Periodontal Surgery

Clinical Attachment Loss And Bleeding On Probing @ UR6

It was decided to surgically investigate the palatal pocket on UR6 following the failure to control bleeding on probing subsequent to closed flap root surface debridement.

A precise assessment of the pocket depth is made difficult due to obstruction by the crown. The pocket is determined to be in excess of 8mm.

Modified Widman Flap

Access to the defect is gained using a modified Widman Flap.

An SM69 blade in microsurgical handle is used to create both the intrasulcular and internally bevelled incisions.

Reflection of the periosteum is made with a periosteal elevator.

Access To The Root Face

Under the high magnification and illumination afforded by the microscope: Only now can the full extent of the defect be readily observed.

To control bleeding and promote good healing, the surgical site should be denuded of granulation tissue with curettes and excavators.

Plaque and calculus aggregations on root face

Under greater magnification, plaque and calculus can be clearly seen on the root face. Root surface debridement [RSD] is carried out with hand and ultrasonic instruments.

With the aid of a microscope this is both precise and thorough. Hypochlorous acid [Sterilox] is used to provide both coolant for the ultrasonic tips and help disinfect the operating site.

Site Assessment

Following removal of the plaque and calculus: The root surface is easily visible under high magnification.

The iatrogenic damage from prior attempts to debride the root face with conventional closed flap RSD is readily apparent.

It is probable that these root surface defects have been mistaken by previous operators as calculus deposits.

Six Months Post Operatively

A reassessment of the site shows a reduction in pocket depth to 3mm. There is an absence of bleeding on probing and an improved prognosis. Overall clinical attachment loss is reduced despite recession.

The patient experienced some degree of cold thermal sensitivity. This was treated with desensitising agents.