4-3. INSTRUMENT SETUPS AND SURGICAL PROCEDURES
a. General. Most of the procedures performed in periodontal surgery have a setup similar to restorative dentistry. In addition, depending on the training of the dental assistant and the techniques and treatment procedures of the dentist, the dental assistant may perform as a special surgical assistant, dental hygienist, or an oral health manager. The treatment in periodontics varies somewhat from restorative dentistry in that there is more emphasis on oral medicine, surgical therapy, prevention, and long-term maintenance care. See figure 4-11 for the basic periodontal instrument setup.
NOTE: As an example of a periodontal surgical procedure, we will discuss the role of the dental assistant in a gingivectomy. A gingivectomy is a procedure, which is fairly well-known among the general public. It will be defined in subparagraph "c".
Figure 4-11. Basic periodontal surgical tray setup.
b. Preparation to Receive the Patient. Preparation to receive a patient begins with the cleanup and sterilization of instruments and materials used during the treatment of the previous patient. Following the dismissal of the previous patient, all evidence of treatment of that patient should be removed. Used instruments should not be allowed to accumulate. They should be cleaned, sharpened as needed, sterilized, and returned to storage as time permits during and between appointments. Linens, bracket table covers, and headrest covers should be replaced. The patient's records and radiographs should be set out for the dentist's reference. Instruments and materials set up for local anesthesia and the planned periodontal procedures should be placed on the bracket table and covered with a sterile drape.
(1) General. Gingivectomy, in its simple form, involves the surgical incision and removal of the soft tissues forming periodontal pockets about the teeth. The gingival tissue is removed to restore an environment that can be maintained in a healthy condition by the patient and to prevent further disease in the tissues supporting the teeth. After the soft tissue is removed, the exposed areas are thoroughly scaled and curetted while visibility is greatest.
(2) Instruments and materials. The usual setup of instruments and materials (previously autoclaved) for a gingivectomy includes a mirror and the items shown in figure 4-11. Other items may be requested as desired by the dentist. A periodontal dressing, which is used as a bandage and controller of hemorrhage, is placed over the areas where the gingivectomy has been performed.
(3) Duties of the dental assistant.
(a) The dental assistant should be at the chair at all times when a patient is present, especially when surgery is in progress. He should aid the periodontist in keeping the patient comfortable, help to maintain visibility in the operating field, have the required instruments available, and anticipate the periodontist's need. The dental assistant should know how much and to what consistency the periodontal protective paste should be mixed to form the periodontal pack or dressing for the periodontal surgery. There is a tube of base, and a tube of accelerator, and a bottle of retarder, which have to be mixed. This is usually prepared immediately before use. After the dressing is put in place, ice water is applied to it to help harden the material. The sooner it hardens, the less likely it is to be displaced by movement of the patient's tongue. Figure 4-12 shows the materials used to mix a periodontal dressing, sometimes called a periodontal pack. The most common commercial periodontal dressing is the Coe-Pak.
Figure 4-12. Materials for mixing a periodontal dressing.
(b) At the conclusion of the gingivectomy, the dental assistant should be certain the patient has been given postoperative instructions, medication or prescriptions, and a reappointment. The dental assistant should observe the patient to be certain that he can take care of himself, that the patient's clothes are arranged properly, and that the patient's face is free of blood or other foreign material. The dental assistant will inform the periodontist if any discrepancies exist.
(c) After dismissal of the patient, the instruments and suction hose and tips should be soaked in a cool detergent solution for 10 minutes before scrubbing, rinsing, and preparing for packaging and autoclaving.