SURGICAL Periodontal
THERAPY
PERI 733
PERIODONTICS III
Dr. Rob Sabatini, DDS, MS
Department of Periodontics
SYLLABUS
COURSE DIRECTOR
Dr. Rob Sabatini, DDS, MS
Office: 303 Wood Bldg
Phone: 828-7985
email:
[email protected] COURSE FACULTY
Dr. Rob Sabatini
Dr. Chris Richardson
Dr. Barry Griffin
DR. John White
DR. Tareq Abdulrasoul
Dr. Whitney Johnson
Dr. Chris Ricker
ACCOMMODATIONS
Formal identification and determination of accommodations
must be made with the VCU Division for Student Success,
located on the MCV campus.
All students wishing to receive accommodations are required to
provide to the course director an official memo indicating the
requested academic accommodations.
Any accommodation related to examinations must be presented
to the course director at least four days prior to the exam.
CONDUCT/ETHICS
The course is governed by the VCU Honor Code, the VCU School of Dentistry Guidelines Governing
Blah, Blah, Blah
Examinations and Laboratory Assignments (available on School of Dentistry intranet), and the American Dental
Association Principles of Ethics and Code of Professional Conduct (available on the American Dental
Association web site www.ada.org) or the Principles of Ethics of the American Dental Hygiene Association
(www.adha.org). Students are responsible for understanding the content of these documents.
No Cheating Allowed
COURSE DESCRIPTION
This course introduces the student to various procedures
used in the surgical treatment of:
• periodontal diseases
• mucogingival defects
• sites requiring pre-prosthetic and pre-implant surgery
This is achieved through a series of lectures and clinical
case presentations. Emphasis is placed on the underlying
biological principles of wound healing.
COURSE GOALS
The goal of this portion of the periodontics
curriculum is to provide the student an
opportunity to acquire background and
understanding of the surgical procedures
currently used in the treatment of
periodontal diseases and conditions.
LEARNING OBJECTIVES
• Recognize and describe clinical periodontal problems
• Understand the rationale for the different therapeutic procedures
• Describe the sequential steps in the various treatment modalities
• Understand the technical aspects of periodontal surgical
procedures
• Understand the relation of wound healing to individual surgical
procedures
TEXTBOOK
Recommended Text
Carranza's Clinical
Periodontology
13th Edition (or later)
Michael G. Newman, Henry H. Takei,
and Fermin A. Carranza, W.B. Saunders
Company.
TEXTBOOK
Recommended Text
Periodontics: Medicine,
Surgery, and Implants
Louis F Rose, Brian L. Mealey
Mosby, Inc.
Schedule
Room 442
1 - 2 PM
ATTENDANCE
• Attendance is mandatory, and unannounced
attendance checks will be done If Necessary
• First excused absence - no effect on grade
• Subsequent excused or unexcused absences
deduct two percentage points FROM AVERAGE
• Points may be restored at discretion of Course
Director with paper on missed topic
GRADING POLCY
Satisfactory completion of PER 733
requires a final cumulative average of
70 or greater based on the following:
a) Mid-term examination (multiple choice/discussion) 50%
b) Final examination (multiple choice/discussion) 50%
100%
GRADING POLCY
• Fractions in the final average grade will be rounded up
to the next highest whole number.
• Answer keys will not be posted, exams will be available
for individual review in my office at scheduled times.
• Following an examination, any critique concerning a
question or answer must be submitted to the course
director within 24 hours.
GRADING POLCY
If an examination is missed, the student must take a
make-up exam to be given at the
discretion of the course director.
The exam must be retaken during the school week,
between 8:00 a.m. and 5:00 p.m. The
examination format will likely contain both
written and oral components.
GRADING POLCY
Grade Scale
90 -100 = A
80 - 89 = B
70 - 79 = C
0 - 69 = F
Tutoring Policy: A student who is not performing adequately,
or who is failing the course, must meet with the course director
to arrange for review of course information and development of
a plan to facilitate successful completion of the course.
COURSE FAILURE
A student earning a failing grade may
remediate or repeat the course, based on
the decision of the Academic Progrerss
Committee (APC).
The method of course remediation or
repetition will also be at the discretion of
the APC.
Expectations
• Expect lectures to be posted on Canvas (possible exceptions)
• Expect that not everyone will receive an A or B grade for the course
• Expect attendance to be taken periodically
• Expect to learn some things about periodontal surgery
• Expect to hear about: Hokies, Yankees, Wild Animals
Periodontal Surgery
Rob Sabatini, DDS, MS
Department of Periodontics, VCU
Periodontal Therapy
Therapeutic Goals:
• Resolve inflammation
• Arrest disease progression
• Regenerate lost periodontium (?)
• Deter recurrent disease
• Establish and maintain comfort, function, esthetics
Periodontal Therapy
Therapeutic Endpoints:
• Plaque control compatible with health
• Shallow sulci
• Eliminate/minimize bleeding on probing/inflammation
• Establish physiologic architecture of soft/hard tissues
PIOESRPEIT
PIOE
SRP
EIT
Pre-doc Treatment Planning
• Periodontal Evaluation
• Initial Therapy Phase
• Evaluation of Initial Therapy
• ???
Periodontal Evaluation: PIOE
• medical history
• examination & charting
• radiographic evaluation
• periodontal diagnosis
• treatment plan
Initial Therapy Phase
• medical consultations
• oral hygiene instructions
• occlusal adjustment
• scaling and root planning (SRP)
• more oral hygiene instructions
Evaluation of Initial Therapy
• evaluate tissue response
• evaluate oral hygiene
• repeat exam and charting
• determine next Tx options
Initial Therapy
Factors Affecting Success of
Initial Therapy
oral hygiene smoking status furcations
bacterial
skill of operator
composition
local anatomic
systemic health pocket depth
factors
Sc/RP: Effectiveness
% calculus
PD free
1 – 3 mm 86
4 – 6 mm 43
> 6 mm 32
Caffesse et al. (1986)
Limitations:
Maxillary Molars
Limitations:
Mandibular Molars
Sc/RP: Response
Initial PD Decr. PD Attch. Gain
4 – 6mm 0.96 0.23
> 7mm 2.2 0.91
Bottom Line
Scaling and root planing will improve probing
depths by about 1 mm in moderate pockets
and 2 mm in deep pockets..
Gains in attachment levels will be even less.
More Importantly
Incomplete removal of subgingival plaque
and calculus often results in persistent
infection and continued loss of attachment.
Possible Outcomes of the EIT
• periodontal health with minimal probing
depth ( < 4mm)
• periodontal health with residual moderate to
severe probing depths ( > 5mm)
• localized sites with persistent inflammation,
bleeding on probing, probing depths > 5mm
• generalized persistent inflammation,
bleeding on probing, probing depths > 5mm
Treatment Options
• periodontal maintenance
• continue initial therapy
• repeat Sc/RP
• systemic antibiotics
• local delivery antibiotics
• surgical perio Tx
Nonsurgical vs Surgical Tx
Disease Recurrence - ScRP vs Surgery
▪ twice as many teeth from ScRP only group required
retreatment compared to surgery group
(Ramfjord,1987)
▪ sites with deeper probing depths are more prone to
further breakdown (Badersten, 1990)
Periodontal Surgery
Definition:
Surgical manipulation of periodontal soft
tissues, tooth roots and bone
Primary Goal:
To create an oral environment that is conducive
to maintaining the patient’s dentition in health,
comfort and function
Surgical Objectives
• Provide access to debride roots and bone
• Modify osseous architecture
• Repair / regenerate the periodontium
• Pocket reduction
• Establish acceptable soft tissue contours
Surgical Options for the
Treatment of Periodontitis
• Open Flap Debridement
• Osseous Resective Surgery, a.k.a. Flap & Osseous
• Regeneration, a.k.a. Guided Tissue Regeneration (GTR)
• Root Resection
• Extraction / Replacement with Dental Implants
PER 733
flap procedures for Tx of
periodontitis periodontal regeneration
procedures
crown lengthening mucogingival surgical
procedures procedures
• make appropriate referrals
• understand procedures
• explain procedures to patients
• know what to expect
The End
