Gingivectomy and Flap Design Flashcards
What are some indications for gingivectomy?
- Hyperplastic tissue
2. Suprabony pockets
What are some contraindications to gingivectomy?
- Osseous involvement
- Mucogingival involvement
- Furcation involvement
T/F: Gingivectomy is indicated when you have a pocket below the crest of bone.
False
Gingivectomy is often done in conjunction with ____________.
Gingivoplasty - recontour tissue to look more normal
What is the first step in gingivectomy after LA has been administered?
Mark pocket depths with bleeding points
You start the incision ___________ to the bleeding point.
Apical
Allows for a beveled incision
T/F: You would typically work distal to mesial for a gingivectomy procedure.
True
What is the general purpose of the gingivectomy?
Makes it easier for patient to clean and removes the anaerobic environment
What is imperative in order for the tissue to regrow and heal after a gingivectomy?
That there is adequate keratinized tissue before and after surgery
T/F: Lasers and electrosurgery can be used for gingivectomy.
True
T/F: Tissues are exposed during healing after flap surgery.
False
Tissues exposed during gingivectomy, not flap surgery
T/F: Flaps are externally beveled.
False
Internal bevel
T/F: Flaps preserve keratinized gingiva and can be closed by suturing.
True
What are some contexts for using a flap?
- Resective surgery
- Conservative (access only)
- Regeneration
T/F: Using a flap is much more versatile than gingivectomy.
True
What is the difference between a full thickness flap and a partial thickness flap?
Full: includes epithelium, connective tissue, and periosteum (peeled off bone surface)
Partial: includes epithelium and a portion of connective tissue
What is the advantage to a partial thickness flap?
Leaves the periosteum on the bone - protecting it from resporption
T/F: Full thickness flaps are more commonly used.
True
What is the most common blade used for a flap?
15 or 15c (smaller)
What instrument is used to elevate a full thickness flap?
Periosteal elevator
T/F: You cut from distal to mesial, elevate from mesial to distal.
True
T/F: The primary incision for a full thickness flap should hit bone.
True
T/F: All soft tissue should be removed from the flapped bony area.
True (debridement)
T/F: Full thickness flaps facilitate an increase in width of keratinized tissue.
False
Partial-thickness flaps
T/F: Partial thickness flaps are reflected with blunt instruments.
False
Sharp scalpel
What would be three indications for partial thickness flap?
- Thin bone
- Not much keratinized tissue
- Tissue grafting
T/F: Vertical incisions should be placed mid facial of a tooth.
False
Over bone, at the line angles of teeth
When would you position the flap coronally to heal?
Regeneration or root coverage
When would you simply put the flap back where it was to heal?
Conservative flaps
When would you position the flap apically to heal?
For pocket elimination of crown lengthening (resective)
T/F: The entire palatal gingival tissue is adhered to bone.
True
How would you reduce pocket size with a palatal flap?
You must thin the flap
A _____________ is a perio sx procedure for removing excessive soft tissue distal to a terminal tooth.
Distal wedge
What are some typical sites for wedges?
Maxillary tuberosity, mandibular retromolar area, edentulous ridges
T/F: It is possible to obtain primary closure of the wound after bulky tissue reduction with a distal wedge.
True
Which distal wedge design is the least difficult and least invasive?
Triangular wedge
Which distal wedge design provides the best access?
Square wedge
Which distal wedge design is best at preserving keratinized tissue?
Linear wedge
T/F: When you have limited keratinized tissue, scalloped incisions are indicated for flap design.
False
Stay sulcular to preserve keratinized tissue
What can allow you to get primary closure in flaps and distal wedges?
Thinning of the flap
T/F: Triangular distal wedges often heal with secondary closure.
True
______________ is a conservative flap design intended to _____________.
Modified Widman flap; minimize recession
In order to have minimal recession, where should the flap be placed for closure?
It should be replaced back where it was
Minimal flap elevation allows for this
T/F: A modified Widman flap is good for anterior teeth.
True
T/F: A modified Widman flap involves 5 mm of scalloping.
False
Minimal scalloping - allows for replaced primary closure
