What is removed in a modified widman flap
sulcular epithelium
pocket epithelium
JE
New CT forms in what direction
apical to coronal
Purpose of membranes
prevent the oral epithelium from contacting the clot that facilitates perio regeneration and CT attachment
ENAP and LANAP mean
Excisional new attachment procedure
Laser assisted new attachment procedure
LANAP removes _ and leaves _
Removes diseased pocket epithelium
Leaves CT
Patients have (more/less) recession and root sensitivity with LANAP
less
New cementum, PDL, and attachment to the root is formed by what for LANAP
stem cells
Is LA needed with LANAP
yes
Laser for LANAP should be held _ in relation to the root surface
parallel
How is the pocket epithelium removed with LANAP
photothermolysis
How many passes are done with the laser in LANAP
2
ADA statements on lasers
- More data on lasers is needed to know what extent LANAP is safe and effective
- Lasers have only inconsistently shown the ability to reduce microorganisms within a perio pocket
- Lasers for the purpose of improved wound healing is contraversial and not well supported by studies
Can lasers harm patients
yes and no- if the inappropriate wavelength is used the laser can damage the perio tissues
What is the superior wavelength for lasers
hasn’t yet be determined
What are the two classifications of perio flaps
- Full thickness
- Partial (split) thickness
Describe a full thickness flap
- Bone completely exposed
- Periosteum included in the flap
- Blunt disection
- Used for osseous surgery, osseous grafting, and guided tissue regenertion
- associated with more bone resorption
Describe partial (split) thickness flap
- Bone still covered by periosteum and CT
- Sharp disection
- Use in areas of thin bone dehiscence, and fenestration
Most common location in the mouth for split thickness flap
Where the roots are prominent in the arch (thinner bone)
- Cuspids
- Maxillary 1st molars (MB root)
Periodontal flaps in addition to being classified based on their thickness are also classified based on
-Their position post operatively
replaced and positioned
Describe the difference between replaced and positioned flaps
Replaced
- Put back where it originally was
- AKA undisplaced and repositioned
Positioned
- AKA displaced or moved
- Apically positioned
- Laterally positioned
- Coronally positioned
What is the most common flap in perio surgery
-Apically positioned flap
Apically positioned flap are
- Get rid of perio pockets
- Exposed root surfaces
- Width of keratinized tissue is maintained
Coronally positioned flap
-Cover root surfaces
Laterally positioned flaps
-Also to cover root surfaces (mucogingival defects)
Coronally positioned flaps are most commonly done with (full/split) thickness flaps
split
Laterally positioned flaps are most commonly done with (full/split) thickness flaps … except when
split…thin biotype
Describe papilla preservation
- No incision through the papilla
- B and a L flap
- Flap is typically brought to the lingual
Papilla preservation is especially useful when
- Holding in graft material
- Esthetic areas (prevents black triangles)
Closed procedures are ususally done in what phase of perio therapy
initial phase (SRP)
Downsides of closed procedures are
-Rely on tactile sense (poorer results in deeper pockets)
Benefits of open procedures
- Visualize and access
- Root surface (subgingival calculus and root defect– i.e cracks)
- Alveolar bone (morphology of the osseous defect– i.e number of walls)
- Furcations
Compare a gingivectomy with a flap
Gingivectomy
- Heals with secondary intention
- “fast” procedure
- No reattachment
- Some post-op bleeding
- No visibility of alveolar bone
- Removes a good deal of keratinized tissue
Falps
- Heals by primary intention
- “Slower” procedure
- Possible reattachment
- Minimal post op bleeding
- Good visibility of bone
- Preserves more keratinized gingiva
Internal bevel incision location is dependent on
the depth of the pocket and the thickness of the tissue
Describe a modified Widman flap
- Paramarginal internal bevel incision
- Percise incisions
- Partial flap reflection (not past the MGJ
- Goal is not pocket eliminaiton rather pocket “healing”
Indications for modified Widman
- All types of periodontitis
- Especially pocket depths of 5-7 mm
- May be used with other procedures (wedge excisions and reflected flaps)
Modified Widman is a (replaced/positioned) flap
replaced
Healing of a modified widman is by (primary/secondary) intention
primary
Advantages of the Modified Widman
- Root debridment with direct vision
- Tissue friendly (minimal bleeding and recession)
- Heals by primary intention
- Minimal loss of crestal bone
- Minimal post-op discomfort
Another name for modified widman is
open flap curretage
Steps for an open flap curretage procedure
First incision -Paramarginal -Scalloping -Parallel to long axis of the tooth -~ 1 mm from the gingival margin -Extended interproximally as far as possible Flap reflection (only within the keratinizaed gingiva) Second incision- sulcular Third incision- horizontal (interproximal) Remove the collar of soft tissue -Root debridmenet -Flap repositioning and suturing
Why is the modified widman extended interproximally as far as possible
to achieve primary closure –> healing by primary intention –> papilla preservation
Incision of a modified widman will contain
sulcular eptihelium and may contain JE
Modified widman is a (full/partial) thickness flap
full
Why back in the day dis some people treat the root surfaces with a diamond
remove necrotic cementum make a biologically compatible surface for attachement
What technique is best for interproximal suturing and why
loops because you get primary closure and you don’t get suture material between the flaps