Flap Surgery

Question 1

Remove the sulcular epithelium in a pocket, leaving the CT attachment.

Answer 1

Gingival curettage

Question 2

Remove the sulcular epithelium, JE, and CT attachment.

Performed apical to the JE.

Answer 2

Subgingival curettage

Question 3

This type of curettage is directed towards the JE and alveolar crest.

Answer 3

Subgingival curettage

Question 4

Removes sulcular and JE: ENAP or LANAP?

Answer 4

ENAP

Question 5

Uses a laser to remove pocket epithelium, and gain access to root surfaces for debridement.

Answer 5

LANAP

Question 6

Most frequently used incision, and is used in flap surgery.

Answer 6

Internal beveled incision.

Question 7

The tip of the blade contacts the tooth APICAL to the JE in this type of incision.

Answer 7

External beveled incision.

Question 8

What do bleeding points indicate?

Answer 8

The apical extent of the pocket, so you know you have to make your external beveled incision slightly apical to that.

Question 9

The first incision in an internal beveled incision.

Answer 9

PARAmarginal, where you create the new gingival margin.

Question 10

Indications for perio flap surgery

Answer 10

• Pockets > 5mm
• Access to root surfaces
• Access to osseous tissue
• Increase the width of attached gingiva
• Crown lengthening
• Cosmetic surgery
• Guided tissue regeneration

Question 11

Adverse sequelae of perio flap surgery.

Answer 11

• Increased clinical crown
• Poor esthetics
• Root sensitivity
• Root surface caries

Question 12

Most common perio surgery.

Answer 12

Full thickness apically positioned flap.

Question 13

Full thickness periodontal flap is AKA what?

Answer 13

Mucoperiosteal flap

Question 14

Soft tissue and the periosteum is reflected to expose the alveolar bone.

Answer 14

Full thickness mucoperiosteal flap.

Question 15

AKA a split-thickness flap.

Answer 15

Partial thickness flap

Question 16

Cut through mucosa and some CT, but leave the periosteum in tact.

Answer 16

Split thickness flap.

Question 17

This flap is done when the dentist doesn’t want to expose bone, or when there’s inadequate width of attached gingiva and the flap will be apically positioned.

Answer 17

Split/partial thickness flap.

Question 18

This flap is done when there’s minimal attached gingiva.

Answer 18

Split/partial thickness flap.

Question 19

If the gingiva is too thin, you can’t do this kind of flap.

Answer 19

Split/partial thickness

Because you need enough thickness to split the gingiva in two.

Question 20

Flap that’s done in areas with a thick biotype/where the gingiva is thick.

Answer 20

Split/partial thickness.

Question 21

Name the flap:

Incision is made from the gingival margin to the tooth.

Then another is made parallel to the root to split the gingiva.

Answer 21

Split/Partial thickness

Question 22

T/F:

Have less chance of bone loss with a split thickness flap bc there’s no bone exposure.

Answer 22

True

Question 23

Incisions in order when doing a perio flap.

Answer 23

1) Internal bevel incision
2) Sulcular/crevicular
3) Interdental

Question 24

This incision determines the new location of the gingival margin.

Answer 24

Internal beveled incision

Question 25

This incision is made 1-2 mm from the gingival margin.

Answer 25

Internal beveled incision

Question 26

Why do we make scalloped incisions in flap surgery?

Answer 26

So that the interproximal papilla can be covered and heal by primary intention, and not have alveolar bone exposed, that would cause bone loss interproximally and alveolitis.

Question 27

Three types of horizontal incisions

Answer 27

1) Internal beveled 2) Sulcular 3) Intedental

Question 28

Incision used on one or both ends of a horizontal incision, goes through keratinized gingiva to the alveolar mucosa, and reduces tension on the flap.

Answer 28

Vertical incision

Question 29

Do not make the vertical releases where?

Answer 29

1) In the middle of the papilla OR 2) Mid-buccal

Question 30

Blades used for the initial scalloping incision.

Answer 30

15 and 15c.

Question 31

Types of knives.

Answer 31

1) Kirkland gingivectomy knife | 2) Orban interdental knife

Question 32

Used to separate mucoperiosteum from bone by blunt dissection.

Answer 32

Periosteal elevator

Question 33

Where do you start elevating the flap and why?

Answer 33

Interproximally bc you're less likely to tear the flap than if you started mid-buccal or mid-lingual.

Question 34

Instruments used to debride granulation tissue.

Answer 34

DeMarco Curettes

Question 35

Instrument that removes granulation tissue and recontours bone.

Answer 35

Sugarman file

Question 36

L:W ratio of a flap.

Answer 36

2:1

Question 37

T/F: Apical part of the flap should be wider than the coronal part.

Answer 37

True

Question 38

T/F: Partial thickness flaps should not be used in areas of thin CT bc of the danger of necrosis.

Answer 38

True