Periodontal surgery employs techniques that include intentional severing or incising of gingival tissues. The rationale of periodontal surgery is accessibility and visibility. The main goal of periodontal surgery is to eliminate infected pockets that do not respond to non surgical periodontal therapy. It also create conditions which allow for efficient plaque control.

1. General Principles of Periodontal
Surgery
By- Dr. Oinam Monica Devi

2. Contents
• Objectives of surgical treatment
• Indications of Periodontal Surgery
• Contraindications of Periodontal Surgery
• Fundamentals of Periodontal Surgery
• Outpatient Surgery
• Hospital Periodontal Surgery
• Conclusion

3. Objectives of surgical treatment
• Traditionally, Pocket elimination was the main objective of periodontal therapy.
• The removal of the pocket by surgical means served two purposes:
(1) The pocket, which established an environment conducive to progression
of periodontal disease, was eliminated.
(2) The root surface was made accessible for professional debridement and
for self‐performed tooth cleaning after healing.
• Signs other than increased probing depth should be present to justify surgical
therapy which include:
1. Clinical signs of inflammation ( exudation and bleeding on probing)
2. Aberrations of gingival morphology

4. • The main objective of periodontal surgery is to contribute to the long‐term
preservation of the periodontium by facilitating plaque removal & infection control.
• Periodontal surgery can serve this purpose by:
1. Creating accessibility for proper professional scaling and root planing.
2. Establishing a gingival morphology which facilitates self‐performed infection
control.

5. Indications of Periodontal Surgery
1. Areas with irregular bony contours, deep craters and others requiring a surgical
approach.
2. Deep pockets where complete removal of root irritants is not possible.
3. In cases of Grade II and III furcation involvement.
4. Infrabony pockets in non-accessible areas which are nonresponsive towards
nonsurgical methods.
5. Persistent inflammation in areas with moderate and deep pockets.
6. Correction of mucogingival problems.

6. Contraindications of Periodontal Surgery
1. In patients of advanced age where teeth may last for life without resorting to
radical treatment.
2. Patients with systemic diseases such as cardiovascular disease, malignancy,
liver diseases, blood disorders, uncontrolled-diabetes, consultation with the
patient’s physician is essential.
3. Where thorough subgingival scaling and good home care will resolve or
control the lesion.
4. Where patient motivation is inadequate.
5. In the presence of infection.
6. Where the prognosis is so poor that tooth loss is inevitable.

7. Fundamentals of Periodontal Surgery
1. Base > Free margin
2. Width of base > Length of Flap ( 2 times)
3. An axial blood supply in the base
4. Hold the flap with periosteal elevator resting on intact bone to prevent
tension
Incisions
• Periodontal surgery involves the use of horizontal (mesial-distal) and
vertical (occlusal-apical) incisions.
• The #15 or #15C surgical blade is used most often to make these incisions.

8. Horizontal Incisions
• Directed along the gingiva in a mesial or distal direction.
• Flaps can be reflected with the use of only horizontal incision if sufficient
access can be obtained in this way and if apical, lateral, or coronal
displacement of the flap is not anticipated.
• If vertical incisions are not made, the flap is called an envelope flap.
Scalloped Incision Straight Incision
Carranza, 13th ed

9. Incisions of Flap Surgery Carranza, 13th ed

10. Internal Bevel Incisions
• Accomplishes three important
objectives:
(1) It removes the pocket lining.
(2) It conserves the relatively uninvolved
outer surface of the gingiva.
(3) It produces a sharp, thin flap margin for
adaptation to the bone–tooth junction.
Carranza, 13th ed

11. Crevicular, Crestal, and Submarginal Incisions
• The crevicular incision is also called intercrevicular incision,
intracrevicular incision, sulcular incision, intrasulcular incision &
intersulcular incision.
• The crestal incision is also called the marginal incision.
• The crevicular and crestal incisions are internal bevel incisions.
• Submarginal incision can be external bevel or internal bevel.
Carranza, 13th ed

12. (A) When keratinized tissue
is abundant, a submarginal
incision may be used.
(B) When keratinized
tissue is limited, a
submarginal incision
eliminates keratinized
tissue that must be
retained.
(C) A crestal incision
maximizes the retained
keratinized
tissue.

13. Vertical Incisions
• Vertical or oblique releasing incisions can be used on one or both ends of
the horizontal incision, depending on the design and purpose of the flap.
• Vertical incisions in the lingual and palatal areas are avoided.
• Facial vertical incisions should not be made in the center of an interdental
papilla or over the radicular surface of a tooth.
Verticle
incision
SHOULD
NOT

14. Flap types
Sato

15. Carranza, 13th ed

17. General Principles of Surgery

18. Outpatient Surgery
Patient
Preparation
Emergency
Equipment
Measures to Prevent
Transmission of
Infection
Reevaluation After Phase I Therapy
Premedication
Smoking
Informed Consent

19. Patient Preparation
Reevaluation After Phase I Therapy
Result after Scaling and root planing combined with patient education:
(1) Eliminate some lesions entirely
(2) Render the tissues firm and consistent, thereby allowing for accurate and
minimally invasive surgery
(3) Acquaint the patient with the office, the clinician, and the assistants, thereby
reducing the patient's apprehension and fear

20. • Phase I therapy and reevaluation are important to minimize the necessity
for periodontal surgery.
Reevaluation
phase
Reprobing
Reexamining all of the
pertinent findings
Persistence of these findings
confirms the indication for
surgery

21. Premedication
• Kidd EA et al. (1974) ; Ariaudo AA (1969) have reported reduced postoperative
complications, including reduced pain and swelling, when antibiotics are given
before periodontal surgery and continued for 4 to 7 days after surgery.
• The prophylactic use of antibiotics in patients who are otherwise healthy has
been advocated for bone-grafting procedures and purported to enhance the
chances of new attachment.
• Additional presurgical medications that may be administered include a
nonsteroidal antiinflammatory drug such as ibuprofen (e.g., Motrin) 1 hour
before the procedure and an antimicrobial mouthrinse such as 0.12%
chlorhexidine gluconate (e.g., Peridex or PerioGard).

22. Smoking
• Patients should be clearly informed of this fact and asked to quit smoking
completely or to stop smoking for a minimum of 3 to 4 weeks after the
procedure.
• For patients who are unwilling to follow this advice, an alternate treatment plan
that does not include complicated techniques (e.g., regenerative, mucogingival,
aesthetic) should be considered.

23. Informed Consent
• The patient should be informed at the initial visit regarding the diagnosis,
prognosis, and recommended treatment options including explanations about
expected outcomes.
• The pros and cons of each approach should be discussed, and the patient should
be encouraged to ask questions.
• At the time of surgery, the patient should again be informed both verbally and in
writing of the procedure to be performed, including the risks and expected
outcome.
• The patient’s agreement to undergo the procedure is indicated by them signing
the informed consent form.

24. Emergency Equipment
• The most common emergency is syncope, which is a transient loss of
consciousness caused by a reduction in cerebral blood flow.
• The most common causes of syncope are fear and anxiety.
• Syncope is usually preceded by a feeling of weakness, and then the patient
experiences pallor, sweating, coldness of the extremities, dizziness, and a
slowing of the pulse.
• The patient should be placed in a supine position with the legs elevated; tight
clothes should be loosened, and a wide-open airway should be ensured.
• The administration of oxygen should be started.
• Every effort should be made to minimize the patient's fear and anxiety, as well as
considering the use of oral sedatives.

25. Emergency drugs in the dental clinic

26. Measures to Prevent Transmission of Infection
• Use of disposable sterile gloves, surgical masks, and protective eyewear.
• All surfaces that may be contaminated with blood or saliva and cannot be
sterilized (e.g., light handles, unit syringes) must be covered with sterile
aluminum foil or plastic wrap.
• Aerosol-producing devices (e.g., ultrasonic scalers) should not be used on
patients with suspected infections, and their use should be kept to a
minimum in all other patients.
• Special care should be taken when using and disposing of sharp items such
as needles and scalpel blades.

27. Sedation and Anesthesia
• Pain control in periodontal surgery is important.
• Most procedures should either be painless or minimally painful.
• The most reliable means of providing painless surgery is the effective
administration of local anesthesia.
• The area to be treated should be thoroughly anesthetized by means of regional
block and local infiltration.
• Injections directly into the interdental papillae may also be helpful.

28. • Apprehensive and neurotic patients may require special management with
antianxiety or sedative–hypnotic agents.
• Modalities for the administration of these agents include inhalation, oral,
intramuscular, and intravenous routes.
• The specific agents and the modality of administration are based on the desired
level of sedation, the anticipated length of the procedure, and the overall
condition of the patient.
• The patient's medical history and physical and emotional status should be
considered when determining the need for sedation, as well as the specific
agents and techniques to be used.

29. Hospital Periodontal Surgery
Indications
(1) Optimal control and management of patients with severe anxiety and
apprehension.
(2) Optimal safety for individuals who cannot endure multiple or extensive
visits to complete surgical treatment.
(3) Optimal medical management of older and severely debilitated or medically
compromised patients.

30. Patient Anxiety and Apprehension
• Gentleness, understanding, and preoperative sedation usually suffice to calm the
fears of most patients.
• Explaining that the treatment at the hospital will be performed painlessly with
anesthesia is an important step in allaying patients' fears.
• The thought of completing the necessary surgical procedures in one session is an
added comfort to many patients because it eliminates the prospect of repeated
anxiety episodes in anticipation of each treatment.

31. Patient Safety and Protection
• Patients with severe cardiovascular disease, abnormal bleeding tendencies,
hyperthyroidism, or uncontrolled hypertension treated in a hospital or an procedure
room with an anesthesiologist present to monitor & manage vital signs & patient
comfort throughout the surgical procedure is the safest way of management.
• The purpose of hospitalization is to protect patients by anticipating their special
needs, not to perform periodontal surgery when it is contraindicated by the
patient's general condition.

32. Patient Preparation
Premedication
• Patients should be given a sedative the night before surgery.
• Benzodiazepines work well for most patients because they allow the patient to
sleep well the night before surgery.
• If the patient is extremely nervous about the procedure, it is also helpful to advise
him or her to take a benzodiazepine the morning of surgery.

33. Anesthesia
• It is important that the patient receive local anesthesia, administered as for routine
periodontal surgery, to ensure comfort for the patient and reduced bleeding during
the procedure.
• The judicious use of local anesthetics to block regional nerves allows the level of
sedation or general anesthesia to be lighter.
• Maximum dose of Lidocaine HCl without epinephrine should not exceed 300 mg
(max volume 15ml= 7 cartridges)
• Maximum dose of Lidocaine HCl with epinephrine should not exceed 500 mg
(max volume 25ml= 12 cartridges)

34. Positioning and Periodontal Dressing
• Surgery in the operating room is typically performed on the operating table with
the patient lying down and the table either positioned flat or with the head
inclined up to 30 degrees.
• Some operating rooms are equipped with dental chairs that can be used either
flat or at up to 30 degrees of inclination.
• When general anesthesia is used, it is advisable to delay placing the periodontal
dressing until the patient has recovered sufficiently to have a demonstrable
cough reflex.
• Periodontal dressings placed before the end of general anesthesia can be
displaced during the recovery period and pose serious risks of blocking the
airway.

35. Tissue Management
1. Operate gently and carefully
• Tissue manipulation should be precise, deliberate, and gentle.
• Traumatic instrumentation must be avoided because it produces excessive tissue
injury, causes postoperative discomfort, and delays healing.
2. Observe the patient at all times
• Facial expressions, pallor, & perspiration are distinct signs that may indicate when a
patient is experiencing pain, anxiety, or fear.
• The clinician's responsiveness to these signs can be the difference between success
and failure.
3. Be certain that the instruments are sharp
• Instruments must be sharp to be effective treatment
• Dull instruments inflict unnecessary trauma as a result of poor cutting and
excessive force applied to compensate for their ineffectiveness
• A sterile sharpening stone should be available on the operating table at all times.

36. Scaling and Root Planing
• All exposed root surfaces after scaling and root planing should be carefully
explored & planed as needed during the surgical procedure.
• Areas of difficult access (e.g., furcations, deep infrabony pockets) must be
checked for rough areas or even calculus that was undetected during the
preparatory sessions.
• The most important objective of periodontal pocket reduction surgery is to gain
access to the root surface for scaling and root planing.
• The exposure obtained to the subgingival root surfaces when the flap is reflected
allows to access for root therapy & alter any existing osseous defects.

37. Hemostasis
• It is an important aspect of periodontal surgery because good intraoperative
control of bleeding permits
1. Accurate visualization of the extent of disease
2. The pattern of bone destruction
3. The anatomy and condition of the root surfaces.
• It provides the operator with a clear view of the surgical site, which is essential
for wound debridement and scaling and root planing.
• Good hemostasis prevents excessive loss of blood into the mouth, oropharynx,
and stomach.

38. • The control of intraoperative bleeding can be managed with aspiration.
• Continuous suctioning of the surgical site with an aspirator is indispensable
when performing periodontal surgery.
• The application of pressure to the surgical wound with moist gauze can be a
helpful adjunct to control site specific bleeding.
• Excessive hemorrhaging after initial incisions and flap reflection may be caused
by the laceration of venules, arterioles, or larger vessels.
• The laceration of medium or large vessels is rare because incisions near highly
vascular anatomic areas (e.g., the posterior mandible [the lingual and inferior
alveolar arteries], the posterior midpalatal regions [the greater palatine arteries])
are avoided by incision and flap procedures.

39. • Proper design of the flaps that takes these areas into consideration will help avoid
accidents.
• If a medium or large vessel is lacerated, a suture around the bleeding end may be
necessary to control the hemorrhage.
• Pressure should be applied through the tissue to determine the location that will
stop blood flow in the severed vessel.
• A suture can then be passed through the tissue and tied to restrict blood flow.
• Excessive bleeding from a surgical wound may also result from incisions across a
capillary plexus.
• Minor areas of persistent bleeding from capillaries can be stopped by applying
cold pressure to the site with moist gauze for several minutes.

40. • The use of a local anesthetic with a vasoconstrictor (epinephrine) may also be
useful for controlling minor bleeding from the periodontal flap.
• Both of these methods act through vasoconstriction, thereby reducing the flow of
blood through incised small vessels and capillaries.
• It is important to avoid the use of vasoconstrictors to control bleeding before
sending a patient home.
• If a more serious bleeding problem exists or if a firm blood clot is not
established, bleeding is likely to recur when the vasoconstrictor has metabolized
and the patient is no longer in the office.

41. be used

43. • It is imperative to recognize that excessive bleeding may be caused by systemic
disorders e.g;
1. Platelet deficiencies
2. Coagulation defects
3. Medications
4. Hypertension
• All surgical patients should be asked about any current medications that may
contribute to bleeding, any family history of bleeding disorders, and hypertension.
• All patients, regardless of health history, patient should have their blood pressure
evaluated before surgery, and anyone who is diagnosed with hypertension must be
advised to see a physician before surgery.
• Laboratory tests should be performed to assess the risk of bleeding.

44. • Thrombin is a very effective drug to help coagulate blood and is applied
topically.
• This drug should never be injected into tissues because it can cause serious
or even fatal intravascular coagulation.
• Thrombin is a bovine-derived drug, so caution should be used for patients
with a known allergy to bovine products.

45. Periodontal Dressings (Periodontal Packs)
• At completion of the periodontal surgical procedure, clinicians may elect to
cover the area with a surgical dressing.
• Dressings have no curative properties but assist healing by protecting the
tissue rather than providing “healing factors.”
• Use of Periodontal dressing
1. Minimizes the likelihood of postoperative infection
2. Facilitates healing by preventing surface trauma during mastication
3. Protects the patient from pain induced by contact of the wound with food or
with the tongue during mastication

46. Zinc Oxide–Eugenol Dressing
• Dressings that are based on the reaction of zinc oxide and eugenol include the
Wonder Pak, which was developed by Ward in 1923.
• The addition of accelerators such as zinc acetate gives the dressing a better
working time.
• Zinc oxide–eugenol dressings are supplied as a liquid and a powder that are
mixed before use.
• Eugenol in this type of dressing may induce an allergic reaction that produces
reddening of the area and burning pain in some patients.

47. Noneugenol Dressing
• The reaction between a metallic oxide and fatty acids is the basis for the Coe-Pak.
• It is supplied in two tubes, the contents of which are mixed immediately before use
until a uniform color is obtained.

48. • One tube contains zinc oxide, an oil (for plasticity), a gum (for
cohesiveness), and lorothidol (a fungicide).
• The other tube contains liquid coconut fatty acids that have been thickened
with colophony resin (or rosin) and chlorothymol (a bacteriostatic agent).
• This dressing does not contain asbestos or eugenol, thereby avoiding the
problems associated with these substances.
• Other noneugenol dressings include cyanoacrylates and tissue conditioners
(methacrylate gels).

49. Retention of Dressing
• Periodontal dressings are usually kept in place mechanically by interlocking the
dressing in interdental spaces & joining the lingual & facial portions of the
dressing.
• In isolated teeth or when several teeth in an arch are missing, retention of the
dressing may be difficult.
• The placement of dental floss tied loosely around the teeth enhances retention of
the dressing.

50. Antibacterial Properties of Dressing
• Improved healing & patient comfort with less odor & taste have been obtained by
incorporating antibiotics into the dressing.
• Bacitracin,5 oxytetracycline (Terramycin),13 neomycin, and nitrofurazone have
been used.
• Care must be taken when any antibiotic products are used because they may
produce hypersensitivity reactions.
• The incorporation of tetracycline powder into the Coe-Pak is generally
recommended, particularly when long and traumatic surgical procedures are
performed.

51. Preparation and Application of Dressing
The working time can be shortened by adding a small amount of zinc oxide to the accelerator
(pink paste) before spatulating.

52. For isolated teeth separated by edentulous spaces, the dressing should be made continuous
from tooth to tooth to cover the edentulous areas

53. • When split-thickness flaps have been performed, the area should be covered
with a sterile tinfoil to protect the sutures before the dressing is placed.
• The dressing should cover the gingiva, but overextension onto uninvolved
mucosa should be avoided.
• Excess dressing irritates the mucobuccal fold and the floor of the mouth, and it
interferes with the tongue.
• Overextension also jeopardizes the remainder of the dressing because the excess
tends to break off and loosens the dressing from the operated area.

54. • The operator should ask the patient to move the tongue forcibly out & to each
side, & the cheek and lips should be displaced in all directions to mold the
dressing while it is still soft.
• After the dressing has set, it should be trimmed to eliminate all excess.
• As a general rule, the dressing is kept on for 1 week after surgery which may be
extended to an additional week.
• If the dressing is lost from the operated area and the patient is uncomfortable, it is
usually best to redress the area.
• The clinician should remove the remaining dressing, irrigate the area with warm
water, and apply a topical anesthetic before replacing the dressing, which is then
retained for another week.

55. Postoperative Instructions
• Patient Instructions After Periodontal Surgery
1. Take two acetaminophen (Tylenol) tablets every 6 hours for the first 24 hours.
2. Do not take aspirin because this may increase bleeding.
3. The dressing will harden in a few hours, after which it can withstand most of
the forces of chewing without breaking off.
4. The dressing should remain in place until it is removed in the office at your
next appointment.
5. For the first 3 hours after the operation, avoid hot food.
6. It is also convenient to avoid hot liquids during the first 24 hours.
7. Semisolid or finely minced foods are suggested.
8. Avoid citrus fruits & fruit juices, highly spiced foods, and alcoholic beverages;
these will cause pain.
9. Do not brush over the dressing.
10. Brush and floss the areas of the mouth that are not covered by the dressing as
you normally would do.
11. Use chlorhexidine (Peridex, PerioGard) oral rinses after brushing.

56. First Postoperative Week
• Patients should be instructed to rinse with 0.12% chlorhexidine gluconate
(Peridex, PerioGard) immediately after the surgical procedure and twice daily
until normal biofilm control can be resumed.

57. The following complications may arise during the first postoperative week,
although they are the exception rather than the rule:
1. Persistent bleeding after surgery
• The dressing is removed & local anesthesia may be needed before the bleeding
areas are located.
• The bleeding is stopped with pressure, the area is again redressed.
2. Sensitivity to percussion
• Extension of inflammation into the periodontal ligament may cause sensitivity to
percussion.
• The dressing should be removed and the surgical area checked for localized areas
of infection or irritation.
• The area should be irrigated or incised to provide drainage if areas of localized
exudate are present.
• Relieving the occlusion can be helpful.
• Sensitivity to percussion may also be caused by excess dressing, which
interferes with the occlusion.

58. 3. Swelling
• During the first 2 postoperative days, some patients may report a soft,
painless swelling of the cheek in the surgical area.
• Lymph node enlargement may occur, & the temperature may be slightly
elevated.
• It may result from a localized inflammatory reaction to the surgical
procedure.
• It generally subsides by the fourth postoperative day without necessitating
the removal of the dressing.
• If swelling persists, enlarges, or is associated with increased pain,
amoxicillin (500 mg) should be taken every 8 hours for 1 week.
• The patient should also be instructed to apply moist heat intermittently
over the area.

59. 4. Feeling of weakness
• Few patients report a “washed-out,” weakened feeling for about 24 hours
after surgery.
• This represents a systemic reaction to transient bacteremia induced by the
procedure.
• This reaction can be prevented by premedication with amoxicillin (500 mg)
every 8 hours.
• This protocol should be started 24 hours before the next procedure and
continued for 5 days postoperatively.

60. Removal of the Dressing and Return Visit
• When the patient returns in 1 week, the periodontal dressing is removed by
inserting a curette along the margin and exerting gentle lateral pressure.
• Pieces of the dressing retained interproximally and particles adhering to the
tooth surfaces are also removed with curettes.
• The entire area is irrigated with peroxide to remove the superficial debris.

61. Findings at the Time of Dressing Removal
• If gingivectomy has been performed, the incised surface is covered with a
friable meshwork of new epithelium. This tissue should not be disturbed.
• If calculus has not been completely removed, red, beadlike protuberances
of granulation tissue will persist.
• The granulation tissue must be removed with a curette to expose the
calculus so the root can be planed.
• Granulation tissue will recur if the residual calculus is not completely
removed.

62. • After a flap operation, the areas that correspond to the incisions are epithelialized,
but they may bleed readily if irritated & should not be disturbed nor probed.
• The facial and lingual mucosa may be covered with a grayish-yellow or white
granular layer of debris that has entered under the dressing.
• The root surfaces may be sensitive to touch or to thermal change which will
disappear with time (4 to 6 weeks).
• Fragments of calculus delay healing

63. Redressing
• Redressing for an additional week is advised for the following types of patients:
(1) Those with a low pain threshold who are particularly uncomfortable when the
dressing is removed
(2) Those with unusually sensitive root surfaces postsurgically
(3) Those with an open wound where the flap edges have necrosed
• Clinical judgment helps when deciding whether to redress the area or to leave the
initial dressing for a longer period.

64. Tooth Mobility
• Tooth mobility usually increases immediately after surgery.
• This results from edema in the periodontal ligament space from the inflammation
that occurs postsurgically.
• The mobility diminishes to the pretreatment level by the fourth week.
• The patient should be reassured before surgery that the mobility is temporary.

65. Mouth Care Between Procedures
• Care of the mouth by the patient between the treatments as well as after the
surgery is completed is extremely important.
• Plaque or biofilm removal post surgery is different from that of presurgical
hygiene because the areas are still healing and uncomfortable.
• Vigorous brushing is not feasible during the first week after the dressing is
removed.
• Patient should use a soft toothbrush and light water irrigation.
• Rinsing with a chlorhexidine mouthwash or applying such a rinse topically with
cotton-tipped applicators is indicated for the first few postoperative weeks.

66. • Patients should be told that
(1) Some gingival bleeding will occur when the wounded areas are gently cleaned
(2) This bleeding is normal and will subside as healing progresses
(3) The bleeding should not deter them from following their oral hygiene regimen.

67. Management of Postoperative Pain
• Periodontal surgery that follows the basic principles outlined here should
produce only minimal pain and discomfort.
• For the few patients who may have severe pain, the control of pain becomes an
important part of patient management.

68. • A common source of postoperative pain is overextension of the periodontal
dressing onto the soft tissue apical to the mucogingival junction or onto the
frena.
• Overextended dressings cause localized areas of edema that are usually noticed 1
to 2 days after surgery.
• The removal of excess dressing is followed by resolution in about 24 hours.
•
• Extensive and excessively prolonged exposure of bone with poor irrigation
during surgery induces greater pain.
• For most healthy patients, a preoperative dose of ibuprofen (600 to 800 mg)
followed by one tablet every 8 hours for 24 to 48 hours is very effective for
reducing discomfort after periodontal surgery.
• Caution should be used when prescribing or dispensing ibuprofen to patients
with hypertension that is controlled by medications.

69. • Patients experiencing severe postoperative pain should be seen on
an emergency basis.
• The area should be anesthetized by infiltration, and the dressing should be
removed to allow for the examination of the area in pain.
• Postoperative pain related to infection is accompanied by localized
lymphadenopathy and a slight elevation in temperature & should be treated with
systemic antibiotics and analgesics.

70. Conclusion
• The efficient, precise, and minimally traumatic management of tissues is
necessary to achieve the most predicable and comfortable result and outcome for
the patient.
• The use of longer-acting local anesthetic agents (e.g., bupivacaine) & protective
periodontal dressings also helps to reduce postsurgical pain.
• During the immediate postsurgical weeks, biofilm control and healing are
enhanced by the use of antimicrobial mouthrinses such as chlorhexidine.
• Postsurgical root sensitivity is well controlled by ensuring that biofilm control is
optimal, and occasionally desensitizing agents will be needed.

71. References
• Newman, Takei, Klokkevold, Carranza. Carranza’s Clinical
Periodontology. 12 th edition. W. B. Saunders Company.
• Newman, Takei, Klokkevold, Carranza. Carranza’s Clinical
Periodontology. 13th edition. W. B. Saunders Company.
• Clinical Periodontology and Implant Dentistry, J Lindhe, 6th Edition
• Periodontics: Medicine, Surgery, and Implants By Louis F. Rose, Brian L.
Mealey, Robert J. Genco, and D. Walter Cohen Elsevier Mosby;
Philadelphia: 2004
• Reddi S. Essentials of clinical periodontology and periodontic. Edisi ke-3.
New Delhi: Jaypee Brothers Medical Publishers. 2011: 82.

72. Thank you