Flap Design Flashcards
1
Q
How do we classify flaps?
A
- Bone exposure after flap reflection
- Placement of the flap after surgery
- Management of the papilla
- Based on presence or absence of releasing incision
2
Q
Flap Classification: Based on the bone exposure after flap reflection
A
- Full Thickness flap
- all soft tissue is reflected to expose bone
- including periosteum
- all soft tissue is reflected to expose bone
- Partial Thickness flap
- only epithelium and splits CT
- bone remains covered by CT and periosteum
- Combination Flap
3
Q
Flap Classification: Based on flap placement after surgery
A
- Nondisplaced flaps
- flap is returned and sutured in original position
- replaced or repositioned flaps
- Displaced flaps
- placed apically, coronally, or lateral to original position
- ex: apical positioned flaps
4
Q
Principles of Flap Design
A
- Apex should not be wider than the base
- Releasing incisions should run:
- parallel
- convergent:
- cover from the base of the flap to its apex (preferred)
- Length:Base ratio
- not greater than 2:1
- Major blood supply is at base of the flap
- travels apical to coronal direction
- Axial Blood supply should be included in base of flap if possible
- Incision made in adjacent area not operative site
- Avoid major nerves and arteries
5
Q
What are the different types of horizontal incisions?
A
- Internal bevel incision
- Crevicular Incision
- Interdental Incision
6
Q
Internal Bevel Incision
A
- Aka Reverse Bevel Incision
- internal bevel incision
- 1st incision in reflection of a perio flap
- Reverse bevel incision bc its reverse direction of gingivectomy incision
- Starts at a distance from gingival margin
- aimed at bone
7
Q
What are the objectives of an internal bevel incision?
A
- removes the pocket lining
- conserves outer surface of gingiva
- if apical→becomes attached gingiva
- produces a sharp, thin flap margin for adaption to the bone-tooth Jxn
8
Q
Crevicular Incision
A
- aka Sulcular Incision
- made from the base of the pocket to bone
- carried around entire tooth
9
Q
Interdental Incision
A
- aka marginal incision
- 3rd incision
- separate the collar of gingiva that is left around tooth
- all the way around the tooth
- use Orban Knife
10
Q
Vertical Incisions
A
- Aka Oblique releasing incisions
- used at one or both ends of horizontal incision
- avoid in lingual and palatal areas
- Always start from level of the line angle
- never from the middle of the papilla or mid buccal/lingual
- compromise vasculature
- never from the middle of the papilla or mid buccal/lingual
11
Q
Gingivectomy: Indications vs Contraindications
A
- Indications:
- eliminate
- supra bony pockets
- pocket wall is fibrous and firm
- depth-doesn’t matter
- gingival enlargements (mainly)
- supra bony perio abscess
- supra bony pockets
- eliminate
- Contraindications:
- need for bone surgery or examine bone shape and morphology
- bottom of the pocket is apical to mucogingival Jxn
- esthetics
- anterior maxilla
12
Q
Gingivectomy: Advantages vs Disadvantages
A
- Advantages:
- simple
- quick
- Disadvantages:
- post-op discomfort
- increased chance of post-op bleeding
13
Q
Gingivectomy
A
- removal of gingival tissue
- reduce soft tissue wall of pocket
- external bevel incision
14
Q
Gingivoplasty
A
- reshape gingiva
15
Q
Ostectomy vs Osteoplasty
A
- Ostectomy
- remove supporting bone (direct contact w/tooth)
- Osteoplasty
- remove non-supporting bone
- reshape
- remove non-supporting bone
16
Q
Original Widman Flap
A
- Goal:
- remove pocket epithelium and inflamed CT
- facilitate optimal clean of root surface
- Steps:
- use 2 vertical releasing incisions
- connected by submarginal scalloped internal bevel incision
17
Q
What are the main advantages of Original Widman Flap vs Gingivectomy?
A
- Less discomfort bc healing occurred by primary intention
- Able to re-establish proper contour of alveolar bone with angular bony defects
18
Q
Modified Widman Flap
A
- 3 incisions
- marginal incision
- 0.5-1mm from gingival margin
- parallel to the long axis of tooth
- crevicular incision
- to the bone
- interdental incision
- perpendicular to root surface
- marginal incision
19
Q
Modified Widman Flap: Main advantages compared to other techniques
A
- close adaptation of soft tissue to the root
- minimum trauma to bone and CT
- less exposure of roots
- esthetic for anteriors
20
Q
Needles: Bite size
A
- Try to stay 3mm away from wound
- to small=tear wound edges
21
Q
Suture Size
A
- Varies from #7 to #12-0
- Number alone
- larger the number, larger the suture
- Number -0:
- larger the number, smaller the suture
- usually use 3-0 to 5-0
22
Q
Suture Materials:
Made of?
Absorption time
A
- Plain Gut
- Beef serosa or Sheep Submucosa
- 70 days
- Chromic Gut
- Beef Serosa or sheep submucosa
- 90 days
- Coated Vicryl
- Polglactin 910
- 56-70 days
- PDS II
- Polydioxanone
- 183-238 days
23
Q
Healing After Flap Surgery: Full vs partial thickness flap
A
- Repair of epithelium and CT is similar
- Bone resorption
- Full thickness-more intense
- Time:
- full=21 days
- partial=28 days
24
Q
Papilla Preservation Flap
A
- used in anterior regions due to esthetics
- Cortellini
- minimally invasive surgery combined with regenerative procedures
- Modified Papilla Preservation Technique:
- ≥ 2mm interdental space b/w teeth
- Simplified Papilla Preservation Flap:
- <2mm interdental space
25
Q
What was the rationale behind the Modified Papilla Preservation Technique?
A
- Achieve and maintain primary closure f Flap in the interdental space over membrane
26
Q
Simplified Papilla Preservation Flap
A
