midterm 2 - lecture 4

Question 1

A thinned palatal flap is a method for achieving optimal post surgical tissue contours and flap adaptation through internal (undermining) incisions that are extended _ to the crest of bone on the palate.

Answer 1

apical

No MJG on palate - everything attached

Want to eliminate pocket - so initial incison is scalloped and approx 4mm
The deeper the pockets the more scalloping in the initial incison

Question 2

palatal flaps Considerations

A. _ is abundant, extending from the gingival margin to the midline
B. Flaps must be designed precisely
C. The flap frequently must be _
D. Technically, _ positioning of the flap is not possible

Answer 2

a. Keratinized gingiva
c. thinned internally
d. apical positioning not possible

Question 3

Design of palatal flap
A. Determining the amount of scalloping (sub-marginal) incisions

~Probing depths:
~Gingival contours: if architecture is flat, _ scalloping
~_ of pocketing: palatal or interproximal
~Objective: _ (resective), _ or conservative
~Underlying soft tissues and osseous topography- _ scalloping needed if thinning of soft tissues or bone will be required because gingival margin will partially rotate to meet tooth surface on closure

Answer 3

PD - more depth, more scallop

need more scalloping if flat

Location of pocketing

pocket elimination - resective

regenerative - conservative

less scalloping if thinning of soft tissue/bone will be required

Question 4

what determines amount of internal thinning of palatal flap

Answer 4

thickness of soft and osseous tissue

Question 5

designs for palatal flaps

Answer 5

direct inverse bevel method

two-step thinning method

Question 6

_ is a periodontal surgical procedure for removal of excessive soft tissue distal to a terminal tooth.
It is designed to treat pockets through _ while gaining access to bone on the distal aspect of terminal teeth (

Answer 6

A distal wedge

tx through internal thinning

maxillary tuberosity mandibular retromolar areas
The technique can also be applied to edentulous areas.

Question 7

advantages of distal wedge flap

A. Closing the wound permits healing by _
B. Permits access to bone and furcations
C. In certain cases, may _ the zone of keratinized gingiva

Answer 7

primary intention

preserve keratinized tissues

Question 8

_ indications

deep pocket distal to terminal tooth with need to:

a. gain access to bone
b. gain access to a furcation
c. have wound closure (e.g.: regenerative procedure)

2. deep pocket in area with thin or absent keratinized gingiva

Answer 8

distal wedge

Question 9

_ contraindications and precautions

potential trauma to lingual nerve or greater palatine artery

other anatomic limitations

limited distal space (e.g.: tuberosity has small mesial-distal length)

Answer 9

distal wedge

Question 10

distal wedge flap designs

provides best access

best for distal defects and removal fair amount of tissue -

Answer 10

Square

incisions that are parallel and in general the more tissue that you are trying to remove the more distance between the two incisions
Parallel incisions with distal releasing incision that allow flap reflection

Question 11

distal wedge flap designs

easier to accomplish, less invasive to cause big wound

Answer 11

Triangular:

have facial and lingual incisions that converge distally and become a point

Question 12

distal wedge flap designs

preserves keratinized gingiva best

simpler good at conserving tissue - use this approach for minimal thinning but access to a distal bony defect graft

Answer 12

Linear

simple single distal straight incision along the crest of the ridge and a transverse releasing incision - good more minor thinning or tissue and access to furcations or defects to graft bone - minor

Question 13

_ flap Objectives:
~Access to debride roots
~Primary closure
~Pocket reduction through resolution of inflammation and long junctional epithelium
~Minimal gingival recession

Answer 13

conservative flap - modified widman flap

treatment of periodontal pockets where recession must be minimized (facial aspect of maxillary anterior teeth- esthetic zone)

Areas not amenable to more definitive approaches

Contraindications=If a more definitive procedure (resection or regeneration) is feasible

Question 14

_ Flap is a scalloped, replaced, mucoperiosteal flap, accomplished with an internal bevel incision providing access for root planing

Answer 14

modified widman flap

1. initial incision is located 0.5 to 1 mm from free gingival margin
2. flap is elevated approximately 2 to 3 mm from alveolar crest
3. intrasulcular incisions to free marginal tissue to be removed
4. interdental incisions to free interproximal tissue to be removed
5. soft tissue removal
6. root planing
7. flap adaptation
8. interdental suturing goal: primary closure

Question 15

_ flap

Initial incision - establishs the amount of tissue removal and margin of the flap

Answer 15

thinned palatal flap

second incision down thru the pcoket
What is left is a blunt thick piece of tissue as a margin
The next step is the make and undermining incison thru the CT to the bone, pretty apical to the crest of bone to thin the tissue and make it normal looking

Question 16

palatale flap Flap thinned and elevated to see underlying bone, Placed at the crest of bone and sutured

Did some minor recontouring of the palatal bone

why?

Answer 16

Allowing the flap to adapt better to the underlying bone

More clinical crown showing 
Better access for cleaning 
Initially epi reattachment 
Epi at margin - forms seal 
Then fibers forming CT start

Question 17

_ refers to a process for internal thinning by removal of a block of tissue

Answer 17

“wedge”

Taking a block of tissue and remove in one step and then go back and thin/wedge to make it go back properly

Question 18

Distal wedges can be done in a single procedure

But usually done in adjunctiion to _

Answer 18

periodontal flap

Question 19

_ design of distal wedge

After making primary incisons remove the block of tissue along with the facial and lingual tissue (tissue that is removed when elevating flap)

And then you have a rectangular defect
Have to thin or undermine the tissue because it is too thick to place back properly

Answer 19

square distal wedge

If did it correctly - on the distal come together end to end and close with suture - distal thinning

Question 20

the 2 conservative flap designs we learned

intended to minimize recession

good for max anteriors

Answer 20

modified widman flap

flap curettage - open flap debridement

Question 21

is modified widman full thickness or partial thickness

Answer 21

Minimum scallopped full thickness flap

Question 22

modified widman

_ positioned

with _ bevel incision (coronal to apical)

what kind of closure

Answer 22

“replaced mucoperiosteal flap” full thickness

internal bevel incision

primary closure

Question 23

initial incision of _ flap has internal bevel 0.5mm-1mm scallop, but may also be intrasulcular

Answer 23

modified widmans flap

2-3mm elevated - NOT PASSED MGJ
There is a limited degree of reflection - not passed MGJ (flap not fully released)

Question 24

with _ flaps, there is little or no bone resection. the flap is adapted to obtain primary closure

Answer 24

conservative flaps

Minimal shrinkage and minial pocket
Objective - not to cause a lot of shrinkage and recession - use the Modified Widman
Good for anteriors
Used when can’t regenerate

we get a little filling in of attachment after going in a debridement post op