Gingivectomy and Flap Design

Question 1

What are some indications for gingivectomy?

Answer 1

1. Hyperplastic tissue

2. Suprabony pockets

Question 2

What are some contraindications to gingivectomy?

Answer 2

1. Osseous involvement
2. Mucogingival involvement
3. Furcation involvement

Question 3

T/F: Gingivectomy is indicated when you have a pocket below the crest of bone.

Answer 3

False

Question 4

Gingivectomy is often done in conjunction with ____________.

Answer 4

Gingivoplasty - recontour tissue to look more normal

Question 5

What is the first step in gingivectomy after LA has been administered?

Answer 5

Mark pocket depths with bleeding points

Question 6

You start the incision ___________ to the bleeding point.

Answer 6

Apical

Allows for a beveled incision

Question 7

T/F: You would typically work distal to mesial for a gingivectomy procedure.

Answer 7

True

Question 8

What is the general purpose of the gingivectomy?

Answer 8

Makes it easier for patient to clean and removes the anaerobic environment

Question 9

What is imperative in order for the tissue to regrow and heal after a gingivectomy?

Answer 9

That there is adequate keratinized tissue before and after surgery

Question 10

T/F: Lasers and electrosurgery can be used for gingivectomy.

Answer 10

True

Question 11

T/F: Tissues are exposed during healing after flap surgery.

Answer 11

False

Tissues exposed during gingivectomy, not flap surgery

Question 12

T/F: Flaps are externally beveled.

Answer 12

False

Internal bevel

Question 13

T/F: Flaps preserve keratinized gingiva and can be closed by suturing.

Answer 13

True

Question 14

What are some contexts for using a flap?

Answer 14

1. Resective surgery
2. Conservative (access only)
3. Regeneration

Question 15

T/F: Using a flap is much more versatile than gingivectomy.

Answer 15

True

Question 16

What is the difference between a full thickness flap and a partial thickness flap?

Answer 16

Full: includes epithelium, connective tissue, and periosteum (peeled off bone surface)

Partial: includes epithelium and a portion of connective tissue

Question 17

What is the advantage to a partial thickness flap?

Answer 17

Leaves the periosteum on the bone - protecting it from resporption

Question 18

T/F: Full thickness flaps are more commonly used.

Answer 18

True

Question 19

What is the most common blade used for a flap?

Answer 19

15 or 15c (smaller)

Question 20

What instrument is used to elevate a full thickness flap?

Answer 20

Periosteal elevator

Question 21

T/F: You cut from distal to mesial, elevate from mesial to distal.

Answer 21

True

Question 22

T/F: The primary incision for a full thickness flap should hit bone.

Answer 22

True

Question 23

T/F: All soft tissue should be removed from the flapped bony area.

Answer 23

True (debridement)

Question 24

T/F: Full thickness flaps facilitate an increase in width of keratinized tissue.

Answer 24

False

Partial-thickness flaps

Question 25

T/F: Partial thickness flaps are reflected with blunt instruments.

Answer 25

False Sharp scalpel

Question 26

What would be three indications for partial thickness flap?

Answer 26

1. Thin bone 2. Not much keratinized tissue 3. Tissue grafting

Question 27

T/F: Vertical incisions should be placed mid facial of a tooth.

Answer 27

False Over bone, at the line angles of teeth

Question 28

When would you position the flap coronally to heal?

Answer 28

Regeneration or root coverage

Question 29

When would you simply put the flap back where it was to heal?

Answer 29

Conservative flaps

Question 30

When would you position the flap apically to heal?

Answer 30

For pocket elimination of crown lengthening (resective)

Question 31

T/F: The entire palatal gingival tissue is adhered to bone.

Answer 31

True

Question 32

How would you reduce pocket size with a palatal flap?

Answer 32

You must thin the flap

Question 33

A _____________ is a perio sx procedure for removing excessive soft tissue distal to a terminal tooth.

Answer 33

Distal wedge

Question 34

What are some typical sites for wedges?

Answer 34

Maxillary tuberosity, mandibular retromolar area, edentulous ridges

Question 35

T/F: It is possible to obtain primary closure of the wound after bulky tissue reduction with a distal wedge.

Answer 35

True

Question 36

Which distal wedge design is the least difficult and least invasive?

Answer 36

Triangular wedge

Question 37

Which distal wedge design provides the best access?

Answer 37

Square wedge

Question 38

Which distal wedge design is best at preserving keratinized tissue?

Answer 38

Linear wedge

Question 39

T/F: When you have limited keratinized tissue, scalloped incisions are indicated for flap design.

Answer 39

False Stay sulcular to preserve keratinized tissue

Question 40

What can allow you to get primary closure in flaps and distal wedges?

Answer 40

Thinning of the flap

Question 41

T/F: Triangular distal wedges often heal with secondary closure.

Answer 41

True

Question 42

______________ is a conservative flap design intended to _____________.

Answer 42

Modified Widman flap; minimize recession

Question 43

In order to have minimal recession, where should the flap be placed for closure?

Answer 43

It should be replaced back where it was Minimal flap elevation allows for this

Question 44

T/F: A modified Widman flap is good for anterior teeth.

Answer 44

True

Question 45

T/F: A modified Widman flap involves 5 mm of scalloping.

Answer 45

False Minimal scalloping - allows for replaced primary closure