Basic concepts of flap design

Question 1

while a gingivectomy has an ___________ bevel, a Flap has a ________ bevel

Answer 1

gingivectomy = external bevel

Flap = internal bevel

Question 2

a flap will Provides access to ______ and ________

Answer 2

bone and furcations

Question 3

T/F: tissue is NOT exposed during flap healing

Answer 3

true

Question 4

what are the 3 contexts for flap use?

Answer 4

– Resection (removal of hard or soft tissue)

– Conservative (for access only)

– Regeneration (new periodontal support)

Question 5

Flaps preserve ___________ gingiva

Answer 5

keratinized

Question 6

how are flaps closed?

Answer 6

suturing

Question 7

surgical access can facilitate what types of periodontal procedures?

Answer 7

1) calculus removal
2) elimination of periodontal pockets
3) periodontal regeneration
4) Clinical crown lengthening

Question 8

what non-periodontal procedures can be facilitated by flaps?

Answer 8

1) surgical extractions
2) Biopsies
3) exploratory surgery
4) Pre-prosthetic surgery

Question 9

what are the 2 major types of flaps?

Answer 9

1) Partial flaps

2) full thickness flaps

Question 10

some flaps are ________ (meaning lowered apically), and some are _________ (e.g. flap curettage)

Answer 10

Repositioned or replaced

Question 11

because flaps use an internal bevel, what structure faces the tooth margin?

Answer 11

the cut gingival margin

Question 12

what is another name for a full thickness flap? what do they require?

Answer 12

Full thickness = mucoperiosteal flap

• require incision that reaches bony crest

Question 13

how is flap elevation achieved during full thickness flaps?

Answer 13

blunt disseciton between Periosteum and Bone

Question 14

the dissection plane of full thickness flaps (mucoperiosteal) is between the ________ and the ________

Answer 14

between periosteum and the bone

Question 15

a mucoperiosteal (full thickness) flap will include what tissue structures?

(theres THREE)

Answer 15

1) epithelium
2) lamina propria of CT
3) periosteum

Question 16

what type of bone is exposed during the process of flap reflection?

Answer 16

alveolar bone

Question 17

compared with partial thickness flaps, full thickness flaps are:

Answer 17

1) easier to accomplish
2) harsher to bone (more resorption)
3) should be avoided in areas with dehiscence (previously closed wound) with Connective tissue attachment only

Question 18

partial thickness flaps are also known as what?

Answer 18

split thickness flaps

Question 19

a partial (split) thickness flap will sharply dissect the _____________ tissue

Answer 19

connective tissue

Question 20

when using periosteal elevators, you should work in what direction?

Answer 20

mesial to distal

and

apically

Question 21

Elevation past the _________________ will fully reflect the flap

Answer 21

mucogingival junction

Question 22

what 2 types of instruments are used to remove soft tissue during flap procedures?

Answer 22

1) back-action hoe

2) curettes and files

Question 23

what is the dissection plane of a partial thickness flap?

Answer 23

WITHIN the connective tissue

Question 24

A partial (split) thickness flap will contain what structures?

Answer 24

1) epithelium
2) portions of underlying CT

DOES NOT include periosteum

Question 25

a portion of connective tissue, and periosteum, remain attached to the bone in what kind of flap?

Answer 25

partial (split) thickness flap

Question 26

Compared to full thickness flaps, partial thickness flaps have what characteristics?

theres FOUR

Answer 26

1) more difficult
2) protect underlying bone from resorption
3) specialized procedure to handle specific clinical problems
4) can be used in CONJUNCTION w/ treatment of gingival recession

Question 27

what Anesthesia is used for blocks during flap procedure? what kind needle is used?

Answer 27

1) block = lidocaine + epinephrine 1:100,000

2) infiltrate with 30 gauge needle

Question 28

what is the 1st incision during a flap procedure? where is it placed

Answer 28

outline scallops

• submarginal

Question 29

what factors determine the amount of scallop for a flap?

Answer 29

1) amount of keratinized gingiva
2) need for access to bone vs. Invasiveness
3) pocket depth (inter-prox, facial)
4) contours to keratinized tissue (rolled margins react more)
5) how much apical positioning is possible

Question 30

what is the purpose of the scallop incision?

Answer 30

A) resective: remove more tissue

B) regenerative or esthetic problems

Question 31

if the patient is worried about esthetics, what type of 1st incision should be used?

Answer 31

intrasulcular incision

Question 32

how should the papillae be narrowed during the 1st incision?

Answer 32

narrow papillae medial-distally

avoid gap when closing

Question 33

where should you aim the blade during the 1st incision? why is this critical

Answer 33

• toward the crest of bone

CRITICAL to establish contact with alveolar crest on periosteal side (NOT PDL side)

Question 34

for the 1st incision, it is essential for a full thickness flap to establish a ___________ dissection plane

Answer 34

blunt dissection plane

Question 35

the direction of the 1st incision is usually from _______ to _______

Answer 35

distal to mesial

Question 36

a variation of the marginal outline scallops (1st cut) can be a double scallop into the _________

Answer 36

furcation