exam 2 (L5) - flap surgery - variations

Question 1

what is the purpose of a thinned palatal flap?

Answer 1

• to get best post-surgery tissue contours and adaptation of flaps
• done by internal “undermining” (the tissue to be removed) incisions that extend apical (below) the alveolar crest on the palate

Question 2

what are some considerations for thinned (conservative) palatal flaps?

Answer 2

• keratinized gingiva is abundant
• precise flap design
• frequent internal thinning of flap
• “technically, apical positioning is not possible”
• probe depths
• gingival contour
• soft tissue thickness
• bone morphology

Question 3

what are some objectives of thinned palatal flap surgeries?

Answer 3

• pocket elimination (via resection)

- tissue regeneration

Question 4

what is a tissue wedge?

Answer 4

a process for internal thinning by removal of a block of tissue

Question 5

what is a distal wedge?

Answer 5

a procedure for removing excessive soft tissue distal to a terminal tooth

Question 6

what are the 3 typical sites for tissue wedges?

Answer 6

• maxillary tuberosity
• mandibular retromolar area
• edentulous ridges

Question 7

advantages of distal wedge?

Answer 7

• access to bone and furcations (of distal teeth)
• allow internal thinning of bulky tissue
• can obtain primary wound closure

Question 8

what are the anatomical limitations of a distal wedge?

Answer 8

• access
• neurovasculature:
  + lingual nerve (mandibular)
  + greater palatine foramen (maxillary)
  + loose connective tissues (CT), raphe

Question 9

what are the 3 distal wedge designs?

Answer 9

• triangular (easy, non-invasive)
• square (best access)
• linear (best at preserving keratinized gingiva)

Question 10

what is the purpose of making a conservative (thin) flap?

Answer 10

• minimizes recession

- good for maxillary anterior teeth (esthetic)

Question 11

what are 2 types of conservative flap designs discussed?

Answer 11

• Modified Widman flap

- flap curettage (open flap debridement)

Question 12

what is a Modified Widman flap?

Answer 12

• a scalloped, replaced mucoperiosteal flap accomplished with and internal bevel incision
• provides access for root planing
• conservative design permits “primary closure” (healing?)

Question 13

what types of incisions are used in the Modified Widman flap?

Answer 13

• 0.5 - 1 mm scalloped incisions
• intrasulcular incisions
• interdental incisions (vertical/interproximal)

Question 14

how far does elevation of the Modified Widman flap go?

Answer 14

2 - 3 mm apical to the alveolar crest

Question 15

T / F

Conservative flaps still require a great deal of bone resection, but can still be adapted to obtain primary closure.

Answer 15

F

• require little or no bone resection

Question 16

what is the purpose of removing soft tissue distal to the terminal tooth in a distal wedge procedure?

Answer 16

excessive soft tissue can act as a reservoir for pathogenic bacteria; area also includes furcation and distal surfaces of terminal tooth