Palatal Flap with Retromolar and Tuberosity Surgery

Question 1

Palatal Flap
 Histologic Differences
(2)

Answer 1

 Keratinized (cannot be apically
positioned)
 Thickness of the connective tissue
(varies among areas and among
patients)

Question 2

Palatal Flap
 Anatomic Differences
(5)

Answer 2

 Palatine foramen and blood vessels
 Rugae
 Incisive papilla with vessels
 Palatal exostosis (40% incidence)
 Palatal form (high to shallow vault-related
to tissue thickness)

Question 3

Palatal Flap
 Plan procedure thoroughly
(2)

Answer 3

 Anticipate underlying bone morphology
 Anticipate palatal root configuration

Question 4

Palatal Flap
 Anticipate treatment goals
(3)

Answer 4

 Regeneration
 Resection
 Combination

Question 5

The amount of
tissue that is
removed is
usually
determined by

Answer 5

the initial probing
depth. Usually
the first incision
is made at the
level of 2/3 of the
probing depth.

Question 6

Palatal Flap (4 incisions)
 Clinical Technique
 Primary incision:

Answer 6

Trace incision
 Scalloped incision versus straight
incision

Question 7

 Secondary Incision

Answer 7

 Undermining or thinning of tissue
with incision in long axis of tooth

Question 8

Tertiary Incision

Answer 8

 Contact with bone

Question 9

Fourth Incision
(4)

Answer 9

 Intrasulcular
 Tissue removal
 Granulation tissue removal
 Defect and root debridement

Question 10

Goal of the flap surgery is

Answer 10

access

Question 11

Access, Access, Access
 Goal of the flap surgery is access
 Access to …
 Access to …
 Access for …

Answer 11

debride the root surface and
the osseous defect
place any bone replacement
graft
osseous correction if
possible

Question 12

Palatal Flap Complications
(7)

Answer 12

 Position of rugae or incisive papilla
 Vertical palatal incision contour
 “Long” flap
 “Short” flap
 Flap necrosis-results in a “short” flap
 Hemorrhage
 Recurrent herpetic outbreak

Question 13

Flap Necrosis

Answer 13

 Flap necrosis due to compromised
blood supply due to over-thinning
of flap or vascular compromise

Question 14

 Source of healing is the (3)

Answer 14

PDL,
flap margin, and underlying bone

Question 15

Factors predisposing the retromolar
and tuberosity areas to periodontal
breakdown
(3)

Answer 15

 Bulk of soft tissue mass
 Inaccessibility to oral hygiene
 Contours favoring plaque retentio

Question 16

Factors affecting retromolar area
(4)

Answer 16

 External oblique ridge
 Lingual bony ridge
 Proximity of the ascending ramus to
the terminal tooth
 Presence of impacted or partially
impacted third molars

Question 17

Factors affecting the tuberosity area
(3)

Answer 17

 Presence of exostosis on the palatal
aspect
 Similar exostosis on buccal aspect
 Presence of impacted or partially
impacted third molars

Question 18

Resection
 Advantages
(1)
 Disadvantages
(4)

Answer 18

 Easier and quicker

 Cannot gain access to osseous defects
 Incision often ends in mucosa
 Extremely broad wound
 Exostoses are often exposed

Question 19

Distal Wedge
 Advantages and indications
(4)

Answer 19

 Management of pockets and keratinized
tissue
 Access to osseous defects
 Access for exostosis removal
 Less post-operative discomfort due to
primary closure

Question 20

Distal Wedge
 Disadvantages
(1)
 Contraindications
(3)

Answer 20

 Harder to do and time consuming

 “Flat” palate
 Limited distal space
 When no osseous defect exists

Question 21

Triangular wedge surgical technique
(6)

Answer 21

 Bone sounding
 Primary incisions
 Secondary incisions
 Wedge removal
 Osseous access if required
 Closure

Question 22

Modifications of distal wedge
 Square distal wedge surgical technique
(4)

Answer 22

 Primary incisions
 Secondary incisions
 Wedge removal
 Closure

Question 23

Linear distal wedge surgical technique
(4)

Answer 23

 Primary incisions
 Secondary incisions
 Wedge removal
 Closure

Question 24

Ochsenbein and Ross (“trap door”)
surgical technique
(4)

Answer 24

 Primary incisions
 Secondary incisions
 Wedge removal
 Closure

Question 25

— when no distal
wedge is required

Answer 25

Scaling and root planing