palatal flaps

Question 1

Palatal Flap
 Histologic Differences

Answer 1

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

Question 2

where is the most keratinized tissue in the mouth

Answer 2

palate

Question 3

palatal tissue anatomy

Answer 3

Question 4

Palatal Flap Anatomic Differences

Answer 4

 Anatomic Differences
 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 5

palatal flap planning

Answer 5

Plan procedure thoroughly
 Anticipate underlying bone morphology
 Anticipate palatal root configuration

Anticipate treatment goals
 Regeneration
 Resection
 Combination

Question 6

The amount of tissue that is removed is
usually determined by?

Usually the first incision is made at the
level of?

Answer 6

The amount of tissue that is removed is usually
determined by the initial probing depth.

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

Question 7

bevel depth of scalpel

Answer 7

1mm

Question 8

palatal flap # incisions

Answer 8

4

Question 9

primary incision of palatal flap

Answer 9

Trace incision
 Scalloped incision versus straight
incision

Question 10

primary incision diagrammed

Answer 10

Question 11

palatal flap secondary incision

Answer 11

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

Question 12

palatal secondary incision diagrammed

Answer 12

Question 13

palatal flap teriarty incision

Answer 13

contact bone

Question 14

palatal flap incision diagrammed

Answer 14

Question 15

fourth incision palatal flap

Answer 15

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

Question 16

palatal flap fourth incision diagrammed

Answer 16

Question 17

access from flap

Answer 17

 Goal of the flap surgery is access
 Access to debride the root surface and the osseous defect
 Access to place any bone replacement graft
 Access for osseous correction if possible

Question 18

incidence rate?

Answer 18

exotoses 40% incidence rate

Question 19

Palatal Flap Complications
 Position of ?
 incision contour?
 flap lengths?
 Flap necrosis-results in?
 bleeding?
 Recurrent event?

Answer 19

 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 20

Flap Necrosis
 Flap necrosis due to?
 Source of healing?

Answer 20

 Flap necrosis due to compromised blood supply due to over-thinning of flap or vascular compromise
 Source of healing is the PDL, flap margin, and underlying bone

Question 21

result of flap necrosis

Answer 21

granulation tissue

Question 22

 Factors predisposing the retromolar and tuberosity areas to periodontal breakdown

Answer 22

 Bulk of soft tissue mass
 Inaccessibility to oral hygiene
 Contours favoring plaque retention (restorations)

Question 23

anatomical factors affecting retromolar area

Answer 23

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

Question 24

Factors affecting the tuberosity area

Answer 24

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

Question 25

advantages of Retromolar and Tuberosity resection

Answer 25

easier and quicker

Question 26

disadvantages of Retromolar and Tuberosity resection:  Cannot gain access to?  Incision often ends in?  wound size?  what are often exposed?

Answer 26

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

Question 27

gingival resection diagrammed -what can be done for better contours?

Answer 27

can bevel edges for better contour

Question 28

distal wedge pros and indications  Management of ?  Access to?  Access for?  Less post-operative discomfort due to?

Answer 28

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

Question 29

distal wedge cons

Answer 29

 Harder to do and time consuming

Question 30

# dist distal wedge contraindications

Answer 30

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

Question 31

Triangular wedge surgical technique  Bone?  Primary?  Secondary?  Wedge?  Osseous access?  Closure?

Answer 31

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

Question 32

trianglular wedge diagram

Answer 32

Question 33

 Modifications of distal wedge

Answer 33

Square distal wedge surgical technique Linear distal wedge surgical technique

Question 34

Square distal wedge surgical technique

Answer 34

 Primary incisions  Secondary incisions  Wedge removal  Closure

Question 35

Answer 35

square distal wedge technique

Question 36

Linear distal wedge surgical technique

Answer 36

 Primary incisions  Secondary incisions  Wedge removal  Closure

Question 37

Ochsenbein and Ross (“trap door”) surgical technique

Answer 37

 Primary incisions  Secondary incisions  Wedge removal  Closure

Question 38

what to do when no D wedge required

Answer 38

SRP

Question 39

Answer 39

Trianglular wedge

Question 40

Answer 40

Square D wedge

Question 41

Answer 41

linear D wedge