DIY Guide of Gingival Surgery for a Fresher Dentist

3) It all starts with a good incision

All incisions should be clear, smooth, and definite. Incision should be placed on firm tissues until you hit the bone to reflect mucoperiosteal flap. Improper incision usually results in uneven ragged flap edges, which requires more healing time.

4) Consider keratinised tissues in flap design

All flaps should be designed for maximum use and retention of keratinized gingival tissue. This maintains a functional zone of attached keratinized gingiva post surgery and prevents needless secondary procedures.

5) Consider access and visibility in flap design

The flap design should allow for adequate access and visibility. For treating localised defect, adjacent teeth must be involved too. For eg- treating a localised defect in canine & 1st molar, the adjacent teeth i.e. Lateral incisor and first premolar, plus 2nd premolar and 2nd molar should be involved.

6) Don’t be aggressive!

The flap design should prevent unnecessary bone exposure, which might result in dehiscence or fenestration formation later.

7) Primary > Secondary

Whenever possible, the surgical procedure should be carried out such that the postoperative healing takes place by primary intention, rather than secondary intention. What this means is- approximate the wound margins closely.

8) Don't forget the base of the flap!

The base of a flap should be wider than the coronal aspect to allow for adequate vascularity.

9) Don’t leave any tissue tags

All the granulation tissue and tissue tags should be removed. A complete elimination allows rapid healing.

10) You have to suture your flaps well.

Adequate flap stabilization with sutures is necessary to prevent

• displacement
• unnecessary bleeding
• hematoma formation
• bone exposure
• possible infection.

Conclusion

The main objective of periodontal surgery is to obtain a healthy and functionally esthetic periodontium. The goal is to eliminate the pathologic changes in the pocket walls, to create a stable, easily maintainable state and if possible to promote periodontal regeneration. Surgery increase accessibility to root surface, making it possible to remove all irritants, reduce or eliminate pocket depth, and reshape soft and hard tissues to attain harmonious topography. However, periodontal surgery has its own indications and contraindications, so proper planning is needed before performing these procedures.

Before periodontal surgery, confirm the diagnosis, complexity and progression risk using a structured staging and grading workflow.