| Behind each of the images below there is a videofile. Click on the image and the video starts. If you use Internet Explorer the viewer is activated directly and the file loaded. If you use Netscape it is recommended you install the plug-in viewer InterVU which plays the |
file streaming on your screen. The filmclips are without sound as
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to image to get a text description. If you have any comments about the
videos please send your feedback to Updated November 1999 |
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| This series of videoclips illustrates periodontal surgery at a single upper canine. The patient is around 70 years old and wears a partial upper denture. Pocket probing demonstrates a shallow depth at the buccal surface and 5-9 mm depths at the other sites. Scaling and root planing has been undertaken but signs of pathology remain at the mesial and palatal surfaces | The x-ray of the tooth reveals an intraosseous defect at the mesial site which seems to extend also to the palatal site | It is determined to undertake a local flap procedure in order to gain access to the root surface and osseous defect. The initial incision is placed close to the tooth at the buccal site. The incision is widened in the mesial region due to the deeper probing depth. A vertical incision is also placed in the bottom of the pocket to facilitate the removal of the granulation tissue. | The pocket wall and the granulation tissue is removed with a curette. It is an advantage to remove the pocket tissue prior to the raising of the flaps. The bleeding is less and the time the bone is exposed to the oral environment is kept at a minimum |
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| The root surface is carefully scaled and attempts are made to create a smooth hard surface. At the mesial surface a root furrow can be observed. The anatomical features may have contributed to the localization of a deepened defect at the mesial site as a result of the accumulation of plaque in this area. | Attempts are made to smooth the root furrow by the instrument and then the flap is gently raised but not more than necessary to obtain insight to the bony defect. | The area is inspected carefully for remaining granulation tissue. If possible the flap should not be raised, on the buccal side, farther than just apical to to the mucogingival line. The granulation tissue is removed. Note the thin bone ledge which borders the defect. | All granulation tissue appears now to be removed. The sharp bone edge prevents proper closing of the flap and also creates a deep one-wall bony defect. It is therefore decided to remove this using a chisel. Gentle gradual removal of the bone reduces the risk of excessive trauma from this procedure. |
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| Rotating instruments more easily generate heat and also create a risk of damage to the root surface. The gradual removal of the bone results in an elimination of the bony defect and on inspection a smooth junction between the bone and the tooth surface can be observed. | The flaps are trimmed to give an optimal closure of the wound and vertical madras sutures are used to secure a firm adaptation of the soft tissue to the tooth and the alveolar bone. | The first suture is placed around 3-4 mm from the gingival margin from the buccal site and the needle pulled through the palatal flap. | The suture is then gently pulled and a knot made. When the knot is made it's important to pull gently. Post-operatively the tissue swells and when the knots are too tight the sutures often cut through the tissue due to the swelling. |
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| One month following treatment the tissue is relatively healed and there is no increased probing depths or bleeding on probing. | Three months following treatment the healing has proceeded and the patient cooperates well and there is no bleeding on probing. However at the distal site where the clasp from the partial prosthesis attaches, the gingival margin is somewhat swollen and red. |
In order to maintain the treatment result it is necessary that the patient receives supportive treatment in the form of regular check ups and professional cleanings. During the first period following the treatment such maintenance treatments shall be given with short intervals. Long term good results have been demonstrated when these treatments are given with 3-6 months interval. |
These
videos were produced by Rolf Attstrom and Danish Dental Association in collaboration with Goof Video, Denmark. Camera and videoediting Tommy Ols, Videocompiling and Sound Recording Anders Nattestad |
