SURGICAL

Pe r i o d o n t a l
THERAPY
PERI 733
PERIODONTICS
III

Dr. Rob Sabatini, DDS, MS

Department o f
Pe r i o d o n t i c s
 SYLLABU
S
COURSE
DIRECTOR
Dr. Rob Sabatini, DDS,
MS Off ice: 303 Wo o d
B l d g Phone:
828-7985
email: [email protected]
 COURSE FACULTY

Dr. Rob Sabatini

Dr. Chris R i c h a r d s o n
Dr. B a r r y
G r i ff i n DR.
J o h n White
DR. Ta r e q
Abdulrasoul
Dr. W h i t n e y
J o h n s o n Dr. C h r i s
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

R e co m m e n d e d Te x t
Carranza's Clinical
Periodontology
13th Edition ( o r
later)

M i c h a e l G. Newman, He nr y H. Takei,
a n d Fermin A. C a r r a n z a , W.B.
S a u n d e r s Company.
 TEXTBOOK

R e c o m m e n d e d Te x t
Periodontics:
Medicine,
Surgery, a n d Implants

Louis F Rose, B r i a n L.
Mealey Mosby, Inc.
Schedul
e Room
442
1 - 2 PM
ATTENDANC
E • A t t e n d a n c e is m a n d a t o r y , a n d
unannounced
a t t e n d a n c e c h e c k s w i l l be d o n e If
Necessary
• First excu sed absence - n o e ff e c t o n g r a d e

• Subsequent excu sed o r u n e x c u s e d

absences d e d u c t t w o p e r c e n t a g e p oints
FROM AVERAGE
• Po i n t s may be r e s t o r e d a t d i s c r e t i o n o f
Course
 GRADIN POLC
G Y
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%
 GRADIN POLC
G Y

• 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.
 GRADIN POLC
G Y

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.
Expectatio
n• Expect
s 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 smoking furcation

hygiene status s

bacterial
skill of
compositio
operator
n

local
systemic pocket
anatomic
health depth
factors
 Sc/RP: Effectiveness
PD % calculus
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