Periodontal surgery

Periodontal surgery
1. Tartar /leaning per jaw/
02. Cleaning with Air Flow / per jaw /
03. Anesthesia
04. Papillotomy
05. Gingivectomia / per segment /
06. Surfacing /deep cleaning of periodontal pockets without flap - per pocket/
07. Healing flap / per segment /
08. Apical / coronary / flap - up to 2 teeth
09. Epithelial graft
10. Connective - tissue insertion graft
11. Laterally displaced foot flap
12. Dental crown elongation
13. Augmentation of a periodontal pocket
14. Frenotomy / by Federspil /
15. Frenotomy - Z plastic
16. Frenotomy with diode laser
17. Coagulation of periodontal pockets with diode laser / per segment /
18. Therapeutic laser / per session /
19. Periodontal dressing
20. Photopolymer splint /per tooth/

"The doctor is obliged to study and know everything they knew before him, if he does not want to lie to himself and others."

If we turn to history, we will find that the caries - the most widespread disease in the humankind has arisen with the emergence and development of civilization. Gum diseases that cause tooth shake and loss are as old as humanity itself.
During excavations in the city of Ur, ancient Mesopotamia, 3000 BC the Sumerians used gold-decorated toothbrushes.  The ancient Babylonians and Assyrians suffered from gum disease, which we learn from an inscription on a clay tablet with instructions for massaging the gums and the use of various decoctions for rinsing the mouth. In the famous Ebbers papyrus from ancient Egypt, we read not only about the symptoms of gum disease, but also about recipes for tightening the gums. There are also described recipes for toothpastes based on honey and propolis.
The ancient Indian treatises Susruta Samhita and Charaka Samhita describe periodontal diseases, including periodontal abscess and a device made of local spicy and astringent wood for brushing teeth twice a day, with an explicit emphasis on not injuring the gums.
Hippocrates in his book De Articulis described the periodontal disease using the term "amphodont".
In the tenth century AD, in his manuscripts, the Arab physician Abul Kazim described some of the first indications of certain etiological factors in periodontitis. Thus, he points to tartar deposits as an etiological factor.
Ambrose Pare / 1517 - 1590 / tries to determine the etiopathogenesis of periodontal diseases as follows: "Teeth shake due to loosening of the gums. This is due to a direct blow, indirectly from inflammation or from the brain, as well as from certain gases. These gases come from the stomach, sometimes when eating hotter. We observe it in old people. Also from the decomposition of poisonous fluids that attack the gums. We must use all substances that have astringent action, such as rinsing water or toothpaste. A decoction of myrrh tightens the gums and strengthens them”.
After Pierre Foshar 1678 - 1761 / describes in detail the clinical picture of the so-called from him "false scurvy" / it is a question of periodontitis /, the question of the reasons of this disease begins to systematically concern scientific medical thought. Countless assumptions date back to that time, most of which are supported by research and clinical observations. Based on this, there are several hundred theories about the etiology and pathogenesis of periodontitis.
Periodontology is the science that deals with the diseases of those around the dental tissues that form the apparatus that supports the tooth, called the "periodontium", and the diseases themselves - periodontal diseases.
Modern periodontal surgery is a relatively young dental discipline in the domain of periodontology, which is a completely separate dental specialty.
The periodontium is a functional complex of tissues that ensure the fixation of the tooth in the jawbone. It includes the alveolar bone, periodontium, dental cementum and gingiva with its epithelial end. These tissues, which are different in structure, perform mainly two physiological functions, namely the function of retaining teeth and the barrier function.
We know that the set of different tissues that perform one or more functions, we classify as an organ.
In this sense, we classify the periodontium and the tooth as an organ - organum dentale.
The removal of the tooth, which is in the center of this functional complex of tissues, leads to the cessation of its existence. That is why periodontal diseases "self-cure" in the edentulous areas.
The unity and differentiation of the tooth and around the tooth tissues in a functional unit - an organ, we can trace through their phylogenetic and ontogenetic development. Teeth that have developed phylogenetically as the protective organs of the skin of Selahia fish have preserved in higher vertebrates only in the mouth, changing their tissue structure and shape according to their new function - chewing food. Thus, instead of roof-protective formations, they become part of the digestive system and acquire a new function. Depending on the type of food, its location and the nature of digestion in different organisms, the teeth acquire a different shape and structure, as well as number and location. Depending on this, the periodontium also changes.
Periodontitis occurs phylogenetically only in higher reptiles and develops in mammals. Therefore, like all phylogenetically young formations, the periodontium has a fine structure, wide parameters of functional adaptability, but also easy irritability and vulnerability to pathogens. In humans, the periodontium appears late in ontogenesis and is constantly exposed to a large number of traumatic and other pathogens that are constantly active in the oral cavity. With this hypothetical statement, Prof. Boyanov explains the heredity, the functional and biochemical instability of the periodontium and its easy local vulnerability. Natural selection, variability and heredity, the influences of the external environment, including the social environment, forcing man to develop articulate speech, undoubtedly play a huge role in this whole process of formation and change.
Periodontics originated as a branch of dental science and practice in the 1940s. Very soon after, periodontal surgery became a part of it.
Among other medical specialties, they are rapidly gaining momentum in their development. The founders are Prof. Slavcho Davidov, Prof. D. Svrakov, Kalmi, more recently Prof. Dzhemileva and others. Unfortunately, their work finds almost no practical application in practicing dentists. The general opinion is that these diseases "have" no cure, which exists until now. Today in the world periodontology and in particular periodontal surgery is a very developed separate medical specialty.
It is gratifying that in the last few years the interest in it has increased in our country, especially in the Dental Faculties. In addition, more and more private dentists have begun to give it its due.
The merit of Dr. Adriana Yosifova is indisputable, who thanks to personal contact and inherent initiative managed to organize scientific and practical courses in 4 levels, led by Prof. Mark Danan - France, a world-famous periodontal surgeon. Her merit is also the establishment of the Bulgarian Society of Periodontology and Oral Implantology / BOPOI /. Therefore, a sage had said, "medicine is surgery and everything else." In general, and in terms of periodontal surgery, he was not far from the truth.
Nowadays, periodontal surgery is a separate science with its own methods. This specific surgery treats the periodontium either with tissues adjacent to the diseased tissue or through tissues elsewhere in the oral cavity. Also through biomaterials as well as synthetic ones, removing diseased tissue to put the tooth and surrounding tissues back to normal, albeit at a lower level. Moreover, through appropriate surgical techniques in many cases it is possible to create already atrophied or resorbed tissues - mucosa, bone, etc.
In this way, we remove pathologically altered tissues, eliminate inflammation and help the body deal with the problem. Since periodontal diseases are polyetiological and polypathogenetic diseases, in their complex treatment, we resort to other therapeutic measures, but in a very large number of cases only with the corresponding, periodontal surgery is achieved almost 100% success.
Today we definitely know that periodontitis / periodontitis / is a poly etiological disease and the treatment is complex, but a major part in this complex falls on periodontal surgery.
Worldwide, periodontal surgery is very developed in France, USA, and Japan. The Atlas of Periodontal Surgery by Naoshi Sato is my table book on periodontal surgery. Due to numerous hacker attacks compared to previous versions of my site, many of the photos from my clinical cases have disappeared. I will share with you the few surviving cases and I will make an appointment in the near future to add more.


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