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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
Q

5 Common Suturing Techniques

A

Interrupted Sutures - Simple loop mod, figure 8 mod
Mattress Sutures - Vertical, Horizontal
Periosteal Sutures
Continuous Sutures - Locking, Horizontal Mattress
Sling Sutures - Independent, Continuous

26
Q

Interrupted Sutures - Uses

A 
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
Q

Interrupted Suture - Simple Loop Mod

A

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
Q

Interrupted Suture - Figure 8 Mod

A

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
Q

Single Interrupted Sling Suture

A

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
Q

Continuous Independent Sling Suture Technique

A

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
Q

Perio Dressing

A

No curative properties

Assist healing by protecting tissues during the healing stage

32
Q

Reasons to use Perio Dressing

A
  • To protect the wound postsurgically
  • To obtain and maintain a close adaptation of mucosal flaps to underlying bone
  • Patient comfort
33
Q

Disadvantage to Perio Dressing

A

Antibacterial rinses cannot work under the dressing

34
Q

CoePak ingredients

A

Oxides of metals (zinc oxide), lorothidol (fungicide), non-ionizing carboxylic acids, and chlorothymol (bacteriostatic)

35
Q

Most important variable in determining long-term result of perio surgery

A

Post Operative Plaque Control - rinse w/ Chlorhexidine

Another important variable is postsurgical wound stability

36
Q

Suture Removal Techniques

A

Cut suture as close to tissue as possible to avoid dragging “dirty suture”

37
Q

Healing Phases (3)

A

Inflammation
Fibroblastic-granulation
Matrix formation and remodeling

38
Q

Primary Intention Healing

A

By clean surgical incision w/ flap surgery

39
Q

Primary Intention Healing Immediate Response (1)

A

Blood clot forms between flap and tooth/bone- containing fibrin reticulum, neutrophils, erythrocytes, platelets, debris, capillaries

40
Q

Primary Intention Healing w/in 24 hours (2)

A

Neutrophils invade CT

Epithelium migrates from wound margin to cover wound

41
Q

Primary Intention Healing 1-3 days (3)

A

Space between flap and tooth/bone thins

Epithelial cells migrate over border of flap contacting tooth

42
Q

Primary Intention Healing 3-7 days (4)

A

Epithelial migration continues
Neutrophils replaced by macrophages
Incision space fills with granulation tissue
Revascularization under way

43
Q

Primary Intention Healing 1 week (5)

A

Epithelial attachment to roots formed by hemidesmosomes and basal lamina
Clot replaced by granulation tissue from CT, bone marrow, and PDL

44
Q

Primary Intention Healing 2 weeks (6)

A

Collagen fibers appear parallel to tooth

Weak union of flap to tooth due to immature collagen

45
Q

Primary Intention Healing 1 month (7)

A

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
Q

Primary Intention Healing w/in 6-8 weeks (8)

A

Wound gains tensil strength

47
Q

Secondary Intention Healing differs from Primary in that (3)

A
  • More inflammation
  • More granulation tissue
  • Wound contraction is much more pronounced
48
Q

Summary of Wound Healing

A

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
Q

Repair

A

Damaged tissues replaced by tissues that don’t duplicate original function or architecture
The usual outcome of therapy

50
Q

Regeneration

A

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
Q

Factors affecting Regeneration

A

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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