Periodontal surgery :: Browse our gallery

It is about a young woman, aged 29, a smoker and as we can see from the photos with a negative attitude towards oral hygiene. The abundant amount of tartar not only spaced and bared the teeth, but also seriously deformed the gums, especially in the front with a bizarre shape.


Here is what the crown looks like after thoroughly cleaning the tartar with an ultrasonic scaler at the front and back. The complete consumption of the attached gingiva in the area of 41 teeth is quite clear.

We suggested surgery "laterally displaced flap on the leg" / see the diagram below /, but the patient refused





In this operation, we cut the gum around the affected tooth in the way shown in the left picture and remove it. Then we move the adjacent strong part and sew it on the defect as we can see from the second picture. A section in the neighborhood remains without a wreath, but with a preserved periosteum. We put a special bandage on the operative wound for 10 days, during which time the surrounding crown covers the exposed area with mucous membrane.

Some more schemes of periodontal surgery:


Kolarov papillectomy


Gingivectomia simplex - left with continuous incision, right with scalloped


Scalpel direction - left in Gingivectomia simplex, right in Gingivectomia radicalis


Scalpel direction - left in Gingivectomia simplex, right in Gingivectomia radicalis


This is how the periodontal pocket and pathologically altered tissues disappear and we return the periodontium to normal, but at a lower level.


Deepening of the vestibule according to Clark. We now call it the apical flap. It is about creating an attached gingiva when it is missing or scarce.




Federspiel's frenectomy. Today we do it more often with a laser.


Frenectomy - Z-plastic according to Limberg. The best we can do to remove a frenulum. Tissue elongation is significant. No possibility of recurrence.


Particularly severe case of gingival recession of the left upper canine tooth. It is about a 55-year-old woman, a non-smoker.

The patient underwent 3 surgical interventions within one year:
- First - laterally moved flap on the leg
- Second - coronary drawn lamp
- Third - inserted connective tissue graft


In the left photo - the effect after the operations. On the right arrows, indicate the surgical scar from the donor area for the connective tissue graft.


Gingival recessions combined with wedge-shaped defects of 22 and 23 teeth.

Follow the arrows in the next picture and you will notice that the width of the gingiva is not the same over all teeth. Above those with crowns, it is about 2 times wider than above those with a recession. In principle, this strip of fixed gingiva (above it is movable) must be at least 4 mm. When it is narrower, such as over 23 and 22 teeth, where it is about 2 mm. There is a micro trauma on the part of the movable gingiva and recessions follow. Above 21 teeth, this strip is again normal in width and of course, there is no recession.



We offered the patient 2 operations:
- First - an apical flap to create a wider strip of attached gingiva.
- Second - coronary flap to eliminate the recession.
She refused out of fear…



You see the blue areas on the teeth.


They represent blockages. We detect them with a special indicator paper.


We file these sections with the turbine and then polish them. If you go back to the first picture, you will see that the upper and lower canines touch each other when the lower jaw moves sideways relative to the upper. There is no blockage here anymore. This has a healing effect.

Another case of gingival recession treated surgically



Gingivitis hypertrophicans - hypertrophic gingivitis, milder form. It is due to local irritants such as dental plaque, tartar, orthodontic anomalies, poor fillings and crowns. I remove the local causes and it usually goes away. If it does not go away, we do an operation. Gingivectomy simplex.


Severe form of hypertrophic gingivitis - Fibromatosis gingivae. It is due to the intake of hydantoin derivatives for the treatment of epilepsy. Treatment - operative.

I present to your attention a case of guided tissue regeneration of a bone pocket in periodontitis.





A 43-year-old woman in good general physical and mental health. For almost a year, he has been treating unsuccessful inflammation of the gums around the first and second large molars at the bottom left.
The dentist finally decided that he could no longer cure the inflammation and referred her to a periodontal surgeon.
During the examination, we found an inflamed crown, a painful and shaken 36 tooth. On the X-ray, we see a very strong resorption of the bone septum between 36 and 37 teeth and exposure of the bifurcations / dissection / of the roots of both 36 and 37 teeth.
Root canal treatment of 38 teeth.
Diagnosis: Periodontitis myxta. Periodontitis chronica 36, 37



The periodontal status in this area currently looks like this:



We see well the exposure of the tooth roots in the bifurcations / marked with green triangles / in millimeters, the withdrawal of the gums / marked with the red line /, as well as the presence of deep bleeding / marked with purple hearts / and pus / marked with yellow hearts /.

Treatment plan:
1. Antibiotic
2. Stimulating bone regeneration preparation
3. Surgery with intervention on the bone and bone graft with Fisiograft - bone replacement.
4. Locking with metal ceramic crowns from 35 to 38 teeth

Here is what the stages of the operative intervention look like:



 

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