Disadvantages and contraindications of periodontal surgery

1. Disadvantages and contraindications of periodontal surgery

2. Objectives of periodontal surgery • attain a cleanable environment • Augment keratinised gingival • Improve aesthetics • Establish biological width • regeneration

3. Factors that affect success rates • Patient selection • The amount of recession (dentists use multiple classification systems to rate the location and severity of gingival recession) • Surgical technique • Patient compliance • The degree to which the underlying cause(s) of the patient's gingival recession has been addressed.

4. General contraindications for Periodontal surgery Patients who have certain systemic diseases or conditions Patients who take certain medications Patients who are totally noncompliant with self care Patients who have a high risk for dental caries Patients who have unrealistic expectations for surgical outcomes.

5. Systemic diseases Recent heart attack Uncontrolled hypertention Uncontrolled diabetes Certain bleeding disorders Kidney dialysis History of radiation to the jaw HIV infection

6. Incompliant patient The outcome of surgery depends on plaque control and oral hygiene Smoking adversely affects healing Post operative care is complex and more demanding of patient

7. Dental caries Some types of periodontal surgery result in partial exposure of tooth root. In patients with uncontrolled dental caries, where the risk for dental caries is high you need consider the devastating effect of rampant root caries.

8. Unrealistic expectation Surgery doesn’t always result in a perfectly restored periodontium even when performed by the most skilled periodontal surgeon If a patient can not develop a realistic expectation,it would not be wise to do the surgery. A dentist and patient may have a different view on whether the outcome is a success or not

9. Disadvantages of specific procedures • Repositioned flap • Apically repositioned flap • Gingivectomy • Grafting

10. Disadvantages of repositioned flap • Often results in recession, which can be un-aesthetic and may lead to sensitivity. • Healing is by the formation of a long junctional epithelium. This may not be stable.

11. Disadvantages of apically repositioned flap • Tooth lengthening, which can be unaesthetic. • Exposure of root surface which can lead to sensitivity and root caries.

12. Disadvantages of gingivectomy • Not suitable for management of deep pocketing. • Exposed root which can lead to sensitivity and root caries. • Loss of attached gingivae. • Sore for pt post-op.

13. General post-operative complications • 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

14. Complications of grafting • Infection • the graft can slough or fail to integrate into the host site • Early healing may be cosmetically unappealing, and may lead the patient to conclude that the procedure was unsuccessful. • For example a soft tissue graft requires 4-6wks before it appears normal. It may then take several weeks before it matures.