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Perio--Surgical (Spring) > 5. Access Flaps > Flashcards

5. Access Flaps Flashcards

1
Q

What is removed in a modified widman flap

A

sulcular epithelium
pocket epithelium
JE

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2
Q

New CT forms in what direction

A

apical to coronal

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3
Q

Purpose of membranes

A

prevent the oral epithelium from contacting the clot that facilitates perio regeneration and CT attachment

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4
Q

ENAP and LANAP mean

A

Excisional new attachment procedure

Laser assisted new attachment procedure

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5
Q

LANAP removes _ and leaves _

A

Removes diseased pocket epithelium

Leaves CT

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6
Q

Patients have (more/less) recession and root sensitivity with LANAP

A

less

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7
Q

New cementum, PDL, and attachment to the root is formed by what for LANAP

A

stem cells

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8
Q

Is LA needed with LANAP

A

yes

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9
Q

Laser for LANAP should be held _ in relation to the root surface

A

parallel

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10
Q

How is the pocket epithelium removed with LANAP

A

photothermolysis

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11
Q

How many passes are done with the laser in LANAP

A

2

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12
Q

ADA statements on lasers

A
  • More data on lasers is needed to know what extent LANAP is safe and effective
  • Lasers have only inconsistently shown the ability to reduce microorganisms within a perio pocket
  • Lasers for the purpose of improved wound healing is contraversial and not well supported by studies
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13
Q

Can lasers harm patients

A

yes and no- if the inappropriate wavelength is used the laser can damage the perio tissues

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14
Q

What is the superior wavelength for lasers

A

hasn’t yet be determined

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15
Q

What are the two classifications of perio flaps

A
  • Full thickness

- Partial (split) thickness

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16
Q

Describe a full thickness flap

A
  • Bone completely exposed
  • Periosteum included in the flap
  • Blunt disection
  • Used for osseous surgery, osseous grafting, and guided tissue regenertion
  • associated with more bone resorption
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17
Q

Describe partial (split) thickness flap

A
  • Bone still covered by periosteum and CT
  • Sharp disection
  • Use in areas of thin bone dehiscence, and fenestration
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18
Q

Most common location in the mouth for split thickness flap

A

Where the roots are prominent in the arch (thinner bone)

  • Cuspids
  • Maxillary 1st molars (MB root)
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19
Q

Periodontal flaps in addition to being classified based on their thickness are also classified based on

A

-Their position post operatively

replaced and positioned

20
Q

Describe the difference between replaced and positioned flaps

A

Replaced

  • Put back where it originally was
  • AKA undisplaced and repositioned

Positioned

  • AKA displaced or moved
  • Apically positioned
  • Laterally positioned
  • Coronally positioned
21
Q

What is the most common flap in perio surgery

A

-Apically positioned flap

22
Q

Apically positioned flap are

A
  • Get rid of perio pockets
  • Exposed root surfaces
  • Width of keratinized tissue is maintained
23
Q

Coronally positioned flap

A

-Cover root surfaces

24
Q

Laterally positioned flaps

A

-Also to cover root surfaces (mucogingival defects)

25
Q

Coronally positioned flaps are most commonly done with (full/split) thickness flaps

A

split

26
Q

Laterally positioned flaps are most commonly done with (full/split) thickness flaps … except when

A

split…thin biotype

27
Q

Describe papilla preservation

A
  • No incision through the papilla
  • B and a L flap
  • Flap is typically brought to the lingual
28
Q

Papilla preservation is especially useful when

A
  • Holding in graft material

- Esthetic areas (prevents black triangles)

29
Q

Closed procedures are ususally done in what phase of perio therapy

A

initial phase (SRP)

30
Q

Downsides of closed procedures are

A

-Rely on tactile sense (poorer results in deeper pockets)

31
Q

Benefits of open procedures

A
  • Visualize and access
  • Root surface (subgingival calculus and root defect– i.e cracks)
  • Alveolar bone (morphology of the osseous defect– i.e number of walls)
  • Furcations
32
Q

Compare a gingivectomy with a flap

A

Gingivectomy

  • Heals with secondary intention
  • “fast” procedure
  • No reattachment
  • Some post-op bleeding
  • No visibility of alveolar bone
  • Removes a good deal of keratinized tissue

Falps

  • Heals by primary intention
  • “Slower” procedure
  • Possible reattachment
  • Minimal post op bleeding
  • Good visibility of bone
  • Preserves more keratinized gingiva
33
Q

Internal bevel incision location is dependent on

A

the depth of the pocket and the thickness of the tissue

34
Q

Describe a modified Widman flap

A
  • Paramarginal internal bevel incision
  • Percise incisions
  • Partial flap reflection (not past the MGJ
  • Goal is not pocket eliminaiton rather pocket “healing”
35
Q

Indications for modified Widman

A
  • All types of periodontitis
  • Especially pocket depths of 5-7 mm
  • May be used with other procedures (wedge excisions and reflected flaps)
36
Q

Modified Widman is a (replaced/positioned) flap

A

replaced

37
Q

Healing of a modified widman is by (primary/secondary) intention

A

primary

38
Q

Advantages of the Modified Widman

A
  • Root debridment with direct vision
  • Tissue friendly (minimal bleeding and recession)
  • Heals by primary intention
  • Minimal loss of crestal bone
  • Minimal post-op discomfort
39
Q

Another name for modified widman is

A

open flap curretage

40
Q

Steps for an open flap curretage procedure

A 
First incision
-Paramarginal
-Scalloping
-Parallel to long axis of the tooth 
-~ 1 mm from the gingival margin 
-Extended interproximally as far as possible 
Flap reflection (only within the keratinizaed gingiva)
Second incision- sulcular 
Third incision- horizontal (interproximal)
Remove the collar of soft tissue
-Root debridmenet
-Flap repositioning and suturing
41
Q

Why is the modified widman extended interproximally as far as possible

A

to achieve primary closure –> healing by primary intention –> papilla preservation

42
Q

Incision of a modified widman will contain

A

sulcular eptihelium and may contain JE

43
Q

Modified widman is a (full/partial) thickness flap

A

full

44
Q

Why back in the day dis some people treat the root surfaces with a diamond

A

remove necrotic cementum make a biologically compatible surface for attachement

45
Q

What technique is best for interproximal suturing and why

A

loops because you get primary closure and you don’t get suture material between the flaps

Perio--Surgical (Spring) (8 decks)

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