Complications of periodontal surgery /certified fixed orthodontic courses by Indian dental academy

Complications of
Periodontal Surgery

INDIAN DENTAL ACADEMY
Leader in Continuing Dental Education

www.indiandentalacademy.com

POST OPERATIVE COMPLICATIONS

 Bleeding
 Infection
 Swelling
 Hypersensitivity
 Adverse tissue changes


BLEEDING
 Periodontal Surgery can produce profuse
bleeding especially during initial incision
and flap reflection
 It disappears or subsides after flap reflection
and removal of granulation tissue


Bleeding …
 Intra operative bleeding can be managed by
aspiration
 Pressure applied with moist gauze is good
adjunct to control site specific bleeding
 If not controlled by this means, indicates a
more serious problem


 Excessive hemorrhage after initial incision
and flap reflection may be caused by
laceration of venules, arterioles, or larger
vessels.
 The laceration of medium or large vessels is
rare because highly vasularised anatomic
areas are avoided in incision and flap design


 In spite of all the care, bleeding may occur
because of anatomic variations.
 If a medium or large vessel is lacerated, a
suture around the bleeding end may be
necessary to control hemorrhage.


 Excessive bleeding from a surgical wound
also may result from incisions across
capillary plexus
 Minor areas can be stopped by applying
cold pressure for several minutes
 Also LA with vasoconstrictor may be useful
 This action is short lived and should not be
relied on for long term hemostasis


 For slow, constant blood flow and oozing,
hemostasis may be achieved with
hemostatic agents.
 Absorbable Gelatin Sponge

 Oxidized cellulose

 Oxidized regenerated cellulose

 Thrombin


 Absorbable Gelatin Sponge is a porous
matrix prepared from pork skin that helps
stabilize a normal blood clot
 The sponge can be cut to the desired
dimensions and either sutured or positioned
within the wound.
 It is absorbed in 4 to 6 weeks


 Oxidized cellulose is a chemically modified
form of surgical gauze that forms an
artificial clot
 The material is friable and can be difficult
to keep in place
 It absorbs in 1 to 6 weeks


 Oxidized regenerated cellulose is prepared
from cellulose by reaction with alkali to
form a chemically pure, more uniform
structure than Oxidized cellulose.
 The material is prepared in a cloth or thin
gauze form that can be cut to the desired
size and sutured or layered on the bleeding
surface.

 Oxidized regenerated cellulose can be used
as a surface dressing because it does not
impair epithelialization and is bactericidal
to many Gram +ve and Gram –ve
organisms both aerobic and anaerobic.
 Caution should be used when wounds are
infected or have an increased potential to be
infected ( immunocompromised) because
absorbable hemostatic agents can serve as a
nidus for infection


 Thrombin is a drug capable of hastening the
process of blood clotting.
 It is intended for topical use and is applied
as a liquid or powder.
 Thrombin should never be injected into
tissues because it can cause serious, even
fatal intravascular coagulation.


 Its imperative to recognize that excessive
bleeding may be caused by systemic
disorders, including platelet deficiencies,
coagulation defects, medications and
hypertension etc.


Sensitivity to Percussion
 Extension of inflammation to the
periodontal ligament may cause sensitivity
to percussion
 Gradually diminishing severity is a
favorable sign
 Pack should be removed and gingiva
checked for irritation or infection which
should be cleaned or incised to provide
drainage

 Particles of calculus that were overlooked
must be removed
 Relieving the occlusion is usually helpful
 Sensitivity may also be caused by excess
pack interfering in occlusion. Removal of
excess usually corrects the condition.


Swelling
 In the first 2 post op days, some patients
may report a soft, painless swelling of the
cheek in the surgical area.
 Lymph node enlargement may occur and
temperature may be slightly elevated.
 This results from a localized inflammatory
reaction to the procedure.


 It generally subsides by the 4th post
operative day without necessitating removal
of the pack.
 If swelling persists or becomes worse or is
associated with increased pain, amoxycillin
500mg TID for a week.
 Also moist heat application by the patient
over the area intermittently.

POST OPERATIVE PAIN
 Surgery done according to the standard
principles would produce only minor pain
and discomfort.
 One study of 304 consecutive periodontal
surgical intervention revealed that 51.3%
had minimal or no pain. 4.6% reported
severe pain.


 Of those with pain only 20.1% took 5 or
more doses of analgesics
 Mucogingival procedures result in 6 times
more discomfort and osseous surgery 3.5
times more discomfort than plastic gingival
surgery.


 A common source of post op pain is
overextension of the pack beyond MG
junction
 Overextended packs cause localized areas
of edema noticed 1-2 days after surgery.
 Removal of excess pack is followed by
resolution in about 24 hours


 Extensive and excessively prolonged
exposure and dryness of bone also induces
severe pain.


 For most of the patients, a preoperative dose
of Ibuprofen (600-800mg) followed by one
tablet TID for 24-48 hours is effective in
reducing the pain and discomfort.
 Pain related to infection is accompanied by
localized lymphadenopathy and a slight
elevation in temperature.
 It should be treated with systemic
antibiotics and analgesics


Complications of periodontal surgery /certified fixed orthodontic courses by Indian dental academy

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