Materials and Procedures
PERIODONTAL SURGERY PROCEDURES
OF THE SOFT AND HARD TISSUES
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.
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.
PERIODONTAL SCALING, ROOT
PLANING, AND GINGIVAL CURETTAGE
These three procedures are often performed by the
dentist or hygienist in conjunction with one another to
decrease periodontal inflammation. Scaling
procedures performed independently involve the
complete removal of supra- and sub-gingival calculus
and bacterial debris with hand instruments or
mechanical (ultrasonic) instrumentation.
procedure is usually done by sextants or quadrants of
the patient's mouth.
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.
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.
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.
Gingival curettage is the intentional removal of
the soft tissue wall of a periodontal pocket done under
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.
PERIODONTAL SOFT TISSUE GRAFTS
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.
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