Flap techniques

Question 1

What are the commonly used flap techniques?

Answer 1

Modified Widman flap
Undisplaced flap
Apically displaced flap

Question 2

True/False:
Indications for using flap techniques for periodontal pocket therapy includes pockets greater than 4mm after phase 1 therapy

Answer 2

False!
Pockets must be greater than 5mm after phase 1 therapy

Question 3

What are the Indications for using flap techniques

Answer 3

Pockets greater than 5mm persisting after phase 1 therapy
Bony pockets and interdental craters
Furcation areas
Need for crown lengthening
Deep, narrow pockets where access is impossible

Question 4

True/False:
Contraindications for flap techniques include aesthetic concerns

Answer 4

True!

Question 5

Which flap technique is best recommended when aesthetics is a concern?

Answer 5

Modified Widman flap

Question 6

Which flap technique requires a sufficient amount of attached gingiva?

Answer 6

Undisplaced flap

Question 7

True/False:
One of the flap techniques is based on shifting the mucogingival junction coronal to the teeth

Answer 7

False!

Question 8

Which flap technique is considered as the “Internal Bevel Gingivectomy”? And why?

Answer 8

The Undisplaced flap
Because the pocket wall is removed with the initial incision

Question 9

Which flap technique uses a continuous sling suture to secure facial and lingual flaps?

Answer 9

The Undisplaced flap

Question 10

Which flap technique increases the width of the attached gingiva?

Answer 10

The Apically displaced flap

Question 11

True/False: Modified Widman flap technique uses vertical incisions

Answer 11

False!
Modified Widman technique uses horizontal incisions only and vertical releasing incisions are not needed.

Question 12

Which flap technique uses bleeding pocket marks?

Answer 12

The Undisplaced flap technique

Question 13

True/False: The Apically displaced technique uses sling sutures only

Answer 13

False!
It uses the sling sutures for full-thickness flap, and the partial thickness flap is sutured to the periosteum

Question 14

True/False:
Full thickness flaps need a sharp dissection with a periosteal elevator

Answer 14

False!
Full thickness flaps need a BLUNT dissection with a periosteal elevator

Question 15

Which flap technique is used to remove the pocket wall and increase the width of the attached gingiva?

Answer 15

The Apically displaced technique

Question 16

Which flap technique does not eliminate the pocket?

Answer 16

The Modified Widman technique

Question 17

Which flap technique heals with a short junctional epithelium?

Answer 17

None

Question 18

True/False: The modified Widman technique heals with a long junctional epithelium

Answer 18

True

Question 19

What are the advantages of the Modified Widman flap technique?

Answer 19

1) Removes the inflamed pocket wall
2) Provides access for root debridement
3) Preserves maximum amount of periodontal tissue
4) Indicated when aesthetics are of main concern

Question 20

What are the reasons for using flap techniques for periodontal pocket therapy?

Answer 20

1) Increase visibility of the root surface and deposits
2) Improved access for oral hygiene & supportive periodontal therapy
3) Eliminate or reduce the pocket depth by removal of the pocket wall
4) Expose area to perform regenerative methods
5) Allow more accurate determination of the prognosis

Question 21

What are the contraindications of using flap techniques for periodontal pocket therapy?

Answer 21

1) Shallow Supra alveolar pockets that can be accessed with conventional SRP
2) Areas where aesthetics may be compromised if flaps are to be raised

Question 22

What are the contraindications of using flap techniques for periodontal pocket therapy?

Answer 22

1) Shallow Supra alveolar pockets that can be accessed with conventional SRP
2) Areas where aesthetics may be compromised if flaps are to be raised

Question 23

List the steps of the Modified Widman flap

Answer 23

Step 1) Initial internal bevel incision to alveolar crest, 0.5-1mm away from gingival margin (follow scalloping of margins)
2) Reflect gingiva with periosteal elevator 2-3mm from bone
3) 2nd sulcular incision
4) 3rd incision in interdental spaces coronal to bone - remove gingival collar
5) Remove tissue tags & granulation tissue with curette - SRP if needed
6) Bone architecture only corrected if prevents good tissue adaptation to the necks of teeth
7) Adapt the facial and lingual inter proximal tissue with no bone exposure at time of suturing
- use interrupted direct sutures