SURGICAL THERAPY: OPEN FLAP DEBRIDEMENT

Even though by itself a non surgical approach to therapy is very efficient in decreasing the risk of onset and progression of various diseases of the gingival tissues, it is also known to have therapeutic limitations.

Factors that contribute to the decreased effectiveness of non surgical therapy include; time constraints, difficulty in accessing the area to be treated, operator experience, individual responses to the therapy by the patient, and anatomical and microbiological influences.  For these above mentioned reasons it may be advantageous and indicated to have surgical access to the area in need of decontamination.

The possibility to elevate a flap and visualize the roots surfaces allows for an accurate and complete elimination of local etiologic factors.  Many different surgical techniques have been described based on the type of case being treated as well as on the objectives of therapy. Among the most relevant clinical problems that can occur after surgery are the unaesthetic outcomes in aesthetic areas (lengthening of the clinical crowns). Some of the incision techniques, that allow us to gain adequate access to the area under treatment, have been designed in such a way as to decrease these undesired outcomes.

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SURGICAL THERAPY: RESECTIVE SURGERY (SECOND CASE)

Osseoresective surgery differentiates itself form the simple open flap debridement technique by its therapeutic indications and the different objectives, which are pre- fixed.  While open flap debridement procedures are surgically tailored to reduce the probings of periodontal pockets, osseoresective surgery has as its goal the complete elimination of all pockets. Obtaining this objective is made possible through surgical remodeling of the gingival and osseous tissues (osteoplasty and ostectomy).  The correct execution of this therapy redesigns tissue anatomy in order to simplify hygiene maintenance both at home and in the professional setting.  Often this type of surgical intervention represents the therapy of choice in areas where restorative prosthetics are indicated or where lesions of the furcation area are present.

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