midterm 2 - lecture 3 Flashcards
a section of gingiva and/or mucosa surgically separated from the underlying tissues to provide visibility and access for treatment
periodontal flap
gingivectomy or flap
external bevel
exposed tissue during healing
gingivectomy
gingivectomy or flap?
internally beveled
provides access to bone
tissues not exposed during healing
flap
Flap is INTERNALLY ( cut margin faces the tooth)
Close to margin down to crest of bone - leave behind tisssues can go pretty far appically
Wound - keratinized and re attach with sutures
Both removal pocket epi
Vectomy - no bone tx
Flap - bone able to be tx
Both remove Pocket epi - but flap provides access to bone
periodontal flap uses
provide access to _ and _
_-removal of hard or soft tissue
_- for access only
_ -new periodontal support
access to bone, roots, furcation
resection = removal of hard or sof tissue
conservative - access only
regeneration - new periodontal support (bone cementum PDL)
gingivectomy or flap
preserve keratinized gingiva
healing more predictable
less inflammation and less blood lose
flaps
and can be closed by suturing primary healing
is crown lengthening an application for peridoontal flaps ?
yes
so is surgical extractions
biopsies
exploratory surgery
pre-prosthetic surgery
_ flap aka mucoperiosteal flap
flap includes epithelium, lamina propria of CT, and periosteum
bone is exposed during reflection
full thickness flap
flap elevation is done thru blunt dissection between periosteum and bone
alveolar bone exposed
compared to partial thickness flaps, full thickness flaps are
hard/easier to control/accomplish?
harsher to bone?
should be avoided in areas of dehiscence with CT attachment only
full thickness flaps
easier to accomplish
harsher to bone (more resorption)
should be avoided in areas of dehiscence with CT attachment only
_ flap aka split thickness flap
sharply dissects thru CT
- dissection plane is within CT
flap includes epi, and a portion of underlying CT
portion of CT and and periosteum remains on bone
partial thickness flap
full or partial thickness?
~more difficult to accomplish
~protects underlying bone from resoprtion to greater extent
~specialized procedures
~can be used in conjunction with tx of gingival recession
partial thickness flaps
surgical steps for full thickness flap
- anesthesia - region block and infiltrate at interprox - control bleeding
- incisions - primary = outline scallops submarginal 1-3mm - defines margin of flap. secondary incision - right against the tooth so it is easier to remove - undermine interprox areas reducing CT bc they tend to be little thicker
- elevation with periosteal elevator after primary and secondary incisions
- debridement and or ossesous surgery or regeneration
- flap closure
- dressing - optional
_ _ _ are essential pre-treatment consideration for full thickness flap
Location of the MJG - do not want to compromise keratinized tissue
PD, amount of keratinized tissue, intended position of flap
Initial incision - varies in location and what you are trying to accomplish
Make incision submarginal like 1mm up to 2-3mm so you a thinning tissue - this is for reducing pocket depth reducing volume above alveolar crest
If just wanting access for SRP - make incision as close to crevice as possible - to preserve some tissue and reduce amount of recession
Regenerate - bone - PDL and cementum - we want to keep as much tissue as possible - pretty close to the gingival margin - just enough to remove it out of the sulcus to remove the pocket epithelium - incision close to gingival margin just to remove pocket epi
we cut _ to _
and elevate _ to _
cut distal to mesial
elevate/reflect mesial to distal
Start mesial work appically and distally
Reflect the flap passed MJG - the adhesion between the flap and bone is no longer there
You can totally releas the flap by elevelating the full thickeness flap passed the MJG
post op full thickness flap to reduce PD
1 week after suture removal
Fair amount of swelling
More apical location than pre op
Exposes fiurcations so patient can clean them better
Once the inflammation goes down the soft tissue will adapt and patient will clean better
The full - designed to reduce pocket depth
The amount of scallooping - distance between gingival margin and initial incision - depends on how deep the pocket is
Deeper pockets - further submarginal to increase the shrinkage
Swallow pockets - 1-2mm or less for incision
full or partial flap
good at procedures trying to increase the width of keratinized gingival tissue
partial thickness
We also want to use a partial thickness flap in areas where the facial bone is very thin or has dishencece (lower canine)
_ incisions
provide access without flap extension to adjacent areas
help with flap positioning
must be made interproximmaly near line angles (never over a root prominence)
should diverge appically for vascular integrity
vertical incisions
flap positioning
_ positioned for regeneration or root coverage
_ for conservative flaps minimal recession - SRP
_ for pocket eliminate or crown lengthening
coronally positioned - regeneration or root coverage
replaced - converative minimal recession
apically - for PD eliminate or crown lengthening - reflected passed MGJ
Full thickness initial incisions
outline scallops - submarginal
determinants - amount of keratinized gingiva
need for access to bone vs invasiveness
PD interprox and facial
how much apical position is possible
contours of keratinized tissue - if rolled margins resect more
purpose - resective - remove more tissue , regenerative or where esthetic problem- use INTRASULCULAR INCISION
full thickness flap secondary incision
intrasulcular to the bone
frees of collar of tissue surrounding teeth
involves incision thru JE and CT attachment
third incision - use a BP 15 blade to separate papillae from interprox tisssue - interpox papillae should be even with rest of flap
elevation of flap
Push between the flap and the bone, starting on the _side of the alveolar crest.
Use gentle to moderate force
Use a _ action with the elevator to separate the tissue from the bonec.
Use index finger from opposite hand to provide a counter-force to prevent flap tearing.
Work from _ to _ and _. The blunt dissection should progress in a distal and apical direction
Follow around the contours of the bone keeping constant contact with the bone
Elevate past the mucogingival junction if the flap is to be _positioned.
starting on periosteal side
twisting action
mesial to distal and apically
pass MGJ if apically positioned flap
Once the flap is elevated past the mucogingival junction, the elastic nature of the mucosa allows the flap to relax into the vestibule
potential problems when elevating flap
_requires a direction of elevation that is almost horizontal. under these circumstances, the flap is easy to tear extreme caution must be exercised to follow the bony contours
it is often easier to reflect if the flap is extended to the _ of an exostosis
Thin bone of dehiscence: _ incisions are helpful
exostoses
mesial
Difficulties in flap elevation 1. can occur if the original incision did not extend completely to bone
2. re-trace incision to bone and try elevating again
Thin bone of dehiscence: vertical incisions are helpful d. Potential damage to blood vessels and nerves
