Flap Technique For Pocket Therapy Flashcards
Flaps are used for pocket therapy to accomplish the followings :
- increase accessibility to root deposited.
- eliminate or reduce the pocket depth by resection of pocket wall.
- expose the area to perform regenerative methods.
What are Technique for access & pocket depth reduction /elimination:?
- modified Widman flap “MWF.”
- undisplced flap.
- apically displaced flap
Talk about wind man flap, indications and contra indications
Modified Widman flap:
Described for exposing the root surface for meticulous instrumentation & for removal the pocket lining. it is not intended to eliminate or reduce pocket depth, except for the reduction that occurs in healing by tissue shrinkage.
Indication Treatment of all type of periodontitis ,but especially effective with pocket depth of 5-7mm.
Contraindication
- Lack of or very thin & narrow attached gingiva render the technique difficult.
- MWF is contraindicated for osseous surgical procedures with very deep osseous defect.
Numerate steps of Modified Widman flap
Step 1:it is an initial, internal bevel incision 0.5 to 1 mm Away from the gingival margin ,directed to the alveolar crest vertical incisions are not required
Step 2:gingiva is reflected with a periosteal elevator.
Step3: crevicular incision is made from the bottom of the pocket to the bone .
Step 4:after the flap is reflected , a third incision is made in the interdental space coronal to the bone with curette or interdental knife (Orban’s knife) & the gingival collar is removed.
Step 5: tissue tags & granulation tissue are removed with a curette .the root surface are checked ,scaled &planed. .
Step 6: bone architecture is not corrected except if it prevents good tissue adaptation ,good approximation of flaps is necessary
Step 7: interrupted direct sutures are placed in each interdental space .
Talk about  Undisplaced flap
Undisplaced flap (most frequently performed type of periodontal surgery It differs from the modified Widman flap in that the soft tissue pocket wall is removed with the initial incision ;thus it may be considered an “internal bevel gingivectomy” .The undisplaced flap &gingivectomy are the two techniques that surgically remove the pocket wall. to perform this technique without creating the mucogingival problem the clinician should determine that enough attached gingiva will remain after removal of the pocket wall.
Enumerate Undisplaced flap procedure
Step 1:the pocket are measured with the periodontal probe & the bleeding point is produced on the outer surface of the gingiva to mark the base of the pocket bottom.
Step 2:the initial , or internal bevel incision is made following the scalloping bleeding points made on the gingiva .This incision is usually carried to appoint apical to the alveolar crest depending on the thickness of the tissue .The thicker the tissue ,the more apical is the ending point of the incision. The flap should be thinned with the initial incision only.
Step 3:the second or crevicular incision is made from the bottom of the pocket to the bone.
Step 4:The flap is then reflected with the periosteal elevator .
Step 5:interdental incision is made with a knife.
Step 6:triangular wedge of tissue is removed with a curette.
Step 7:The area is debrided , removing tissue tags & granulation tissue with sharp curette..
Step 8: after the necessary scaling & root planing ,the flap is edge should rest on the root –bone junction Step
9: a continuous sling suture is used to secure the facial the facial and the lingual flaps.
Talk about apical displaced flap, objective and contraindications
Apically displaced flap The flap is displaced apically from the original position.
Objective
- pocket eradication
- Augmentation of attached gingiva Contraindication
- periodontal pocket in areas where esthetic is critical
- Pt. with high risk of caries
- Tooth with marked mobility & sever attachment loss.
Apically displaced flap (procedure)
Step 1:internal bevel incision is made , about 1 mm from the crest of & directed towards the crest of the bone .(there is no need to mark the bottom of the pocket in the external gingival surface because the incision unrelated to pocket depth.
Step 2: crevicular incision are made followed by initial elevation of flap & then intrdental incision is performed ,the wedge of tissue containing the pocket wall is removed .
Step 3: vertical releasing incisions are made extending beyond the mucogingival junction & flap is elevated with a periosteal elevator.
Step 4:remove all the granulation tissue , scaling root planing is done & & osseous surgery if needed flap is displaced apically .
Step 5:flaps are sutured together.
Talk about Flaps for reconstructive surgery: and its designs
Flaps for reconstructive surgery:
In reconstructive therapy ,bone grafts, membranes or a combination of these ,with or with out other agents ,the flap design should therefore be set up so that the maximum amount of gingival tissue & papilla are retained to cover the material(s) placed in the pocket.
Two flap design are available :
- papilla preservation flap
- conventional flap with only crevicular incisions.
Procedure for Papilla preservation flap:
Step 1: crevicular incision is made around each tooth with no incisions through the interdental papilla .
Step 2: the preserved papilla can be incorporated in to facial or lingual /palatal flap(mostly with facial ).
Lingual or palatal incision consists of semi lunar incisio across the interdental papilla in it ,s palatal or lingual aspect at least 5 mm from the crest of the papilla.
Step 3: the papilla is dissected from the lingual or palatal aspect using Orban knife & elevated intact with the facial flap.
Step 4 : the flap is reflected without thinning the tissue
Procedure for Conventional flap:
Step 1: using a # 12 bade ,incise the tissue at the bottom of the pocket & to the crest of the bone , splitting the papilla below the contact point .
Step 2: reflect the flap ,maintaining it as thick as possible to prevent exposure of the graft or the membrane resulting from the necrosis of the flap margins.
