exam 2 (L4) - perio flap surgery - basic concepts Flashcards
what is a periodontal flap?
a section of gingiva and/or mucosa surgically separated from the underlying tissues to provide visibility and access for treatment
what is the difference between a gingivectomy and flap surgery?
- gingivectomy: external bevel, tissue exposed during healing
- flap surgery: internally beveled, access to bone (and furcations), tissue not exposed during healing
indications for perio flaps?
- resection (remove hard or soft tissue)
- conservative approach (for access - saves some gingiva)
- regenerative (grow new periodontal support)
- wish to preserve keratinized gingiva
- want to suture wound (can’t do w/ gingivectomy)
surgical access via flap surgery allows what benefits?
- deep calculus removal
- eliminate perio pockets
- encourages periodontal regeneration
when might flaps be used outside of periodontics?
- surgical extractions
- biopsies
- exploratory surgery
- clinical crown lengthening
- pre-prosthetic surgery
what steps are there during a full-thickness flap surgery?
- local anesthetic
- incision
- flap elevation
- debridement
- osseous surgery or regeneration
- flap placement
- suturing
- dressing
list some essential pre-flap surgery considerations before the first incision.
- pocket depth
- amount of keratinized gingiva
- intended position of the flap
how does the dissection plane differ between full thickness (mucoperiosteal) and partial (split) thickness flaps?
- full thickness is between periosteum and bone (includes epi, lamina propria of CT, periosteum); easier to do, but bone exposure slows healing/more BL; avoid in areas of dehiscence
- partial thickness is within connective tissue (includes epi, PART of underlying CT, NOT periosteum); more difficult, but protects bone more than full
the initial surgical cut has what considerations?
- scalloped (submarginal) incisions from D to M
- access to bone VS invasiveness
- how apical can it be made
the initial (primary) surgical cut uses which instrument?
Blade Parker 15 blade (BP 15), cut toward alveolar crest
what is critical for later flap elevation (after all incisions are made) during the primary incision?
contacting the bone (alveolar crest) with the BP 15
what is done during the second incision?
free the collar (flaps) of tissue surrounding bone by cutting JE and CT
what is done during the third (final) incision?
thinning papilla by separating it from interproximal tissue
what step is done after incisions are made? what does it involve?
- elevation, via use of periosteal elevator
- plane of dissection between periosteum (below/part of peridontium) and bone
- blunt dissection in distal and apical direction
- full flap reflection done by elevating past the MGJ
what potential problems occur during elevation?
- hard to do if incision doesn’t extend to bone
- too much force/improper direction can tear flap
- exostoses force the use of a more horizontal elevation
- thin bone dehiscence (vertical incisions help)
- neurovasculature damage
