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Perio--Surgical (Spring) > 5. Access Flaps > Flashcards

5. Access Flaps Flashcards

1
Q

What is removed in a modified widman flap

A

sulcular epithelium
pocket epithelium
JE

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2
Q

New CT forms in what direction

A

apical to coronal

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3
Q

Purpose of membranes

A

prevent the oral epithelium from contacting the clot that facilitates perio regeneration and CT attachment

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4
Q

ENAP and LANAP mean

A

Excisional new attachment procedure

Laser assisted new attachment procedure

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5
Q

LANAP removes _ and leaves _

A

Removes diseased pocket epithelium

Leaves CT

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6
Q

Patients have (more/less) recession and root sensitivity with LANAP

A

less

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7
Q

New cementum, PDL, and attachment to the root is formed by what for LANAP

A

stem cells

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8
Q

Is LA needed with LANAP

A

yes

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9
Q

Laser for LANAP should be held _ in relation to the root surface

A

parallel

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10
Q

How is the pocket epithelium removed with LANAP

A

photothermolysis

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11
Q

How many passes are done with the laser in LANAP

A

2

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12
Q

ADA statements on lasers

A
  • 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
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13
Q

Can lasers harm patients

A

yes and no- if the inappropriate wavelength is used the laser can damage the perio tissues

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14
Q

What is the superior wavelength for lasers

A

hasn’t yet be determined

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15
Q

What are the two classifications of perio flaps

A
  • Full thickness

- Partial (split) thickness

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16
Q

Describe a full thickness flap

A
  • 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
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17
Q

Describe partial (split) thickness flap

A
  • Bone still covered by periosteum and CT
  • Sharp disection
  • Use in areas of thin bone dehiscence, and fenestration
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18
Q

Most common location in the mouth for split thickness flap

A

Where the roots are prominent in the arch (thinner bone)

  • Cuspids
  • Maxillary 1st molars (MB root)
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19
Q

Periodontal flaps in addition to being classified based on their thickness are also classified based on

A

-Their position post operatively

replaced and positioned

20
Q

Describe the difference between replaced and positioned flaps

A

Replaced

  • Put back where it originally was
  • AKA undisplaced and repositioned

Positioned

  • AKA displaced or moved
  • Apically positioned
  • Laterally positioned
  • Coronally positioned
21
Q

What is the most common flap in perio surgery

A

-Apically positioned flap

22
Q

Apically positioned flap are

A
  • Get rid of perio pockets
  • Exposed root surfaces
  • Width of keratinized tissue is maintained
23
Q

Coronally positioned flap

A

-Cover root surfaces

24
Q

Laterally positioned flaps

A

-Also to cover root surfaces (mucogingival defects)

25
Coronally positioned flaps are most commonly done with (full/split) thickness flaps
split
26
Laterally positioned flaps are most commonly done with (full/split) thickness flaps ... except when
split...thin biotype
27
Describe papilla preservation
- No incision through the papilla - B and a L flap - Flap is typically brought to the lingual
28
Papilla preservation is especially useful when
- Holding in graft material | - Esthetic areas (prevents black triangles)
29
Closed procedures are ususally done in what phase of perio therapy
initial phase (SRP)
30
Downsides of closed procedures are
-Rely on tactile sense (poorer results in deeper pockets)
31
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
32
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
33
Internal bevel incision location is dependent on
the depth of the pocket and the thickness of the tissue
34
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"
35
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)
36
Modified Widman is a (replaced/positioned) flap
replaced
37
Healing of a modified widman is by (primary/secondary) intention
primary
38
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
39
Another name for modified widman is
open flap curretage
40
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 ```
41
Why is the modified widman extended interproximally as far as possible
to achieve primary closure --> healing by primary intention --> papilla preservation
42
Incision of a modified widman will contain
sulcular eptihelium and may contain JE
43
Modified widman is a (full/partial) thickness flap
full
44
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
45
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

Perio--Surgical (Spring) (8 decks)

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