PERIO - Important surgery notes

What is the treatment sequence for buccal tooth movement when there is inadequate attached gingiva (<2 mm)?

Periodontal surgery first, then orthodontics

What is the treatment sequence for lingual tooth movement?

Orthodontics first, then periodontal surgery if needed

What are the initial acute phase treatment modalities for Necrotizing Ulcerative Gingivitis (NUG)?

Debridement, hydrogen peroxide (or CHX or warm saline) rinses, and oral hygiene instruction

What systemic antibiotic is prescribed for NUG with systemic involvement?

Amoxicillin (250 mg TID for 7 days) and/or Metronidazole (250 mg TID for 7 days)

What surgical procedure is used after the acute phase of NUG to eliminate residual soft tissue interdental craters?

Gingivoplasty

What surgical procedure is indicated for Drug-Induced Gingival Enlargement (DIGE)?

Gingivoplasty

How does a gingivectomy heal?

By secondary intention

What surgical procedure is indicated if Drug-Induced Gingival Enlargement involves more than 6 teeth or an infrabony lesion?

Gingivectomy (may be in combination with gingivoplasty)

What is the primary objective of a Modified Widman Flap (Open Flap Debridement alone)?

Root surface instrumentation and pocket lining

What is the secondary objective of a Modified Widman Flap?

Probing pocket depth reduction

Where is the incision placed relative to the gingival margin in a Modified Widman Flap?

1 to 2 mm apical to the gingival margin

What probing depth criteria indicate a Modified Widman Flap in anterior versus posterior regions?

Probing depth ≥ 4 mm in anterior or ≤ 5 mm in posterior

Where is the incision placed relative to the gingival margin in an Apically Displaced Flap (OFD-AP)?

0.5 mm to 1 mm apical to the gingival margin

What is the purpose of a distal wedge procedure?

Pocket reduction distal to the last tooth and access for debridement

What is the primary objective of an Apically Displaced Flap (OFD-AP)?

Probing pocket depth elimination, access for debridement, and osseous surgery

What probing depth criteria indicate an Apically Displaced Flap (OFD-AP)?

Posterior probing depth ≥ 5 mm requiring pocket depth elimination

What is a contraindication for an Apically Displaced Flap (OFD-AP)?

Anterior sextant

What surgical procedure is indicated for crown lengthening when the attached gingiva is greater than 3 mm?

Gingivectomy

What surgical procedure is indicated for crown lengthening when the attached gingiva is less than 3 mm?

Apically Displaced Flap

What treatment is indicated for 1-wall and 2-wall osseous defects with angular bone loss or shallow craters?

Osseosection (ostectomy plus osteoplasty)

What treatment is indicated for a deep 2-wall defect with shallow craters greater than 4 mm deep requiring regeneration?

Osseosection (ostectomy ± osteoplasty) plus Guided Tissue Regeneration (GTR)

What treatment is indicated for a 3-wall defect or a Grade II furcation in lower 1st and 2nd molars?

Guided Tissue Regeneration (GTR)

What treatment is indicated for a Grade I furcation with early horizontal tissue loss?

Scaling and Root Planing (SRP)

What treatment is indicated for a Grade III furcation (especially lower molars) with through-and-through bone loss?

Hemisection (with apically displaced flap)

What endodontic treatment must precede a hemisection?

Endodontic therapy

What is a high-risk complication associated with tunneling for mandibular Class III furcations?

High risk of root caries

What surgical technique is used to increase the width of attached gingiva in the anterior region for better esthetics and primary intention healing?

Autogenous connective tissue graft (partial thickness flap)

What surgical technique is used to increase the width of attached gingiva in the posterior region (with poor esthetics and secondary intention healing)?

Full thickness flap / Free gingival graft (with apically displaced flap)

What is the primary indication for a coronally displaced flap?

Root coverage only, when an adequate zone of attached gingiva (>2–3 mm) and an adequate vestibule are present apical to the recession

What type of flap is used in a coronally displaced flap?

Partial thickness flap

Does a coronally displaced flap include the zone of attached gingiva in the flap design?

No

What are the requirements for a laterally displaced flap?

An isolated tooth with enough attached gingiva and enough vestibular depth

What is the gold standard surgical technique for root coverage over canines for single or multiple Class I or II Miller recessions?

Subepithelial connective tissue graft (partial thickness)

What tissue and anatomical conditions are required for a subepithelial connective tissue graft?

Good vestibular depth and sufficient gingival thickness for a split thickness flap elevation

What procedure is indicated for shallow gingival recession with adequate attached gingiva (>2–3 mm) and adequate vestibule?

Coronally displaced flap

What is a free gingival graft (FGG) useful for regarding recession and lower incisors?

Small narrow recession, or lower incisors with a shallow vestibule or high frenal attachment

What treatments address Altered Passive Eruption in an anterior single tooth in the esthetic zone?

Orthodontically or surgical crown lengthening

What treatments address Altered Passive Eruption in a posterior non-esthetic site?

Gingivectomy or Apically Displaced Flap

What tissue conditions are required to perform crown lengthening via gingivectomy?

Adequate attached gingiva and greater than 3 mm of tissue coronal to the bone crest

When is crown lengthening performed via a flap instead of a gingivectomy?

In cases of inadequate attached gingiva (<3 mm soft tissue)