Periodontal flaps- Review

Question 1

Reproduction or reconstitution of a loss or injured part:

Answer 1

Regeneration

Question 2

List the three components of periodontal regeneration:

Answer 2

1. alveolar bone
2. PDL
3. cementum

Question 3

In periodontal regeneration, new alveolar bone, cementum, and PDL ligament are formed, restoring:

Answer 3

new architecture and function of the attachment apparatus

Question 4

Give an example of periodontal regeneration:

Answer 4

Bone replacement grafting

Question 5

Bone graft material placed to maintain space and allow new bone, cementum and PDL cells to come in and create new materials:

What is this an example of?

Answer 5

Bone replacement grafting; periodontal regeneration

Question 6

The union of connective tissue with the root surface that has been deprived of its original attachment apparatus. Provides a reunion of CT with the root surface that has been pathologically exposed:

Answer 6

New attachment

Question 7

The new attachment is defined as the union of connective tissue with the root surface that has been deprived of its ORIGINAL attachment apparatus.

What does this provide?

Answer 7

Provides a reunion of CT with a root surface that has been pathologically exposed

Question 8

Tissue grafting (connective tissue graft covering area of root recession) is an example of:

Answer 8

New attachment

Question 9

The reunion of connective tissue with the root surface on which viable PDL tissue is present:

Answer 9

Reattachment

Question 10

Biologic width /supracrestal tissue - existed before a flap was reflected and when the flap is replaced, reattachment occurs with the intact CT fibers.

This is an example of:

Answer 10

reattachment

Question 11

The healing of a wound that does NOT fully restore the architecture or function of the part:

Answer 11

Repair

Question 12

The healing by a long junctional epithelium, that is the body’s protective healing to precent ankylosis and root resorption. This is an example of:

Answer 12

Repair

Question 13

ALL soft tissue including the periosteum is reflected exposing the underlying bone:

Answer 13

Full thickness flap

Question 14

Most commonly used flap:

Answer 14

Full thickenss flap

Question 15

A full thickness flap is also called:

Answer 15

Mucoperiosteal flap

Question 16

A flap in which epithlium and some connective tissue is reflected, LEAVING PERIOSTEUM and some connective tissue overlying the bone:

Answer 16

Partial thickness flap

Question 17

What type of flap is less commonly used?

Answer 17

Partial thickness flap

Question 18

Another name for partial thickness flap:

Answer 18

Split thickness flap

Question 19

List the principles of tissue attachments: (5)

Answer 19

1. preparation of soft tissue wall (not necessary as a separate procedure it is accomplished in conjunction with scaling)
2. preparation of root surface
3. debridement of bony defects
4. adaptation of soft tissue to root surface
5. control of etiology pre- and post-surgery

Question 20

Root changes hindering tissue attachment include:

Answer 20

1. Foreign body nature of exposed diseased root surfaces (presence of endotoxin)
2. Pathologic changes in root surface (hypo- and hypercalcification areas)
3. Decreased organic material in exposed cementum (loss of fibers and alterations in the organic material related to endotoxin)

Question 21

What is the therapeutic endpoint (success) of periodontal flap surgeries?

Answer 21

A functional, comfortable, healthy dentition with stable probing attachment levels

Question 22

How do you know what surgical periodontal procedure to use?

Answer 22

1. diagnosis
2. know your endpoint (regeneration, pocket elimination, pocket reduction)
3. know indications and contraindications
4. maintenance

Question 23

removal of connective and epithelial attachment with a currette:

Answer 23

Currettage

Question 24

Removal of connective tissue and epithelial attachment circumferentially with a scalpel:

Answer 24

ENAP

Question 25

Two ways to surgically involve the gingiva. Normal epithelium has finger-like projections (rete ridges). The connective tissue grows down and epithelium grows upwards:

Answer 25

Gingivectomy vs. Gingivoplasty

Question 26

The excision of the soft tissue wall of the periodontal pocket. Incision forms an external bevel or surface that is exposed to the oral cavity:

Answer 26

Gingivectomy

Question 27

REMOVES diseased gum tissue:

Answer 27

Gingivectomy

Question 28

What is the function of a gingivectomy?

Answer 28

Eliminates gingival enlargement and eliminates suprabony pockets

Question 29

T/F: A gingivectomy is responsible for removing infrabony pockets

Answer 29

False- suprabony pockets

Question 30

Gingival deformities are reshaped and reduced to create a normal and functional form. The incision creates an external bevel:

Answer 30

Gingivoplasty

Question 31

What is the function of a gingivoplasty?

Answer 31

reshapes otherwise healthy gum tissue

Question 32

Reshapes otherwise healthy gum tissue:

Answer 32

Gingivoplasty

Question 33

What is the most common indication for a gingivectomy?

Answer 33

Elimination of gingival enlargements

Question 34

List the indications for a gingivectomy:

Answer 34

1. elimination of gingival enlargements (most common) 2. elimination of asymmetrical or unesthetic gingival topography 3. exposure of unerrupted teeth when adequate keratinized tissue is present

Question 35

-elimination of gingival enlargements (most common) -elimination of asymmetrical or unesthetic gingival topography -exposure of unerrupted teeth when adequate keratinized tissue is present

Answer 35

Indications for gingivectomy

Question 36

List the contraindications for a gingivectomy:

Answer 36

1. Access is needed to INFRAbony defects 2. Base of pocket is apical to MG junction 3. When keratinized tissue is inadequate (in this case a gingivectomy would removal ALL keratinized tissue) 4. Severely inflamed tissue (needs SRP) 5. Esthetics (anterior maxilla) 6. Anatomical preclusion (lack of keratinized tissue)

Question 37

T/F: A gingivectomy is a great option for anterior maxilla gingival overgrowth

Answer 37

False- contraindicated in this region

Question 38

List the advantages of gingivectomy:

Answer 38

Simple & fast

Question 39

List the disadvantages of gingivectomy:

Answer 39

1. limited applicability (suprabony defects only) 2. longer healing period (4-5 weeks) 3. less effective than flap surgery (no access to osseous defects)

Question 40

Three indications for gingivectomy that are usually corrected via flap surgery for access:

Answer 40

1. elimination of SUPRAbony pockets which cannot be adequately debrided without tissue removal 2. elimination of SUPRAbony pockets if the pocket wall is fibrous and firm and therefore will NOT shrink after non-surgical therapy 3. access for restorative with SUPRAbony pockets

Question 41

Describe the gingivectomy technique:

Answer 41

1. marking of pocket depth 2. resection of the gingiva with incision starting APICAL to the pocket base and externally beveled at a 45 degree angle 3. removal of pocket (tissue) 4. debridement of granulation tissue 5. post-surgical control of bleeding

Question 42

T/F: With a gingivectomy bone exposure is to be avoided

Answer 42

True

Question 43

T/F: With a gingivectomy, partial removal of pocket is ideal if possible

Answer 43

False- complete removal of pocket

Question 44

T/F: With a gingivectomy thick tissue will require a more coronal start of the incision

Answer 44

False- apical

Question 45

Surgical debridement of the root surface and removal of granulation tissue from osseous defects following reflection of mucoperiosteal flap:

Answer 45

Open flap debridement

Question 46

What type of incision is used in an open flap debridement?

Answer 46

Intrasulcular bevel incison

Question 47

List the modifications of an open flap debridement:

Answer 47

1. Modified widman 2. Anterior curtain

Question 48

What is the key to success of all surgical periodontal procedures?

Answer 48

Patient's home care and maintenance

Question 49

The anterior curtain OFD modification is used on:

Answer 49

maxillary anteriors

Question 50

Open flap objectives include: (5)

Answer 50

1. ACCESS to root surface and osseous defects 2. PRESERVATION of osseous support 3. REDUCTION or elimination of periodontal pockets 4. MINIMIZE post-surgical pain, root sensitivity and esthetic compromise 5. IMPROVED ACCESS for better patient home care

Question 51

Open flap indications:

Answer 51

1. advanced disease where access is needed to roto surfaces and osseous defects 2. where regeneration may be possible 3. to preserve tissue for esthetics 4. as an exploratory procedure or as part of the non-surgical phase of treatment for fibrous tissue 5. less post-op discomfort

Question 52

Open flap contraindications: (3)

Answer 52

1. patient is unable to tolerate a surgical procedure 2. increased tissue recession may result to esthetic compromise 3. potential of root caries and root sensitivity due to greater root exposure post-surgically

Question 53

Describe open flap technique: (5)

Answer 53

1. Intrasulcular incison 2. Papillas thinned to uniform thickness 3. mucoperiosteal flap is reflected 4. vertical incisions can be used 5. palatal incisions placed dependent on extent of defects and amount of pocket reduction planned

Question 54

What type of incison is NOT indicated in open flap technique, why?

Answer 54

Step back incisons are not indicated due to them being ineffective

Question 55

What type of flap is used in an open flap technique?

Answer 55

Mucoperiosteal

Question 56

The modified widman (modification to open flap technique) results in:

Answer 56

minimal tissue recession

Question 57

Modification of the subgingval currettage with flap reflection, allowing for access to the root surface and does not reflect past the alveolar crest:

Answer 57

Modified widman flap

Question 58

In a modified widman flap, the tissue is NOT reflected past:

Answer 58

alveolar crest

Question 59

The modified widman flap conserves _____ due to no osteoplasty or ostectomy

Answer 59

alveolar bone

Question 60

Indications for modified widman flap: (5)

Answer 60

1. moderate disease 2. INFRAbony defects 3. high caries rate 4. root sensitivity 5. anterior esthetic areas

Question 61

Contraindications for modified widman flap:

Answer 61

severe disease and greater access needed

Question 62

List the advantages to the modified widman flap:

Answer 62

1. great access to root surface 2. possible esthetic improvement 3. minimal recession occurs 4. primary closure

Question 63

List the disadvantages to the modified widman flap:

Answer 63

Flat or concave post-op tissue contour

Question 64

A conservative approach and will not increase the width of keratinized tissue:

Answer 64

Modified widman flap

Question 65

- First incison is started 0.5-1mm apical to the gingival margin and "aimed" at alveolar crest -Second incison is intrasulcular to create wedge -Third incison made horizontally following the alveolar crest to remove wedge

Answer 65

3 steps of modified widman (incisions)

Question 66

Modification to open flap debridement that aims to gain access to interproximal defects in the maxillary anterior region with minimal recession:

Answer 66

Anterior curtain flap

Question 67

Indication for aterior curtain flap:

Answer 67

1. maxillary anterior region with interproximal or palatal osseous defects and no facial bone loss 2. esthetic concerns

Question 68

What is the only contraindication to anterior curtain flap?

Answer 68

Facial bone loss

Question 69

In this type of flap modification, incisons are only made in the facial interproximal (no direct facial incisors):

Answer 69

Anterior curtain

Question 70

Describe the anterior curtain flap technique:

Answer 70

1. palatal flap 2. incisions only in the facial interproximal areas (with no direct facial incisions) 3. debridement 4. closure/suture

Question 71

-Advanced disease where access is needed to root surfaces and osseous defects -Where regeneration may be possible -To preserve tissue for esthetics -As an exploratory procedure or as part of the non-surgical phase of treatment for fibrous tissue -Less post-op discomfort -If you think root is fractured and need to confirm

Answer 71

Indications for open flap debridement

Question 72

-Patient is unable to tolerate a surgical procedure -Patient has already had surgery and did not see improvement -Increased tissue recession may result in tissue compromise -Potential root caries and potential root sensitivity due to greater root exposure

Answer 72

Contraindications to open flap debridement

Question 73

1. Intrasulcular incison placed and papillas are thinned to a uniform thickness 2. mucoperiosteal flap is reflected 3. root surface and osseous defect debridement 4. flap closure with apcial positioning 5. sutures

Answer 73

Open flap technique

Question 74

With an open flap procedure a _____ incision may be used to reduce tension

Answer 74

Vertical

Question 75

With an open flap procedure _____ incisions may be used dependent on the extent of the defects and amount of pocket reduction planned

Answer 75

Palatal

Question 76

Why would we modify the open flap procedure to include minimal osteoplasty?

Answer 76

To improve flap adaptation

Question 77

Complication of periodontal surgery due to compromised blood supply due to over-thinning of flap or vascular compromised:

Answer 77

Flap necrosis

Question 78

List the reasons of flap necrosis:

Answer 78

-compromised blood supply due to over-thinning of flap

Question 79

In minimal osteoplasty, bony projections (i.e. exostoses) should be removed _______ to ______ to allow the flap to approach the tooth in better manner and allow for better flap adaptation

Answer 79

prior; flap suturing

Question 80

In minimal osteoplasty, flaps should be positioned in relation to the ____ for either pocket reduction or elimination

Answer 80

osseous crest

Question 81

Situation in which the flap was too thin and was not approximated to crestal bone and shrunk back up due to a lack of blood supply

Answer 81

Flap necrosis

Question 82

What is the source of healing?

Answer 82

PDL

Question 83

What is the goal of periodontal surgery?

Answer 83

All flaps regardless of technique should function to provide ACCESS

Question 84

list three places of access provided by periodontal surgery:

Answer 84

1. access to debride the root surface and osseous defect 2. access to place bone replacement graft 3. access for osseous correction