Osseous surgical procedures with very deep osseous defects and irregular bone loss, facially and lingually/ palatally. Conventional flaps include the modified Widman flap, the undisplaced flap, the apically displaced flap, and the flap for reconstructive procedures. While doing laterally displaced flap for root coverage, the vertical incision is made at an acute angle to the horizontal incision, in the direction toward which the flap will move, placing the base of the pedicle at the recipient site. Contents available in the book . - Undisplaced flap - Apicaliy displaced flap - All of the above - Modified Widman flap. The vertical incision should be made in such a way that interdental papilla is completely preserved. The objectives for the other two flap proceduresthe undisplaced flap and the apically displaced flapinclude root surface access and the reduction or elimination of the pocket depth. The buccal and palatal/lingual flaps are reflected with the help of a periosteal elevator. Ahmad Syaify, Sp.Perio (K) Spesialis Konsultan Bedah Perio & Estetik. Tooth with marked mobility and severe attachment loss. For regenerative procedures, such as bone grafting and guided tissue regeneration. 11 or 15c blade. 2. For the management of the papilla, flaps can be conventional or papilla preservation flaps. With this access, the surgeon is able to make the. What are the steps involved in the Apically Displaced flap technique? After the area to be operated is irrigated with an anti-microbial solution, local anesthesia is applied and the area is isolated after profound anesthesia has been achieved. Disain flep ini memberikan estetis pasca bedah yang lebih baik, dan memberikan perlindungan yang lebih baik terhadap tulang interdental, hal mana penting sekali dalam tehnik bedah yang mengharapkan terjadinya regenerasi jaringan periodontium. A full-thickness flap is elevated with the help of a periosteal elevator whereas partial-thickness flap is elevated using sharp dissection with a Bard-Parker knife. For the correction of bone morphology (osteoplasty, osseous resection). Periodontal pockets in areas where esthetics is critical. Short anatomic crowns in the anterior region. 2. 12 blade on both the buccal and the lingual/palatal aspects continuing it interdentally extending it in the mesial and distal direction. To evaluate clinical and radiological outcomes after surgical treatment of scaphoid nonunion in adolescents with a vascularized thumb metacarpal periosteal pedicled flap (VTMPF). Frenectomy-frenal relocation-vestibuloplasty. This incision, together will the para-marginal internal bevel incision, forms a V-shaped wedge ending at or near the crest of bone, containing most of the inflamed and, The base of the flap should be wider than the flap margin so that the blood supply to the flap is not jeopardized. Then sharp periodontal curettes are used to remove the granulomatous tissue and tissue tags. This incision, together will the para-marginal internal bevel incision, forms a V-shaped wedge ending at or near the crest of bone, containing most of the inflamed and . Otherwise, the periodontal dressing may be placed. that still persist between the bottom of the pocket and the crest of the bone. Placing periodontal depressing is optional. Contents available in the book . This incision causes extensive loss of tissue and is indicated only in cases of gingival overgrowth. Rough handling of the tissue and long duration of the surgery commonly result in post-operative swelling. The buccal and the lingual/palatal flaps are then elevated to expose the diseased root surfaces and the marginal bone. Swelling hinders routine working life of patient usually during the first 3 days after surgery 41. 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. b. Papilla preservation flap. No incision is made through the interdental papillae. The intrasulcular incision is given using No. Contents available in the book .. The starting point on the gingiva is determined by whether the flap is apically displaced or not displaced (Figure 57-7). The interdental incision is then made to severe the inter-dental fiber attachment. Different Flap techniques for treatment of gingival recession (Lateral-coronal-double papilla-semilunar-tunnel-apical). They are also useful for treating moderate to deep periodontal pockets in the posterior regions. Following is the description of these flaps. This is especially important in maxillary and mandibular anterior areas which have a prime esthetic concern. The most apical end of the internal bevel incision is exposed and visible. 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. C. According to flap placement after surgery: 2. These meniscus tears are displaced into the tibia or femoral recesses and can be often difficult to diagnose intraoperatively. If a full-thickness flap has been elevated, the sutures are placed along the mesial and the distal vertical incision lines to. With this incision, the gingiva containing pocket lining is separated from the tooth surface. Incisions used in papilla preservation flap using primary and secondary incisions. As described in History of surgical periodontal pocket therapy and osseous resective surgeries the palatal approach for . Its final position is not determined by the placement of the first incision. The choice of which procedure to use depends on two important anatomic landmarks: the pocket depth and the location of the mucogingival junction. This incision is not indicated unless the margin of the gingiva is quite thick. The challenging nature of scaphoid fracture and nonunion surgery make it an obvious target. 35. The first documented report of papilla preservation procedure was by Kromer 24 in 1956, which was designed to retain osseous implants. The interdental incision is then given to remove the wedge of tissue that contains the pocket wall. Two basic flap designs are used. After debridement, flaps are closely adapted around the teeth in close approximation, allowing healing by primary intention. To improve esthetics as well as treat periodontal disease the method of choice remains is undisplaced flap surgery [12, 13]. This drawback of conventional flap techniques led to the development of this flap technique which intended to spare the papilla instead of splitting it. Coronally displaced flap Connective tissue autograft Free gingival graft Laterally positioned flap Apically displaced flap 5. A. The scalloping of the incision may not be accentuated as the flap has to be apically displaced and is not adapted interdentally. Under no circumstances, the incision should be made in the middle of the papilla. This website is a small attempt to create an easy approach to understand periodontology for the students who are facing difficulties during the graduation and the post-graduation courses in our field. Periodontal flaps can be classified on the basis of the following: For bone exposure after reflection, the flaps are classified as either full-thickness (mucoperiosteal) or partial-thickness (mucosal) flaps (Figure 57-1). Flap reflection till alveolar mucosa to mobilize the flap causes more post-operative pain and discomfort. Laparoscopic technique for secondary vaginoplasty in male to female transsexuals using a modified . 1. In addition, thinning of the flap should be performed with the initial incision, because it is easier to accomplish at this time than it is later with a loose, reflected flap that is difficult to manage. It is better to graft an infrabony defect than not grafting. Therefore, the two anatomic landmarksthe pocket depth and the location of the mucogingival junctionmust be considered to evaluate the amount of attached gingiva that will remain after the surgery has been completed. The incision is made not only around the facial and lingual radicular area but also interdentally, where it connects the facial and lingual segments to free the gingiva completely around the tooth (Figure 57-9; see Figure 57-5). It enhances the potential for effective periodontal maintenance and preservation of attachment levels. The vertical incisions are extended far enough apically so that they are at least 3 mm apical to the margin of the interproximal bony defect and 5 mm from the gingival margin. It is contraindicated in areas where the width of attached gingiva would be reduced to < 3 mm. This is essentially an excisional procedure of the gingiva. This incision is made 1mm to 2mm from the teeth. Contents available in the book .. Conflicting data surround the advisability of uncovering the bone when this is not actually needed. Areas which do not have an esthetic concern. A periodontal flap is a section of gingiva and/or mucosa surgically separated from the underlying tissue to provide visibility and access to the bone and root surfaces, Periodontal flap surgeries are also done for the establishment of. 2. Flaps in which the interdental papilla is split beneath the contact of two approximating teeth, allowing the reflection of buccal and lingual flaps, are described as the conventional flaps. Papilla Preservation Flaps :it incorporates the entire papilla in one of the flap by means of crevicular interdental incison to sever the connective tissue attachment & a horizontal incision at the base . The patient is recalled after one week for suture removal. Contents available in the book .. Internal bevel and is 0.5-1.0mm from gingival margin Modified Widman Flap Scaling, root planing and osseous recontouring (if required) are carried out. Preservation of good blood supply to the flap is another important consideration. Step 4:After the flap is reflected, a third incision is made in the interdental spaces coronal to the bone with a curette or an interproximal knife, and the gingival collar is removed (Figure 59-3, E and F). Conventional flaps include the. 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. Fugazzotto PA. The base of the flap should be wider than the flap margin so that the blood supply to the flap is not jeopardized. 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 . Crown lengthening procedures to expose restoration margins. Conventional flaps include the modified Widman flap, the undisplaced flap, the apically displaced flap, and the flap for reconstructive procedures. 12 or no. The bleeding is frequently associated with pain. 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. Within the first few days, monocytes and macrophages start populating the area 37. Step 2: The initial, internal bevel incision is made after the scalloping of the bleeding marks on the gingiva. The area to be operated is irrigated with an antimicrobial solution and isolated. The secondary flap removed, can be used as an autogenous connective tissue graft. Following shapes of the distal wedge have been proposed which are, 1. The incision is made around the entire circumference of the tooth using blade No. The incision is usually scalloped to maintain gingival morphology and to retain as much papilla as possible. 1. a. . This incision is always accompanied by a sulcular incision which results in the formation of a collar of gingival tissue which contains the periodontal pocket lining. Alveolar crest reduction following full and partial thickness flaps. During the initial phase of healing, inflammatory cells are attracted by platelet and complement derived mediators and aggregate around the blood clot. 2. Scalloping follows the gingival margin. Contents available in the book .. The local anesthetic agent is delivered to achieve profound anesthesia. This will allow better coverage of the bone at both the radicular and interdental areas. The patients were assigned randomly to one of the techniques, and results were analyzed yearly for up to 7 years after therapy. May cause esthetic problems due to root exposure. Periodontal pockets in severe periodontal disease. The primary incision is placed at the outer margin of the gingivectomy incision starting at the disto-palatal line angle of the last molar and continued forward. According to flap reflection or tissue content: C. According to flap placement after surgery: Diagram showing full-thickness and partial-thickness flap. It enhances the potential for effective periodontal maintenance and preservation of attachment levels. - Charter's method - Bass method - Still man method - Both a and b correct . The square . 12 or no. Conventional surgical approaches include the coronal flap, direct cutaneous incision, and endoscopic techniques. The apically displaced flap provides accessibility and eliminates the pocket, but it does the latter by apically positioning the soft-tissue wall of the pocket.2 Therefore, it preserves or increases the width of the attached gingiva by transforming the previously unattached keratinized pocket wall into attached tissue. The pockets are measured with the periodontal probe, and a bleeding point is produced on the outer surface of the gingiva to mark the pocket bottom. Within the first few days, monocytes and macrophages start populating the area, Post-operative complications after periodontal flap surgery, Hemorrhage occurring after 7-14 days is secondary to trauma or surgery. Flap adaptation is then done with the help of moistened gauze and any excess blood is expressed. . If detected, they are removed. One technique includes semilunar incisions which are . These, 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, The triangular wedge technique is used in cases where the adequate zone of attached gingiva is present and in cases of short or small tuberosity. Horizontal incisions are directed along the margin of the gingiva in a mesial or distal direction. Periodontal maintenance (Supportive periodontal therapy), Orthodontic-periodontal interrelationship, Piezosurgery in periodontics and oral implantology. In the upcoming chapters, we shall read about various regenerative procedures which are aimed at achieving regeneration of lost periodontal structures. The no. Apically displaced flaps have the important advantage of preserving the outer portion of the pocket wall and transforming it into attached gingiva. The three different categories of flap techniques used in periodontal flap surgery are as follows: (1) the modified Widman flap; (2) the undisplaced flap; and (3) the apically displaced flap. Long-term outcome of undisplaced fatigue fractures of the femoral neck in young male adults; Several techniques such as gingivectomy, undisplaced flap with or without osseous surgery, apically repositioned flap with or without resective osseous surgery, and orthodontic forced eruption with or without fibrotomy have been proposed for clinical crown lengthening. Apically displaced flap can be done with or without osseous resection. The area is then irrigated with an antimicrobial solution. After the removal of the secondary flap, scaling and root planing is done and the flap is adapted to its position.