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Perio 2 Exam 2 > Flap Surgery: Flap Positioning, Suturing, and Healing > Flashcards

Flap Surgery: Flap Positioning, Suturing, and Healing Flashcards

1
Q

Types of Flap Positioning

A

Replaced
Apically positioned
Coronally positioned
Laterally positioned

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2
Q

Replaced flap

A

returned to its original position -like in the modified Widman flap

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3
Q

Apically Positioned Flap

A

eliminates pocket by apically displacing the soft tissue wall of the pocket
thus is preserves/increase width of attached gingiva by transforming previously unattached keratinized pocket wall into attached gingiva tissue

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4
Q

Coronally and Laterally Positioned Flaps

A

Used to cover areas of recession

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5
Q

6 Goals of Suturing

A

Provide adequate tension of wound closure w/out dead space but loose enough to prevent tissue ischemia/necrosis
Maintain hemostasis
Permit healing by Primary Intention
Reduce postoperative pain
Prevent bone exposure–>delayed healing and bone resorption
Permit proper flap position

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6
Q

Nonresorbable Suture Materials

A

Silk
Polyester- nylon
- PTFE

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7
Q

Resorbable Suture Materials

A

Natural - plain gut
- Chromic gut
Synthetic - Coated Vicryl

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8
Q

Chromic Gut

A

Resorp Rate: 7-10 days by proteolytic enzymatic processes
Tensile strength: +
Tissue rxn: Moderate
Uses: Rapidly healing mucosa, avoiding suture removal

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9
Q

Coated Vicryl (polyglactin 910)

A

Resorp Rate: 56-70 days by slow hydrolysis
Tensile strength: +++
Tissue rxn: Minimal
Uses: To resist muscle pull; subepithelial mucosal surfaces, resorbable

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10
Q

Surgical Silk

A

Resorp Rate: Nonresorbable, Gradual encapsulation by fibrous CT- lost after 2 years
Tensile strength: ++
Tissue rxn: Moderate
Uses: Mucosal surfaces, nonresorbable

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11
Q

ePTFT, Gore-Tex (monofilament)

A

Resorp Rate: Nonresorbable
Tensile strength: +++
Tissue rxn: Extremely low
Uses: All types of soft tissue approximation

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12
Q

6 Qualities of Ideal Suture Material

A 
Pliability- ease of handling
Knot Security
Sterilizable
Appropriate elasticity
Nonreactivity
Adequate tensile strength
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13
Q

Suture Material used most often

A

Silk and synthetics

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14
Q

Suture Material used when retrieval is difficult

A

Gut sutures

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15
Q

Recommended Suture Material for bone augmentation

A

Monofilament sutures- to prevent “wicking”, reduce inflammation, and permit longer retention

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16
Q

Recommended Suture Material for GTR

A

Gore-Tex and Coated Vicryl Sutures

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17
Q

Direction Suturing Should Take Place

A

From movable to a nonmovable tissue

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18
Q

Where to grasp the needle

A

1/4 to 1/2 the length from the swaged area

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19
Q

To avoid wicking of bacteria, Knots should not be placed…

A

in incision lines

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20
Q

What are the ears of a knot?

A

The cut ends of the suture

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21
Q

Types of Knots

A

Square, Slip, Surgeon’s

22
Q

Square Knot

A

Two overhand knots in opposite directions, one above and one below the jaws of the needle holder
May loosen if made of synthetic or monofilament

23
Q

Slip Knot

A

Two overhand knots in same direction, both above needle holder and in same direction

24
Q

Surgeon’s Knot

A

Most common in dentistry
Modified Square Knot
Double the loop above the needle holder, and then one loop under the needle holder in opposite direction

25
5 Common Suturing Techniques
Interrupted Sutures - Simple loop mod, figure 8 mod Mattress Sutures - Vertical, Horizontal Periosteal Sutures Continuous Sutures - Locking, Horizontal Mattress Sling Sutures - Independent, Continuous
26
Interrupted Sutures - Uses
``` Vertical incision tuberosity and retromolar Bone regeneration Widman flap, open flap debridment, replaced flap, apically positioned flap Edentulous spaces Partial or split-thickness flaps Dental implants ```
27
Interrupted Suture - Simple Loop Mod
Most used suture in dentistry For when facial and lingual flaps have been elevated Pass needle thru facial, under contact, thru lingual on inner, under contact, tie on facial
28
Interrupted Suture - Figure 8 Mod
For very restricted areas (lingual 2nd molar) Interposes suture material between edges of the flaps- usually a 4-0 size thread allows primary closure still Pass needle thru facial, under contact, reverse and enter lingual from outer, under contact, tie on facial side
29
Single Interrupted Sling Suture
For when flap has been elevated on one side or when facial and lingual flaps are positioned at different levels For 2 papillae Pass needle thru outer surface of mesial papilla, move around tooth, pass under distal contact, pentrate flap from inner, pass back under distal around tooth, under mesial and tie knot
30
Continuous Independent Sling Suture Technique
For a flap with 3 or more papillae on only one surface Tie interrupted suture on distal, pass needle under contact point to opposite side, look needle and thread around tooth, pass needle through the next interdental area below contact, repeat procedure until the last interdental area
31
Perio Dressing
No curative properties | Assist healing by protecting tissues during the healing stage
32
Reasons to use Perio Dressing
- To protect the wound postsurgically - To obtain and maintain a close adaptation of mucosal flaps to underlying bone - Patient comfort
33
Disadvantage to Perio Dressing
Antibacterial rinses cannot work under the dressing
34
CoePak ingredients
Oxides of metals (zinc oxide), lorothidol (fungicide), non-ionizing carboxylic acids, and chlorothymol (bacteriostatic)
35
Most important variable in determining long-term result of perio surgery
Post Operative Plaque Control - rinse w/ Chlorhexidine Another important variable is postsurgical wound stability
36
Suture Removal Techniques
Cut suture as close to tissue as possible to avoid dragging "dirty suture"
37
Healing Phases (3)
Inflammation Fibroblastic-granulation Matrix formation and remodeling
38
Primary Intention Healing
By clean surgical incision w/ flap surgery
39
Primary Intention Healing Immediate Response (1)
Blood clot forms between flap and tooth/bone- containing fibrin reticulum, neutrophils, erythrocytes, platelets, debris, capillaries
40
Primary Intention Healing w/in 24 hours (2)
Neutrophils invade CT | Epithelium migrates from wound margin to cover wound
41
Primary Intention Healing 1-3 days (3)
Space between flap and tooth/bone thins | Epithelial cells migrate over border of flap contacting tooth
42
Primary Intention Healing 3-7 days (4)
Epithelial migration continues Neutrophils replaced by macrophages Incision space fills with granulation tissue Revascularization under way
43
Primary Intention Healing 1 week (5)
Epithelial attachment to roots formed by hemidesmosomes and basal lamina Clot replaced by granulation tissue from CT, bone marrow, and PDL
44
Primary Intention Healing 2 weeks (6)
Collagen fibers appear parallel to tooth | Weak union of flap to tooth due to immature collagen
45
Primary Intention Healing 1 month (7)
Inflammatory cells are gone Fibroblasts proliferate and collagen accumulates Revascularization process regresses Fully epithelialized gingival crevice w/ well-defined attachment Supracrestal fibers assume functional arrangement
46
Primary Intention Healing w/in 6-8 weeks (8)
Wound gains tensil strength
47
Secondary Intention Healing differs from Primary in that (3)
- More inflammation - More granulation tissue - Wound contraction is much more pronounced
48
Summary of Wound Healing
Wound debrided by inflammatory cells Parenchymal cells regenerate Parenchymal and CT cells migrate and proliferate Extracellular matrix proteins (collagen) synthesized CT and parenchymal components remodel Wound gains strength
49
Repair
Damaged tissues replaced by tissues that don't duplicate original function or architecture The usual outcome of therapy
50
Regeneration
Damaged tissues replaced by tissues that duplicate structure and function of original tissues Involves formation of new cementum, PDL, alveolar bone Rare but most desirable
51
Factors affecting Regeneration
Contamination by bacteria Requires concerted action of many cells (cemento, osteo, fibro -blasts, JE cells, etc) Requires formation of specialized junctional complexes Root surface is avasclar and cant contribute new vessels Requires complex interactions between ECM and cells

Perio 2 Exam 2 (7 decks)

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