You will need to prepare a tray with a mirror, explorer, periodontal probe, cotton forceps, articulating paper forceps, various rotary stones, rubber wheels and points, high-speed handpiece, articulating paper, occlusal waxes, and gauze sponges. An occlusal equilibration may require that a study cast be made to determine where the occlusion must be adjusted. During the procedure, the dentist uses articulating paper or occlusal wax on the patient's teeth for an accurate registration of occlusal contacts. You will use the gauze sponges to wipe off marks and keep the teeth dry to assure the accuracy of marking. The dentist removes the occlusal interferences by selectively grinding the teeth with a diamond stone in the high speed handpiece. The occlusion is rechecked and the adjusted tooth surfaces are polished with abrasive rubber wheels or points.
These three procedures are often performed by the dentist or hygienist in conjunction with one another to decrease periodontal inflammation.
Scaling and root planing performed together involve more extensive scaling procedures to remove subgingival calculus located in the periodontal pockets and smoothing of root surfaces. Scaling and root planing procedures usually are done by sextants or quadrants of the patient's mouth with local anesthetic.
Scaling procedures performed independently involve the complete removal of supra- and sub-gingival calculus and bacterial debris with hand instruments or mechanical (ultrasonic) instrumentation. This procedure is usually done by sextants or quadrants of the patient's mouth.
Gingival curettage is the intentional removal of the soft tissue wall of a periodontal pocket done under local anesthesia.
A Periodontal patients may experience root sensitivity when elimination of periodontal pockets exposes root surfaces. Root desensitization involves the application of agents or drugs to exposed root surfaces to reduce or eliminate dentinal sensitivity.
Periodontal surgery procedures involving the soft tissue include gingivectomy, gingivoplasty, periodontal flap, and soft tissue graft procedures. Surgery of the hard tissue includes osseous surgery, metallic implants, root amputations, hemisections, and bicuspidization. Your responsibilities in periodontal surgery are similar to those of oral surgery. To properly carry out your duties, you must know which instruments and instrument packs the periodontist desires. You should have all instruments and supplies needed for the particular periodontal treatment set up before the arrival of the patient. A typical periodontal surgery tray is shown in figure 6-14.
Gingivectomy is the surgical excision of the soft tissue wall of suprabony pockets (above the alveolar bone) to eliminate periodontal pockets. The procedure is limited to gingival pockets where a wide band of attached gingiva exists. This surgery results in gingival recession and may expose tooth roots. If a gingivectomy is indicated, the gingival tissue should first be cleared of acute infection. Gingivectomy may be performed with either a scalpel or periodontal knife.
This procedure involves the reshaping of gingival deformities to improve form and function. This technique is useful when gingival overgrowth or gingival craters exist. A gingivoplasty is done to remove excess tissue and recontour the gingiva. Gingivoplasty may be performed with a periodontal knife, a scalpel, or electrosurgery.
A periodontal flap is a technique used in an attempt to correct gingival defects. With the flap technique, a section of the gingiva and or mucosa is surgically separated from the underlying tissues. The roots are thoroughly planed and the gingiva is repositioned to correct a gingival defect and sutured into place.
A soft tissue graft involves the complete separation of tissue from the donor site and placement in another location to correct periodontal or mucogingival defects. You must exercise special care to avoid aspiration of the tissue graft with the suction equipmentContinue Reading