.
The needle is held with the needle holder and
should enter the tissues at right angles and no less
than 2-3mm from the incision.

34. PERIODONTAL DRESSINGS (Periodontal
Packs)
They are mainly used-
1.To protect the wound post surgically
2.To obtain and maintain a close
adaptation of the mucosal flaps
3. For the comfort of the patient

35. It should have the following properties
1.The dressing should be soft and have enough
plasticity and flexibility
2.The dressing should harden within a reasonable time
3.Should be sufficiently rigid to prevent fracture and
dislocation
4.They should have a smooth surface to prevent
irritation to the cheeks and lips
5.Should have bactericidal properties
6.Must not interfere with healing

36. Zinc Oxide-Eugenol Packs
These dressings are supplied as liquid and a
powder that are mixed prior to use.They are based
on the reaction of zinc oxide and eugenol with the
addition of accelerators such as zinc acetate .e.g.
the Wondr-Pak developed by Ward in 1923.
Noneugenol packs
The reaction between a metalic oxide and
fatty acids is the basis for Coe-Pak.This is supplied
in two tubes, the contents of which are mixed
immediately until a uniform colour is obtained.

37. A. One tube contains, an zinc oxide oil (for
plasticity),
a gum (for cohesiveness), and Lorothidol ( a
fungicide)
B. The other tube contains liquid coconut fatty
acids
thickened with Colophony resin (or Rosin) and
Chlorothymol (Bacteriostatic agent)
Other non-eugenol packs include cyanoacrylates
and tissue conditioners (Methacrylate gels)

40. RETENTION OF PACKS
Periodontal dressings are usually kept in place
mechanically by interlocking in interdental spaces
and joining the facial and lingual portions of the
pack
Splints, Stents, and placement of dental floss
enhances retention

41. ANTIBACTERIAL PROPERTIES
Improved healing and patient comfort have been
obtained by incorporating anti-biotics in the pack
Incorporation of Tetracycline powder in Coe-pak is
recommended when long and traumatic surgeries are
performed
Disadvantages
Hypersensitivity reactions
Emergence of resistant organisims &
opportunistic infection

42. PREPARATION AND APPLICATION
Zinc Oxide packs are mixed with eugenol or non-
eugenol liquids on a wax paper pad with a wooden tongue
depressor until a thick paste is formed.
Coe-pak is prepared by mixing equal lengths of paste
from tubes containing the accelerator and base. A capsule
of Tetracycline powder can be added at this time
The pack is placed in a cup of water at room
temperature in two to three minutes looses its tackiness

43. PACK PREPARATION

44. 1.The pack is then rolled into two strips approximately
the length of the treated area
2.The end of one strip is bent into a hook shape and
fitted around the distal surface of the last tooth
3.The remainder of the strip is brought forward along
the facial surface to the mid line and pressed into
place along the gingival margin and interproximally
4.The second strip is applied from the lingual surface. It
is joined to the pack at the distal surface of the last
tooth
5.The strips are joined interproximally by applying
gentle pressure

45. PACK APPLICATION

46. 1.The operator should ask the patient to move the
tongue forcibly out and to each side, and cheeks
and lips should be displaced in all directions to
mould the pack
2.After the pack has set it should be trimmed to
eliminate all excess
3.The pack should cover the gingiva but over
extension on to uninvolved mucosa should be
avoided
4.The pack should not interfere with occlusion as this
jeopardizes retention
5.The pack is kept for one week after the surgery

47. MEASURES TO PREVENT TRANSMISSION OF
INFECTION
In recent years, the danger of transmitting infection
has become apparent, with a threat of acquired immune
deficiency syndrome (AIDS) & Hepatitis B The centre
for disease control recommended infection control
practices:
1. Medical history
2. Use of protective attire and barrier techniques
a) Gloves must be worn when handling blood, saliva or
mucous membrane
b) Change gloves between patients or when torn/punctured

48. c) Surgical masks and protective eye wear or face shields
must be worn
d) Re-useable/disposable gowns must be worn
e) Environmental surfaces must be covered with
impervious material
f) Procedures should minimise splatters and aerosol
formation
3. Hand washing and care of hands
a) Hands must be washed between patients
b) Members of the team who have exudative lesions or
weeping dermatitis should refrain from patient care

49. 4. Use and care of sharp instruments
a) Disposal sharp instruments should be placed in
puncture resistant containers
b) Needles should not be recapped, bent or broken
5. Indications for High Level Disinfections
a) Instruments that penetrate soft tissue or bone
should be sterilised after each use
6. Metal and heat stable instruments should be
sterlised under pressure, dry heat or chemical
vapour

50. 7. Surfaces should be cleaned and disinfected with a
suitable chemical germicide
8. Laboratory supplies and materials should be
disinfected prior to use
9. Routine sterlization of ultrasonic scalers and
hand pieces are desireable

51. LOCALANESTHESIA IN PERIODONTAL
SURGERY
1.Pain management is an ethical obligation and will
improve patient satisfaction and recovery
2.Local Anesthesia is defined as a loss of feeling or
sensation that is confined to a certain area of
the body
3.Local Anesthetics prevent the inward movement
of sodium ion which initiates depolarization

52. TECHNIQUES FOR ANESTHESIA
In the mandible
Analgesia of teeth and soft/hard tissues are
obtained by mandibular block and/or a mental
block
Buccal soft tissues are anesthetized by local
infiltration or blocking the buccal nerve
The lingual tissues are anesthetized by blocking the
lingual nerve and/or by infiltration in the floor
of the mouth close to the site of operation
Supplementary injections may be made in the
interdental papillae.

53. Local anesthesia in the maxilla
1.Local anesthesia of the teeth and buccal
periodontal tissues obtained by injections in
the mucogingival fold of the treatment area.
2.The palatal nerves are anesthetized by
injections made at right angles to the mucosa
and placed 10mm apical to the gingival
margin
For periodontal surgery involving molars
supplementary blocking of the greater
palatine nerve could be considered.

54. COOPERATIVE PERIODONTAL SURGERY
The surgeon and an assistant collaborate in the
surgical management to provide competent care
for the patient.

55. The surgeon must review the following
1.Patient considerations
2.Anatomic consideration & surgical access
3.Design and plan the surgery

56. PRESURGICAL PROCEDURES FOR DENTAL
ASSISTANTS
1.Preparation of the Operatory
2.Wash hand thoroughly
3.Refill towel and soap dispensers
4.Wash all standing equipment-counters, dental
unit, chair, light, instrument panel and chair
attachments
5.Monitor all mobile equipment- oxygen,
vacuum, for proper function
6.Post radiographs, records and charts

57. PREPARATION OF THE ASSISTANT
Cover hair with net and cap
Remove all rings or other jewelry
Scrub hands-use sterile hand brush and
wash from elbows to finger tips for three minutes
Put on operatory gown
PREPARATION OF SURGICALAREA
Attach all sterile instruments to panel-suction tip,
aspirator, evacuators
Arrange medications
Arrange Instrumentation packages and keep
covered with sterile towl

58. PREPARATION OF PATIENT
1.Have patient remove glasses (if appropriate)
2.Drape the patient
3.Site of the operation washed liberally with
antiseptic solution such as iodine lotion
FINAL PREPARATION
1.Put on sterile gloves
2.Uncover surgical instruments

59. CHARACTERISTIC OF AN EXCELLENT SURGICAL
ASSISTANT
1. Is professional and efficient
2. Has a geniune interest in the health care of the patient
3. Keeps patients record neat and orderly and sets the X-
Ray films on the view box
4. Sharpens surgical instruments
5. Prepares and stores the periodontal pack
6. Protects the patients lips by applying petroleum jelly
before surgery

60. 7. Is aware of each stage of the operation
8. Hands instruments to the surgeon in proper
sequence
9. Is responsible for keeping the patient’s face clean
10. Knows how to position mirrors and take
photographs
Is responsible for these measures:
a) Retracting the lips, tongue, and cheeks
b) Aspirating
c) Adjusting the lighting
d) Positioning flaps for stability and access

61. PRINCIPLES OF ATRAUMATIC SURGERY
Psychological preparation of the patient
should protect him against psychological trauma
associated with surgery.
Careful presurgical preparation of the
instruments, the settings of the operation, the
patient, and the personnel involved should protect
against preventable physical injury.

62. TISSUE MANAGEMENTAND HEMOSTASIS
1. Operate gently and carefully
Tissue manipulation should be precise, deliberate and
gentle. Thoroughness is essential but roughness must be
avoided
2. Observe the patient at all times
Pay careful attention to the patient’s reactions. Facial
expression, pallor and perspirations indicate the patient is
experiencing pain, anxiety or fear
3. Be certain the instruments are sharp

63. HEMOSTASIS
Is an important aspect of periodontal surgery
because control of bleeding permits an accurate
visualization of the extent of disease essential for
wound debridement and scaling/root planing
Methods used:
Continuous suctioning with an aspirator
Application of pressure with moist gauze

64. For slow, consistant blood flow and oozing
hemostasis may be achieved with hemostatic agents
Absorbable gelatin sponge is a porous matrix
prepared from pork skin that helps stablize a normal
blood clot. The sponge may be cut into various
sizes and applied to bleeding surfaces. It is absorbed
in 4 to 6 weeks
Oxidized cellulose is a chemical modified form
of surgical gauze that forms an artificial clot. It
absorbs in 1 to 6 weeks

65. ABSORBABLE HEMOSTATIC AGENTS
GENERIC NAME
ABSORBABLE GELATIN
SPONGE
OXIDISED CELULOSE
OXIDISED
REGENERATED
CELLULOSE
MICROFIBRILLAR
COLLAGEN HEMOSTAT
THROMBIN
BRAND NAME
GELFOAM
OXYCEL
SURGICAL
ABSORBABLE
HEMOSTAT
COLLACOTE
THROMBOSTAT

66. Oxidized regenerated cellulose is prepared from
cellulose by reaction with alkali to form a
chemically pure more uniform structure than
oxidized cellulose. It can be used as a surface
dressing because it does not impair epithelialization
and it is bactericidal.
Thrombin is a drug capable of hastening the
process of blood clotting. It is intended for tropical
use and applied as liquid or powder.

67. GENERIC
NAME
ABSORBABLE
GELATIN SPONGE
OXIDISED
CELLULOSE
REGENERATED
CELLULOSE
THROMBIN
ADVERSE
EFFECTS
NIDUS FOR
INFECTION
FOREIGN BODY
REACTION
CYST FORMATION
ALERGIC
REACTION
PRECAUTIONS
SHOULD NOT BE
OVER PACKED
FRIABLE-IMPAIRS
BONE
REGENERATION
INTERFERES WITH
WOUND HEALING
NOT INJECTED
INTO TISSUE OR
VASCULATURE

68. POST OPERATIVE CARE AND MANAGEMENT
Patient instruction after surgery
After the pack is placed, printed instructions are given to
the patient to be read before he/she leaves the chair.
The instructions are:
1. For the first three hours after the operation avoid hot food
to permit the pack to harden. Chew on the non-operated
side. Avoid citrus fruits, highly spiced foods, alcoholic
beverages

69. 2. The pack should remain in place until the next
appointment. Do not investigate dressing with tongue or
fingers
3. Do not smoke
4. Do not brush over the pack
5. During the first day apply ice intermittently on the face
over the operated area
6. Follow regular activities but avoid exertion
7. If swelling occurs, apply moist heat over the operated
area

70. try to stop bleeding by rinsing
8.For post operative comfort take medication
according to instructions in the prescription
given.
9.If there is considerable bleeding, take a piece
of gauze form it into the shape of a “U”, apply it
to both sides of the pack for twenty minutes.

71. smoking
 The deleterious effect of smoking in
healing of periodontal wounds have been
well documented in
Preber & Bergstrom- Effect of cigarette
smoking on periodontal healing following
surgical therapy.
Patient should be informed to quit smoking
for a minimum of 3-4 weeks after the
procedure.

72. THE FIRST POST OPERATIVE WEEK
The following complications may arise in the
first post-operative week although they are the
exception rather than the rule:
1. Persistent bleeding after Surgery.The pack is
removed, the bleeding points are located and
stopped with pressure,electrosurgery/
electrocautery
2. Sensitivity to percussion. The gingiva is checked
for localized areas of infection/irritation, which
should be cleaned or incised to provide drainage

73. 3. Swelling occurs sometimes within the first two
post operative days. If it persists/becomes worst
then amoxyicillin, 500mg should be taken every
8 hours for one week and patient instructor to
apply moist heat intermittently
4. Feeling of weakness. Occasionally patients
experience a “washed-out”, weakened feeling
for about 24 hours after the operation. This
represents a systemic reaction to a transient
bacteremia

74. REMOVAL OF THE PERIODONTAL PACK
AND RETURN VISIT CARE
When the patient returns after one week, the pack
is taken off by inserting a surgical hoe along the
margin and exerting gentle lateral pressure. Pieces of
pack retained interproximally are removed with
scalers. The entire area is rinsed with peroxide to
remove superficial debris

75. FINDINGS AT PACK REMOVAL
1. If gingivectomy has been performed, the cut surface is covered
with a friable mesh work of new epithelium. If calculus has not
been completely removed, red, beadlike protruberances of
granulation tissue will persist
2. After a flap operation areas corresponding to the incisions are
epithelialized but may bleed when touched. Pockets should not
be probed
3. The facial lingual mucosa may be covered with a layer of food
debris. This is removed with a moist cotton pellet

76. REPACKING
It is adviceable to repack for an additonal week for
patients with
1. A low pain threshold
2. Extensive periodontal involvement
3. Slow healing
TOOTH MOBILITY
Is increased immediately after surgery but diminishes
below the pretreatment level by the fourth week

77. COMPLICATIONS FOLLOWING SURGERY
The most significant complications are
1.Shock
2.Hemorrhage
3.Pain
4.Swelling
5.Delayed healing
6.Allergic reactions
7.Sensitivity of the teeth

78. MANAGEMENT OF POST-OPERATIVE PAIN
A preoperative dose of ibuprofen (600-800mg)
followed by one tablet every eight hours for 24 to 48
hours is effective in reducing discomfort after therapy
When severe post-operative pain is present the area is
anesthetized by infiltration/topically, the pack is removed
and wound examined
A common source of post-operative pain is over
extension of the periodontal pack
Removal of excess pack is followed by resolution in
about 24 hours

79. TREATMENT OF SENSITIVE ROOTS
The root hypersensitivity may occur
spontaneously as a result of gingival recession or
may appear after scaling and root planing and
surgical procedures
It is manifested as pain induced by cold or
hot temperature, citrus fruits/sweets or contact
with tooth brush/dental instrument

80. The patient should be informed about the
possibility of root hypersensitivity before
treatment is undertaken
The following information should be given
to the patient:
1. Hypersensitivity appears as a result of exposure
of dentin, which is inevitable if calculus & plaque
are removed
2. Hypersensitivity slowly disappears over a few
weeks
3. Plaque control is important for the reduction of
hypersensitivity

81. 4. Desensitizing agent have to be used for several
days/weeks to produce results
Desensitizing agents can be applied by the patient at
home or by the dentist in the dental hospital

82. AGENTS USED BY THE PATIENT
The most common agents used are dentifrices. The
following have been approved by the American Dental
Association
Sensodyne &Thermodent:contain strontium chloride
Denquel and Promise: contain potassium nitrate
Protect: contains sodium citrate

83. OFFICE TREATMENT FOR HYPERSENSITIVITY
(Dent Clin North Am 1990)
CAVITY VARNISHES
ANTIINFLAMATORY AGENTS
BURNISHING OF DENTIN
SILVER NITRATE
ZINC CHLORIDE
FORMALIN
CALCIUM COMPOUNDS
FLUORIDE COMPOUNDS
IONTOPHORESIS
STRONTIUM CHLORIDE
POTASSIUM OXALATE
RESTORATIVE RESINS
DENTIN BONDING AGENTS

84. Hospital periodontal surgery
The purpose of hospitalization is to
protect patients by anticipating their special
needs & not to perform periodontal surgery
when it is contraindicated by the patient’s
general condition

85. INDICATIONS
1.Optimal control and management of
apprehensive patient
2. For individuals who cannot endure multiple
visits to complete surgical treatment
3. Patient protection.
4. The purpose of hospitalization is to protect
patient by anticipating their special needs, not to
perform periodontal surgery when it is
contraindicated by the patients general condition.

86. The length of the hospital stay is 48 hours.The
patient is admitted in the afternoon preceeding the
day of operation to allow time for a physical
examination,a hemogram and other laboratory
procedures.
Patients should be given a sedative/tranquilizer
the night before surgery.Local anesthesia is the
method of choice as it permits unhampered
movement of the head necessary for optimal
visibility and accessibility.

87. Surgery is performed on the operating table
positioned flat or with the head inclined up to 30
degrees.The assistant stands on the side of the
table opposite the operator.When under general
anesthesia periodontal dressing is placed after the
patient has recovered sufficiently to have a
demonstrable cough reflex.

88. CONCLUSION
1.Establish specific objectives prior to the
periodontal surgery
2.Avoid surgery when it may constitute a health
hazard to the patient
3.Prepare the patient both mentally and
physically
4.Take proper precautions against surgical
infections

89. 5.Follow the principles of atraumatic surgery
6.Be prepared to handle emergency situations
7.Give proper post operative care