Periodontology: a clinical approach. 4. Periodontal 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)