Areas with irregular bony contours or deep
Pockets on teeth in which a complete removal
of root irritants is not considered clinically
In cases of grade II or III furcation
Infrabony pockets in distal areas of last
Persistent inflammation in areas with
moderate to deep pockets may require a
Patients who do not exhibit good plaque
Uncontrolled or progressive systemic
disease (uncontrolled diabetics,leukemia
Patients taking large doses of
corticosteriods may have reduced
resistance to stress associated with
Patients with imminent terminal disease
who are debilitated are not candidates for
• It is the procedure that means to
eliminate or reduce the pocket, by
excising or amputating the tissue
constricting the pocket wall.
(in this case we remove bone).
Apically positioned flap without
Apically positioned flap with osseous
surgery (Osteoplasty, Osteoctomy).
It is the reunion of connective
tissue by formation of new
cementum with inserting
collagen fibers on root surface
that has been deprived of its
Gingivectomy: Excision of soft tissue wall of
Basic rational is pocket elimination to allow access
for root instrumentation.
Gingivoplasty: To restore gingival contours.(not
commonly used now days).
External bevel incision is done to remove excess
gingiva and healing is by secondary intention.
Are surgical procedures aimed at
Reproduction or reconstruction of lost or
Aim is to restore the periodontium to the
normal physiologic levels.
b) Therapeutic options, such as bone grafts, enamel matrix derivative (EMD),
platelet-derived growth factor (PDGF) or platelet-rich plasma (PRP), can be placed
in the periodontal defect.
c) A membrane (shown in blue) is inserted to guide tissue regeneration (black
Swelling and bruising
Pain, excessive bleeding, exposing the apex,
damage to flap.
infection, secondary to bleeding and pain.
Possible nerve injury may follow depending on site
Keep pack in place.
Avoid hot food.
Use ice pack on the face.
Do not brush the area.
Use mouth rinse after one day.
Do not smoke, follow normal activity, however avoid
Come back to your next appointment.
junction to the
Class I - Incipient furcal involvement
Class II - Patent furcal involvement
Class III - Communicating furcal involvement
Class IV - Clinically visible furcation
Dental implant is an artificial
titanium fixture which is placed
surgically into the jaw bone to
substitute for a missing tooth and
First Surgical Phase (Implant Placement)
Under Local anesthetic the dentist places dental
implants into the jaw bone with a very precise
surgical procedure. The implant remains covered
by gum tissue while fusing to the jaw bone.
Second Surgical Phase (Implant Uncovery)
After approximately six months of healing. Under
local anesthetic, the implant root is exposed and a
healing post is placed over top of it so that the
gum tissue heals around the post.
Prosthetic Phase (Teeth)
Once the gums have healed, an implant crown is
fabricated and screwed down to the implant.
Quality of healing response is also influenced by the
nature of tissue disruption and circumstances
surrounding wound closure.
Healing by First Intention
Healing by Second Intention
Healing by Third intention
This occurs when a clean laceration or surgical incision is
closed primarily with sutures/clips with the edges in
Healing proceeds rapidly with no dehiscence and
minimal scar formation
Soundly united within 2weeks and dense scar tissue is
laid down within 1 month.
Occurs when the wound edges are separated and the gap
between them cannot be bridged directly.
Commonly associated with avulsive injury, local infection or
inadequate closure of wound
Healing occurs slowly from bottom to the surface by a
protracted filling of the tissue defect with granulation and
Results in greater scar tissue formation
Scars shrink in time resulting in wound contracture.
Occurs through a staged procedure that combines
secondary healing with delayed primary closure.
Avulsive or contaminated wound are repeatedly
debrided, along with antibiotic therapy and allowed to
granulate and heal by secondary intention for 5-7 days.
Once adequate granulation tissue has formed and risk of
infection minimal, the wound is then sutured close to
heal by primary intention.