Periodontics | Surgical Therapy | INBDE, ADAT

Ryan introduces the topic of surgical therapy in periodontics, emphasizing the importance of local therapy to remove bacterial plaque and local factors. He discusses when surgical therapy is considered after non-surgical treatments prove insufficient. Gingival flap design is introduced as a method for better access and visibility during surgery. Key concepts include ensuring the base of the flap is wider than the top for adequate blood supply, making incisions over intact bone, and avoiding vital structures. The importance of post-operative plaque control is highlighted as crucial to the success of periodontal surgery.

The video covers two types of gingival flaps: split or partial thickness and full thickness or mukouperiosteal flaps. The mucosal flap is less aggressive and used for minor surgeries, while the full thickness flap, which includes the periosteum, is used for more invasive procedures like bone work. The discussion also touches on papilla preservation techniques and specific incisions for full thickness flaps, such as the internal bevel incision and interdental incision. Modified Widman flap and its role in accessing subgingival areas for debridement are also explained.

The paragraph delves into more advanced flap techniques like the apical reposition flap, which requires vertical releasing incisions. It also discusses the use of periodontal packs post-surgery for wound protection and comfort. The video then transitions into gingival surgery, which involves procedures like gingivectomy for eliminating pockets or enlargements and gingivoplasty for aesthetic reshaping. Distal wedge surgery is introduced for pocket reduction, and the importance of understanding the different types of incisions used is emphasized.

Ryan explains the importance of soft tissue grafts, including free gingival grafts and connective tissue grafts, for periodontal health. The free gingival graft aims to widen the band of keratinized tissue, which is beneficial for natural teeth, crowns, and implants. In contrast, the connective tissue graft is used to cover exposed root surfaces, promoting sensitivity reduction. The video also differentiates between the two grafts based on their location relative to the gingival margin and the palate as the common donor site.

The focus shifts to osseous surgery, which involves the bone. The video discusses the importance of analyzing bone architecture before treatment, differentiating between positive, flat, and negative architecture. Two types of osseous surgery are introduced: aesthetic, which removes supporting bone, and osteotomy, which removes non-supporting bone. Clinical crown lengthening is also mentioned as a way to expose more tooth structure by lowering the bone, which can be combined with gingival surgery for effective treatment.

The video outlines the two primary outcomes of periodontal surgery: regeneration, which restores architecture and function, and repair, which forms a long junctional epithelium. Reattachment and new attachment are defined, with the latter involving the growth of new periodontal ligament fibers into new cementum. The concept of regenerative surgery, or guided tissue regeneration, is introduced, aiming to regenerate lost bone, cementum, and periodontal ligament. The 'three B's of regenerative surgery'—barrier membrane, bone graft, and biologic agent—are explained using a gaming analogy to help remember their functions.

Ryan concludes with a discussion on bone graft materials, categorizing them into autograft, allograft, xenograft, and alloplast. Each type is associated with different qualities like osteoconductive, osteoinductive, and osteogenic properties. The video simplifies these definitions for board exam preparation. Finally, the ideal types of defects for restoration with respective treatments are summarized with the mnemonic 'three for three-wall, two for class two, and one for Miller class one,' providing a clear guideline for determining the best surgical approach.