This document provides an overview of principles of periodontal surgery. It discusses patient preparation including pre-treatment with scaling and root planing. It outlines measures to prevent infection transmission and the use of sedation or anesthesia. The document details proper tissue management during surgery, achieving hemostasis, using periodontal dressings, and providing post-operative instructions and follow-up care including pack removal and managing any pain.

1. Principles of Periodontal Surgery

2. OVERVIEW
 Out patient surgery
 Patient preparation.
 Emergency equipment.
 Measures to prevent transmission of infection.
 Sedation and Anesthesia
 Tissue Management.
 Scaling and root planing.
 Haemostasis
 Periodontal dressings.
 Postoperative instructions
 First postoperative week
 Removal of pack and return visit
 Mouth care between procedures.
 Management of postoperative pain.

3. Outpatient surgery
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.

4. Premedication –the prophylactic
use of antibiotics in patients who
are otherwise healthy has been
advocated for bone grafting
procedures and purported to
enhance the chances of new
attachment.

5. Smoking and informed consent
Patient are asked to quit smoking
for minimum of 3 to 4 weeks after
the procedure.
Informed consent– should be
informed at the initial visit about the
diagnosis, prognosis , different
possible treatments , with their
expected results all pros and cons
of each approach.

6. Emergency equipment
The most common emergency is
syncope , the operator , all
assistants and office personnel
should be trained to handle all the
possible emergencies that may
arise.

7. Prevention of infection
Universal precautions ,including
protective attire ,and barrier
techniques are strongly
recommended.

8. Sedation and anesthesia
The area to be treated should be
thoroughly anesthetized by means
of regional block and local
infiltration injections.
Apprehensive and neurotic patients
require special management with
anti anxiety or sedative-hypnotic
agents.

9. Tissue management
Operate gently and carefully.
Observe the patient at all times.
Be certain the instruments are
sharp.

10. Scaling and root planing
Under phase one therapy, all
exposed root surfaces should be
carefully explored and planed as
needed as part of the surgical
procedure.

11. Hemostasis
 Periodontal surgery can produce
profuse bleeding, especially during the
initial incisions and flap reflection.
 After flap reflection and removal of
granulation tissue , bleeding is reduced.
 Hemostasis may be achieved with
hemostatic agents. Absorbable gelatin
sponge , oxidized cellulose , and
microfibrillar collagen hemostat are
useful hemostatic agents for the control
of bleeding in capillaries , small blood
vessels and deep wounds.

12. Periodontal dressings
Zinc oxide eugenol packs-
Non eugenol packs

13. Post operative instructions
Printed instructions are given to the
patient to be read before he or she
leaves the chair.

14. Pack removal
When the patient returns after one
week ,pack is taken off , the entire
area is rinsed with peroxide to
remove superficial debris.

15. Mouth care between procedures
Rinsing with a chlorhexidine
mouthwash or its topical
application with cotton tipped
applicators is indicated .

16. Post-operative pain
 When severe post operative pain is
present , the patient should be seen at
the office on emergency basis . The area
is anesthetized , the pack is removed ,
and the wound is examined.
 Post operative pain related to infection
is accompanied by localized
lymphadenopathy and slight elevation in
temperature. It should be treated with
systemic antibiotics and analgesics.

17. Hospital periodontal surgery
Indications –optimal control,
Management of apprehension,
convenience for individuals who
cannot endure multiple visits to
complete surgical treatment.
Patient protection.

18. Thank you.