Basics of Flap Design and Surgical Instruments

Question 1

What are the 5 stages of a surgical extraction in Dentistry

Answer 1

1. Preparation: treatment plan, consent, anaesthesia
2. Gain Access: Incision, raising a flap
3. Clear path of withdrawal for tooth: Bone removal/sectioning
4. Dealing with the wound: Debridement/wound closure
5. Post-op management: instructions/ antibiotics/ analgesics

Question 2

What is the point of raising a flap in a surgical extraction

Answer 2

• Gain access to buried object e.g. tooth, root, fracture etc.
• Remove bone to allow access to tooth and create a path for withdrawal
• Section roots of a multi-rooted tooth
• Section crown of impacted tooth

Question 3

What is a mucoperiosteal flap

Answer 3

• Mucosa and periosteum raised from the underlying bone

Question 4

What are some of the errors to avoid when designing and raising flaps in a surgical extraction

Answer 4

• Avoid excessive trauma
• Avoid gingival margin scarring
• Avoid anterior mouth scarring
• Avoid lip/ tongue/ palatal deformity

Question 5

What are some of the aims of designing and raising flaps

Answer 5

• Gain adequate access
• Maintain blood supply to the soft and hard tissues
• Place incisions over sound bone
• Make sure surgical area can be extended if needed
• Make sure wound can be closed
• Regain original soft tissue anatomy where possible

Question 6

Describe the flap design of an envelope flap

Answer 6

• The flap follows the gingival contour and is usually extended either side of the tooth to be removed
• Flap must be long to stretch it away from the bone to gain enough access to the tooth to be removed

Question 7

Describe the flap design of a 2-sided flap

Answer 7

• This flap has 2 sides - one is the gingival margin incision and the other is called a relieving incision
• This allows for better access than the envelope flap and so is often shorter than an envelope flap

Question 8

Describe the flap design of a 3-sided flap

Answer 8

• This flap has 3 sides, one is the gingival margin incision and the other 2 are relieving incisions
• Better access than the envelope and 2 sided but is more traumatic and more to close

Question 9

How can we maintain the blood supply to the soft and hard tissues when making a flap for surgical extraction

Answer 9

• Angling the relieving incisions

- Make sure the base (attached part) is wider than the apex (free part)

Question 10

AY BAWS CAN I HABE DE NOTE PLZ

Answer 10

Remember to avoid vital structures like nerves when making the flaps

Question 11

What are the names of the instruments used to raise flaps

Answer 11

• Howarth;s periosteal elevator
• Ward’s periosteal elevator
• Mitchell’s trimmer