The partial-thickness flap is indicated when the flap is to be positioned apically or when the operator does not want to expose bone. 1. To improve esthetics as well as treat periodontal disease the method of choice remains is undisplaced flap surgery [12, 13]. Scalloping follows the gingival margin. When bone is stripped of its periosteum, a loss of marginal bone occurs, and this loss is prevented when the periosteum is left on the bone. An electronic search without time or language restrictions was . HGF is characterized as a benign, slowly progressive, nonhemorrhagic, fibrous enlargement of keratinized gingiva.It can cover teeth in various degrees, and can lead to aesthetic disfigurement. THE UNDISPLACED FLAP TECHNIQUE Step 1: Measure pockets by periodontal probe,and a bleeding point is produced on the outer surface of the gingiva by pocket marker. The beak-shaped no. techniques revealed that 67.52% undergone kirkland flap, 20.51% undergone modified widman flap, 5.21% had papilla preservation flap, 2.25% had undisplaced flap, 1.55% had apically displaced flap and very less undergone distal wedge procedure which depicts that most commonly used flap technique was kirkland flap among other techniques. Pocket depth was initially similar for all methods, but it was maintained at shallower levels with the Widman flap; the attachment level remained higher with the Widman flap. This technique offers the possibility of establishing an intimate postoperative adaptation of healthy collagenous connective tissue to tooth surfaces,2,3,5,6 and it provides access for adequate instrumentation of the root surfaces and immediate closure of the area. 15 scalpel blade, parallel to each other beginning at the distal end of the edentulous area, continued to the tooth. In the present discussion, we discussed various flap procedures that are used to achieve these goals. 2. The secondary flap removed, can be used as an autogenous connective tissue graft. Laterally displaced flap. The antibiotics should be started before the surg-ical procedure so that appropriate antibiotic levels are there in blood at the time of surgery to prevent spread of infection. With this access, the surgeon is able to make the. (1985) 26 modified this procedure to preserve anterior esthetics after flap surgery. Sulcular incision is now made around the tooth to facilitate flap elevation. The main objective of periodontal flap surgical procedures is to allow access for the cleaning of the roots of teeth and the removal of the periodontal pocket lining, as well as to treat the irregularities of the alveolar bone, so that when gingiva is repositioned around the teeth, it will allow for the reduction of pockets, infections, and inflammation. The first step . During crown lengthening, the shape of the para-marginal incision depends on the desired crown length. Contents available in the book .. . Preservation of good blood supply to the flap is another important consideration. If detected, they are removed. The flaps may be thinned to allow for close adaptation of the gingiva around the entire circumference of the tooth and to each other interproximally. 2. The flap was repositioned and sutured [Figure 6]. As soon the granulation tissue is removed, the clear bone margins and root surfaces are visible. The no. Contents available in the book .. They are also useful for treating moderate to deep periodontal pockets in the posterior regions. The horizontal or interdental incision is then made using a small knife (Orban 1 or 2), severing the supracrestal gingival fibers. May cause esthetic problems due to root exposure. The aim of this study was to test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated by dental implants being inserted by a flapless surgical procedure versus the open flap technique, against the alternative hypothesis of a difference. Later on Cortellini et al. These are indicated in cases where interdental spaces are too narrow and when the flap needs to be displaced. - Undisplaced flap - Apicaliy displaced flap - All of the above - Modified Widman flap. Contents available in the book . It produces a sharp, thin flap margin for adaptation to the bone-tooth junction. The area is re-inspected for any remaining granulation tissue, tissue tags or deposits on the root surfaces. 1. The internal bevel incision may be a marginal incision (from the top of gingival margin) or para-marginal incision (at a distance from the gingival margin). After administration of local anesthesia, bone sounding is done to assess the thickness of gingiva and underlying osseous topography. 30 Q . Within the first few days, monocytes and macrophages start populating the area 37. Along with removing the tissue above the alveolar crest, this incision also reveals the thickness of the soft tissue. Contents available in the book .. Contents available in the book .. The blade is introduced into the sulcus or pocket and is inserted as far as possible into the interdental space around the tooth, keeping it close to the crown. Unsuitable for treatment of deep periodontal pockets. Historically, gingivectomy was the treatment of choice for these areas until 1966, when Robinson 32 addressed this problem and gave a separate surgical procedure for these areas which he termed distal wedge operation. Endodontic Topics. Also, complicated or prolonged surgical procedures that require full-thickness mucoperiosteal flaps with resultant edema can lead to trismus. The surgical approaches that split the papilla cause shrinkage and decrease in the height of the interdental papilla leading to the exposure of interproximal embrasures. Contents available in the book .. The thicker the tissue is, the more apical the ending point of the incision (see Figure 59-4). Apically displaced flaps have the important advantage of preserving the outer portion of the pocket wall and transforming it into attached gingiva. Periodontal pockets in areas where esthetics is critical. The incision is carried around the entire tooth. The necessary degree of access to the underlying bone and root surfaces and the final position of the flap must be considered when designing the flap. The flap is placed at the toothbone junction by apically displacing the flap. That portion of the gingiva left around the tooth contains the epithelium of the pocket lining and the adjacent granulomatous tissue. Log In or, (Courtesy Dr. Kitetsu Shin, Saitama, Japan. Flap for regenerative procedures. 6. The interdental papilla is then freed from the underlying bone and is completely mobilized. 4. 2. After this, the second or the sulcular incision is made from the bottom of the pocket till the crest of the alveolar bone. 2006 Aug;77(8):1452-7. The papillae are then carefully pushed back through the interdental embrasures to palatal or lingual aspect. Short anatomic crowns in the anterior region. It is also known as a partial-thickness flap. Conventional flaps include the modified Widman flap, the undisplaced flap, the apically displaced flap, and the flap for reconstructive procedures. Contents available in the book .. In this flap procedure, no ostectomy is performed; however, minor osetoplasty may be done to modify the undesired bony architecture. After removing the wedge of the tissue the margins of the flap are undermined with the help of scalpel blades, In this technique, two incisions are made with the help of no. FLAP PERIODONTAL. These incisions are made in a horizontal direction and may be coronally or apically directed. Coronally displaced flap Connective tissue autograft Free gingival graft Laterally positioned flap Apically displaced flap 5. Smaller incisions usually cause less postoperative swelling and pain as compared to larger incisions. The first step, Trismus is the inability to open the mouth. An interdental (third) incision along the horizontal lines seen in the interdental spaces will sever these connections. Contents available in the book .. A periosteal elevator is inserted into the initial internal bevel incision, and the flap is separated from the bone. Incisions can be divided into two types: the horizontal and vertical incisions 7. After one week, the sutures are removed and the area is irrigated with normal saline solution. After removing the wedge of the tissue the margins of the flap are undermined with the help of scalpel blades . In this flap, only epithelium and the underlying connective tissue are reflected, leaving the periosteum intact. No incision is made through the interdental papillae. This is a commonly used incision during periodontal flap surgeries. The term gingival ablation indicates? Clinical crown lengthening in multiple teeth. The main advantages of this procedure are the preservation of maximum healthy tissue and minimum post-operative discomfort to the patient. Step 2:The gingiva is reflected with a periosteal elevator (Figure 59-3, D). 1. It is contraindicated in the areas where treatment for an osseous defect with the mucogingival problem is not required, in areas with thin periodontal tissue with probable osseous dehiscence or osseous fenestration and in areas where the alveolar bone is thin. - Charter's method - Bass method - Still man method - Both a and b correct . The coronally directed incision is designated as external bevel incision whereas the apically directed incisions are the internal bevel and sulcular incision. Increase accessibility to root deposits for scaling and root planing, 2. Minor osteoplasty may be carried out if osseous irregulari-ties are observed. Contents available in the book .. A. Contents available in the book .. Step 3:A crevicular incision is made from the bottom of the pocket to the bone in such a way that it circumscribes the triangular wedge of tissue that contains the pocket lining. So, this procedure cannot be employed when modified Widman flap, excisional new attachment procedure and regenerative procedures such as osseous grafting are done because these procedures require primary closure. Position of the knife to perform the crevicular (second) incision. Conventional flaps include the modified Widman flap, the undisplaced flap, the apically displaced flap, and the flap for reconstructive procedures. Need to visually examine the area, to make a definite diagnosis. The papilla preservation flap incorporates the entire papilla in one of the flaps by means of crevicular interdental incisions to sever the connective tissue attachment as well as a horizontal incision at the base of the papilla to leave it connected to one of the flaps. The margins of the flap are then placed at the root bone junction. 2. Trochleoplasty with a flexible osteochondral flap; The role of the width of the forefoot in the development of Morton's neuroma; February. Contents available in the book .. Following are the steps followed during this procedure. The interdental incision is then made to severe the inter-dental fiber attachment. To preserve the present attached gingiva or even to establish an adequate strip of it, where it is narrow or absent. 7. After suturing, the flap is adapted around the neck of the teeth with the help of moistened gauze. The first incision or the internal bevel incision is then made from the bleeding points directed at an apical level to the alveolar crest. The triangular wedge of the tissue, hence formed is removed. The most apical end of the internal bevel incision is exposed and visible. The reasons for placing vertical incisions at line angles of the teeth are. 15 or 15C surgical blade is used most often to make this incision. One incision is now placed perpendicular to these parallel incisions at their distal end. The classic treatment till today in developing countries is removal of excess gingival growth by scalpel but one should remember about the periodontal treatment which should be done before commencing the surgical part of . After the flap has been elevated, a wedge of tissue remains on the teeth and is attached by the base of the papillae. Platelets rich fibrin (PRF) preparation and application in the . The granulomatous tissue is then removed and the deposits on the root surfaces are removed by scaling. If the incisions have been made correctly, the flap will be at the crest of the bone with the scalloped papillae positioned interproximally, thus permitting its primary closure. With this access, the surgeon is able to make the third incision, which is also known as the interdental incision, to separate the collar of gingiva that is left around the tooth. Modified flap operation, Although some details may be modified during the actual performance of the procedure, detailed planning allows for a better clinical result. It does not attempt to reduce the pocket depth, but it does eliminate the pocket lining. Vertical incisions increase flap mobility, thus facilitating better access to the operative area. Because the alveolar bone is partially exposed, there is minimum post-operative pain and swelling. In the following discussion, we shall study in detail, the surgical techniques that are followed in various flap procedures. Care should be taken to insert the blade in such a way that the papilla is left with a thickness similar to that of the remaining facial flap. Periodontal pockets in severe periodontal disease. One incision is now placed perpendicular to these parallel incisions at their distal end. a. Full-thickness flap. At last periodontal dressing may be applied to cover the operated area. The beak-shaped no. After pushing the papillae buccally, both the flap and the papilla are reflected off the bone with a periosteal elevator. ), Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on 59: The Flap Technique for Pocket Therapy, Several techniques can be used for the treatment of periodontal pockets. Placement of the vertical incisions is absolutely essential in cases where the flap has to be re-positioned coronally (coronally displaced flap) or apically (apically displaced flap) from its original position. Fugazzotto PA. The periodontal flap is one of the most frequently employed procedures, particularly for moderate and deep pockets in posterior areas (see Chapter 57). The internal bevel incision starts from a designated area on the gingiva, and it is then directed to an area at or near the crest of the bone (Figure 57-6). Persistent inflammation in areas with moderate to deep pockets. b. Papilla preservation flap. ), Only gold members can continue reading. These landmarks establish the presence and width of the attached gingiva, which is the basis for the decision. The partial-thickness flap may be necessary when the crestal bone margin is thin and exposed with an apically placed flap or when dehiscences or fenestrations are present. A periodontal flap is a section of gingiva, mucosa, or both that is surgically separated from the underlying tissues to provide for the visibility of and access to the bone and root surface. May cause hypersensitivity. Conventional flap. Tooth with extremely unfavorable clinical crown/root ratio. There are two types of incisions that can be used to include interdental papillae in the facial flap: One technique includes semilunar incisions which are. Enter the email address you signed up with and we'll email you a reset link. The periodontal flap is one of the most frequently employed procedures, particularly for moderate and deep pockets in posterior areas (see, Increase accessibility to root deposits for scaling and root planing, Eliminate or reduce pocket depth via resection of the pocket wall, Gain access for osseous resective surgery, if necessary, Expose the area for the performance of regenerative methods, Technique for Access and Pocket Depth Reduction or Elimination, All three flap techniques that were just discussed involve the use of the basic incisions described in. It differs from the modified Widman flap in that the soft-tissue pocket wall is removed with the initial incision; thus, it may be considered an internal bevel gingivectomy. The undisplaced flap and the gingivectomy are the two techniques that surgically remove the pocket wall. Different Flap techniques for treatment of gingival recession (Lateral-coronal-double papilla-semilunar-tunnel-apical). Sutures are placed to secure the flaps in their position. Once bone sounding has been done, a gingivectomy incision without bevel is given using a periodontal knife to remove the tissue above the alveolar crest. The periodontal dressing is not required if the flap has been adapted adequately to cover the interdental area. 7. To overcome the problem of recession, papilla preservation flap design is used in these areas. The flap also allows the gingiva to be displaced to a different location in patients with mucogingival involvement. The root surfaces are checked and then scaled and planed, if needed (. The first, second and third incisions are placed in the same way as in case of modified Widman flap and the wedge of the infected tissue is removed. During this whole procedure, the placement of the primary incision is very important because if improperly given it may become short, leaving exposed bone or may become longer requiring further trimming which is difficult. The secondary. The main advantages of this procedure are maximum conservation of the keratinized tissue, maximum closure of the flaps and greater access to the underlying bony topography and the distal furcation.



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