Flap Surgery Flashcards
Remove the sulcular epithelium in a pocket, leaving the CT attachment.
Gingival curettage
Remove the sulcular epithelium, JE, and CT attachment.
Performed apical to the JE.
Subgingival curettage
This type of curettage is directed towards the JE and alveolar crest.
Subgingival curettage
Removes sulcular and JE: ENAP or LANAP?
ENAP
Uses a laser to remove pocket epithelium, and gain access to root surfaces for debridement.
LANAP
Most frequently used incision, and is used in flap surgery.
Internal beveled incision.
The tip of the blade contacts the tooth APICAL to the JE in this type of incision.
External beveled incision.
What do bleeding points indicate?
The apical extent of the pocket, so you know you have to make your external beveled incision slightly apical to that.
The first incision in an internal beveled incision.
PARAmarginal, where you create the new gingival margin.
Indications for perio flap surgery
- Pockets > 5mm
- Access to root surfaces
- Access to osseous tissue
- Increase the width of attached gingiva
- Crown lengthening
- Cosmetic surgery
- Guided tissue regeneration
Adverse sequelae of perio flap surgery.
- Increased clinical crown
- Poor esthetics
- Root sensitivity
- Root surface caries
Most common perio surgery.
Full thickness apically positioned flap.
Full thickness periodontal flap is AKA what?
Mucoperiosteal flap
Soft tissue and the periosteum is reflected to expose the alveolar bone.
Full thickness mucoperiosteal flap.
AKA a split-thickness flap.
Partial thickness flap
Cut through mucosa and some CT, but leave the periosteum in tact.
Split thickness flap.
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.
Split/partial thickness flap.
This flap is done when there’s minimal attached gingiva.
Split/partial thickness flap.
If the gingiva is too thin, you can’t do this kind of flap.
Split/partial thickness
Because you need enough thickness to split the gingiva in two.
Flap that’s done in areas with a thick biotype/where the gingiva is thick.
Split/partial thickness.
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.
Split/Partial thickness
T/F:
Have less chance of bone loss with a split thickness flap bc there’s no bone exposure.
True
Incisions in order when doing a perio flap.
1) Internal bevel incision
2) Sulcular/crevicular
3) Interdental
This incision determines the new location of the gingival margin.
Internal beveled incision
This incision is made 1-2 mm from the gingival margin.
Internal beveled incision
Why do we make scalloped incisions in flap surgery?
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.
Three types of horizontal incisions
1) Internal beveled
2) Sulcular
3) Intedental
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.
Vertical incision
Do not make the vertical releases where?
1) In the middle of the papilla
OR
2) Mid-buccal
Blades used for the initial scalloping incision.
15 and 15c.
Types of knives.
1) Kirkland gingivectomy knife
2) Orban interdental knife
Used to separate mucoperiosteum from bone by blunt dissection.
Periosteal elevator
Where do you start elevating the flap and why?
Interproximally bc you’re less likely to tear the flap than if you started mid-buccal or mid-lingual.
Instruments used to debride granulation tissue.
DeMarco Curettes
Instrument that removes granulation tissue and recontours bone.
Sugarman file
L:W ratio of a flap.
2:1
T/F:
Apical part of the flap should be wider than the coronal part.
True
T/F:
Partial thickness flaps should not be used in areas of thin CT bc of the danger of necrosis.
True
