Periodontal Flap Flashcards
(43 cards)
Indications
Increase accessibility to the underlying structures for
debridement/degranulation of root deposit, alveolar bone & soft
tissue
Eliminate or reduce moderate and deep PD pockets in
inaccessible areas
Gain access to perform regenerative procedure (bone graft,
GTR), crown lengthening, root resection, implants, ridge
augmentation and MG procedures
Elimination of gingival enlargement when gingivectomy is not
indicated or place gingival margins at desire position during
suturing
Rationale for surgery
It may be difficult and even impossible to resolve periodontal
inflammation completely with nonsurgical therapy alone in
moderate to advanced cases, and in cases with furcation invasion
and infrabony defects
To enhances access for root instrumentation and allows for
reduction of periodontal pockets and correction of osseous defects
Periodontal access surgery frequently results in
Periodontal access surgery frequently results in gingival recession
and loss of interdental papillae in the anterior maxilla
If vertical incisions are not made and only horizontal
incision, the flap is called an
Envelope flap
Perio surgery involves use of
Periodontal surgery involves the use of:
Horizontal (mesial-distal) incision
Vertical (occlusal-apical) incisions
Surgical blade is used most often to make these incisions
Horizontal incision is from
margin of the gingiva in mesial or distal direction
A. Internal bevel incision
B. Crevicular incision
C. Interdental incision
External bevel or bevel incision; starts
at the
External bevel or bevel incision; starts
at the surface of the gingiva apical to
the periodontal pocket and is directed
coronally toward the tooth apical to the
bottom of the periodontal pocket.
Use of external bevel
gingivectomy, can be made with a
scalpel or a knife
Scalloped Incisions; follows the scalloped
morphology of the gingival architecture
Straight incision; follows a straight line
Uses; both
Uses; both gingivectomy and flap surgery
to eliminate the interdental tissue
Why is scalloped advantageous
The scalloped incision is advantageous in
preserving the interdental architecture in gingivectomy and
creating surgical papillae and
preserving soft tissue over the interdental areas
Internal or reverse bevel incision or inverse
bevel incision; Start from the
designated area on the surface of the gingiva & directed
apically to the bone crest. It is the incision
from which the flap is reflected to expose the
underlying bone and root
Uses of internal bevel incision
Remove the pocket lining
Produce a sharp, thin flap margins
Conserves the relative uninvolved outer surface of
the gingiva - becomes AG if placed apically
Crevicular, intercrevicular, intracrevicular, sulcular,
intrasulcular incision, intersulcular incision; starts
gingival crevice and is directed apically through the junctional
epithelium and connective tissue attachment and down to the
bone
Crestal incision or marginal incision; . starts
at the surface of the gingiva at the gingival margin and is directed apically
down through the epithelium and connective tissue to the bone
Crestal incision is used to
remove the granulation and
inflamed tissue on the lateral surface
and between the bottom of pocket & crest of the bone
Why do you use
Interdental incision?
Remove the V shaped wedge that contains granulation area
Vertical Incisions must extend beyond the
beyond the mucogingival junction to reach
the alveolar mucosa(release of the flap to be displaced
Usually on Facial surface and avoided in the lingual & palatal
Facial vertical incisions should not be made in
Facial vertical incisions should not be made in the center of an
interdental papilla or over the radicular surface of a tooth
Incisions should be made at the line angles of a tooth either to
include the papilla in the flap or to avoid it completely.
Avoid long (coronal-apical) and narrow (mesial-distal) flaps, and
(jeopardize the blood supply to the flap)
FULL THICKNESS FLAP is
Soft tissue with mucoperiosteum is reflected leaving
denueded underlying bone surface by blunt dissection
Uses of full thickness flap
Open flap curettage,
Osseous surgery,
Bone graft,
GTR and
Implants
Advantages of full thickness flap
Primary wound closure
Improved visibility& exposure
Less bleeding & post operative pain
PARTIAL THICKNESS FLAP is
Overlying gingival mucosa is sharply dissected off from the
underlying bone to leave a layer of lamina propria & periostium
still overlying the bone surface - normally limited to buccal
surface
Uses of partial thickness
Uses;
Free gingival or pedical graft
Apical positioned flap.
To prevent uncovering the bone in fenestration & dehiscence
or prominent roots.
CLASSIFICATION OF FLAP
According to the Flap Placement
According to the flap placement; To allow the gingiva to
displaced in different location
Displaced - apical – coronal – lateral – double papilla
(vertical releasing incision)
Non-displaced flap – Envelope (no releasing incision)
Papilla Preservation Flap; Based on management of the
papilla;
