PubMed · 5269420
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J Murphy. 1970. The gingivectomy.. https://pubmed.ncbi.nlm.nih.gov/5269420/
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Periodontal pockets deeper than 4-5 mm require surgical treatment. Records of surgical journals of a periodontology room over 6 years are reviewed and 2183 operations performed by six periodontologists are analyzed. The results of surgery are determined by patient's status, site of anesthesia, type of secondary adentia, convenience of surgical access, terms between operations. Individual features of surgical technique of each of the six surgeons are shown.
There is a debate concerning the role that surgical procedures should play in the treatment of inflammatory periodontal diseases. This review details some of the situations in which surgery can be of benefit. Benefits include obtaining shallower probing depths and therefore reducing the areas that are hospitable to pathogenic bacteria associated with disease. Also, removal of tooth-accumulated materials such as plaque and calculus in probing depths greater than 5 mm is more predictable with surgery. In some forms of aggressive periodontitis, elimination of potentially pathogenic bacteria is found more frequently with surgical procedures. Regeneration of lost bone and attachment apparatus are predictable only with surgery.
Results from comparative surgical studies have shown small differences between methods when evaluated over a few years post-surgically. Early interim results suggest that apical repositioning is more effective at reducing probing depth, replaced flaps (such as the modified Widman technique) offer slight advantages in terms of gain in clinical attachment, and procedures which involve extensive bone removal or exposure result in more bone loss and loss of attachment. The replaced flaps should in theory produce better aesthetics than the apical repositioned flap. In the long term however, the former tend to recede slightly whilst there is some coronal rebound in the latter, thereby producing relatively little difference between them when good plaque control is maintained. In all procedures there is loss in height of the interdental tissues, even if the labial tissue is maintained, and this can be aesthetically displeasing to some individuals. However it should also be remembered that effective non-surgical treatment can result in similar changes in tissue height and contour, and there is no guarantee of preservation of pre-existing dentogingival aesthetics. All routine periodontal treatment results in gingival shrinkage to some degree. In many cases periodontal surgery will, in reality, involve a combination of replacement, apical repositioning and resection due to the uneven pattern of disease and different anatomical constraints of the palate, tuberosities and retromolar regions. This is shown in figure 12. In summary the surgical procedures should: 1. Produce well contoured flaps of even thickness which are tailored to the shape of the tooth surfaces and permit good coverage of the alveolar bone and any bone defects.(ABSTRACT TRUNCATED AT 250 WORDS)