flap design Flashcards
Aims of endo surgery
Endodontic periapical surgery is performed to surgically preserve a tooth with a recurrent lesion of endodontic origin when conventional orthograde retreatment is either contraindicated or unsuccessful
Considerations for endo surgery
~ GLARES
GINGIVA
- Condition
- Biotype
- Width
- Frenum
LESION
- Size
- Location(vital structures)
- Perio-endo
ACCESS
- Anterior
- Posterior
RESTORATION
- Presence
- Quality
- Type
ESTHETIC
- Demands
- Smile line
SITE
- Demands
- Smile line
Blood supply to ST:
- Periodontal vessels
- Alveolar bone vessels
- Supraperiosteal vessles
Biological width:
the distance between the bone of the gingival sulcus and the height of the alveolar bone. JE + CT attachment = 2.04mm
Flap designs
Semilunar flap
Intrasulcular flap
Papilla-base
Submarginal flap
Describe semilunar flap
- Full thickness flap in the alveolar mucosa at the level of the tooth apex seldom used
- Seminar circle is made from the the apex of the adjacent tooth, onto the attached gingiva, finishing at the apex of the tooth on the other side
- Not recommended
List the advantages and disadvantages of semilunar flap
ADVANTAGE • Fast and easy to reflect- no crestal bone exposure • No involvement of marginal and interdental papilla (no risk of recession) DISADVANTAGE • Poor access • Scarring • Haemorrhage • Blood supply interrupted
Describe intrasulcular flap
- Most commonly used
- Incision is made intrasulcularly with a releasing arm
- Vertical incision is made firmly down the line angle of the teeth into the gingival crevice
- Horizontal incision is made along the gingival crevice
Describe intrasulcular flap
- Most commonly used
- Incision is made intrasulcularly with a releasing arm
- Vertical incision is made firmly down the line angle of the teeth into the gingival crevice
- Horizontal incision is made along the gingival crevice
List the advantages and disadvantages of intrasulcular flap
ADVANTAGE • Enhanced surgical access • Excellent visibility • Excellent wound healing potential • Minimal disruption of blood supply • Good to view dehiscences and fenestrations DISADVANTAGE • Difficult to incise and reflect • Possible for recession
Describe papilla-based flap
- Full thickness flap with incision placed intrasulculary and a curved incision placed at the base of the papilla
- PBI for marginal mucoperiosteal flap was suggested to prevent loss of interdental papilla height (Velvart 2002)
- Allows for preservation of entire papilla, thus eliminating any substantial loss of height
List the advantages and disadvantages of papilla-based flap
ADVANTAGE
• Where insufficient gingival width available for SMI
• Less loss of attachment and gingival recession when compared to intrasulcular (Velvart 2002)
DISADVANTAGE
• Highly aesthetic demanding pts (high lip line)
Describe submarginal flap
- AKA oschenbein-Luebke
- Horizontal incision if a scalloped incision within the attached gingival, following the gingival contour
- Incision must be placed onto the bony surface and at least 2mm apically from the base of the sulcus.
- Incision too close or into the free gingiva cuts off blood supply necrosis
- Vertical incision is made down the distal aspect of the adjacent to the point of 4mm short of the gingival margin
- Horizontal incision is scalloped following the gingival contour through the attached gingiva all through to the adjacement tooth
List the advantages and disadvantages of submarginal flap
ADVANTAGE
• Does not involve marginal or interdental gingiva nor exposed crestal bone
• Minimise crestal bone loss and gingival recession
• Easy flap reapproximation
DISADVANTAGE
• Scarring
• Unable to extend flap if needed
• Disruption of blood supply to marginal tissues, must rely on collateral
• Limited visibility for root and crestal bone
The design of the surgical flap is to provide an obstructed view of the operating site and to allow access of instrumentation. What are the considerations in designing a flap
o Biological
♣ Blood supply
♣ Neurovascular bundle
♣ Sound bone
♣ Frenum
♣ Sinus
o Pathology
♣ Size and extent
♣ Location
o Patient
♣ Demands
♣ Smile line
