midterm 2 - lecture 3

Question 1

a section of gingiva and/or mucosa surgically separated from the underlying tissues to provide visibility and access for treatment

Answer 1

periodontal flap

Question 2

gingivectomy or flap

external bevel
exposed tissue during healing

Answer 2

gingivectomy

Question 3

gingivectomy or flap?

internally beveled
provides access to bone
tissues not exposed during healing

Answer 3

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

Question 4

periodontal flap uses

provide access to _ and _

_-removal of hard or soft tissue

_- for access only

_ -new periodontal support

Answer 4

access to bone, roots, furcation

resection = removal of hard or sof tissue

conservative - access only

regeneration - new periodontal support (bone cementum PDL)

Question 5

gingivectomy or flap

preserve keratinized gingiva

healing more predictable

less inflammation and less blood lose

Answer 5

flaps

and can be closed by suturing primary healing

Question 6

is crown lengthening an application for peridoontal flaps ?

Answer 6

yes

so is surgical extractions
biopsies
exploratory surgery
pre-prosthetic surgery

Question 7

_ flap aka mucoperiosteal flap

flap includes epithelium, lamina propria of CT, and periosteum

bone is exposed during reflection

Answer 7

full thickness flap

flap elevation is done thru blunt dissection between periosteum and bone

alveolar bone exposed

Question 8

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

Answer 8

full thickness flaps

easier to accomplish
harsher to bone (more resorption)

should be avoided in areas of dehiscence with CT attachment only

Question 9

_ 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

Answer 9

partial thickness flap

Question 10

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

Answer 10

partial thickness flaps

Question 11

surgical steps for full thickness flap

Answer 11

1. anesthesia - region block and infiltrate at interprox - control bleeding
2. 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
3. elevation with periosteal elevator after primary and secondary incisions
4. debridement and or ossesous surgery or regeneration
5. flap closure
6. dressing - optional

Question 12

_ _ _ are essential pre-treatment consideration for full thickness flap

Location of the MJG - do not want to compromise keratinized tissue

Answer 12

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

Question 13

we cut _ to _

and elevate _ to _

Answer 13

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

Question 14

post op full thickness flap to reduce PD

1 week after suture removal

Answer 14

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

Question 15

full or partial flap

good at procedures trying to increase the width of keratinized gingival tissue

Answer 15

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)

Question 16

_ 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

Answer 16

vertical incisions

Question 17

flap positioning

_ positioned for regeneration or root coverage

_ for conservative flaps minimal recession - SRP

_ for pocket eliminate or crown lengthening

Answer 17

coronally positioned - regeneration or root coverage

replaced - converative minimal recession

apically - for PD eliminate or crown lengthening - reflected passed MGJ

Question 18

Full thickness initial incisions

Answer 18

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

Question 19

full thickness flap secondary incision

Answer 19

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

Question 20

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.

Answer 20

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

Question 21

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

Answer 21

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