Palatal Flap Retromolar and Tuberosity Surgery Flashcards
what are the histologic differences in the palatal flap
- keratinized - cannot be apically positioned
- thickness of the connective tissue - varies among areas and patients
what are the anatomic differences with the palatal flap
- palatine foramen and blood vessels
- rugae
- incisive papilla with vessels
- palatal exostosis
- palatal form - high to shallow vault
what is the incidence of palatal exostoses
40%
what is the palatal form (high to shallow vault) related to
tissue thickness
what should be anticipated in palatal flap procedure
- underlying bone morphology
- palatal root configuration
what are the treatment goals of the palatal flap
- regeneration
- resection
- combination
what is the amount of tissue removed determined by
the initial probing depth
where is the first incision made
at the level of 2/3 of the probing depth
how deep is the bevel on the scalpel blade
1mm deep
12 cuts which ways
front and back
what are the 4 types of incisions in a palatal flap
- primary incision
- secondary incision
- tertiary incision
- fourth incision
what is a primary incision
- trace incision
- scalloped incision versus straight incision
what is the secondary incision
undermining or thinning of tissue with incision in long axis of tooth
what is the tertiary incision
- contact with bone
what is the fourth incision
- intrasulcular
- tissue removal
- granulation tissue removal
- defect and root debridement
goal of the flap surgery is:
access
what are the goals of access
- access to debride the root surface and the osseous defect
- access to place any bone replacement graft
- access for osseous correction if possible
what are the palatal flap complications
- position of rugae or incisive papilla
- vertical palatal incision contour
- long flap
- short flap
- flap necrosis
- hemorrhage
- recurrent herpetic outbreak
what is the result of flap necrosis
a short flap
what is flap necrosis due to
compromised blood supply due to over-thinning of flap or vascular compromise
what is the source of healing in flap necrosis
PDL, flap margin and underlying bone
what are the factors predisposing the retromolar and tuberosity areas to periodontal breakdown
- bulk of soft tissue mass
- inaccessibility to oral hygiene
- contours favoring plaque retention
what are the factors affecting retromolar area
- external oblique ridge
- lingual bony ridge
- proximity of the ascending ramus to the terminal tooth
- presence of impacted or partially impacted third molars
what are the factors affecting the tuberosity area
- presence of exostosis on the palatal aspect
- similar exostosis on buccal aspect
- presence of impacted or partially impacted third molars
what are the advantages and disadvantages of resection
- advantages: easier and quicker
- disadvantages: cannot gain access to osseous defects, incision often ends in mucosa, extremely broad wound, exostoses are often exposed
what are the advantages and indications of the distal wedge
- management of pockets and keratinized tissue
- access to osseous defects
- access for exostosis removal
- less post-operative discomfort due to primary closure
what are the disadvantages of distal wedge
harder to do and time consuming
what are the contraindications for the distal wedge
- flat palate
- limited distal space
- when no osseous defect exists
what is the triangular wedge surgical technique
- bone sounding
- primary incisions
- secondary incisions
- wedge removal
- osseous access if required
- closure
what are the modifications of distal wedge
- square distal wedge surgical technique
- linear distal wedge surgical technique
- ochsenbein and Ross (“trap door”) surgical technique
- scaling and root planing
what is the square distal wedge surgical technique
- primary incisions
- secondary incisions
- wedge removal
- closure
what is the linear distal wedge surgical technique
- primary incisions
- secondary incisions
- wedge removal
- closure
what is the ochsenbein and ross (“trap door”) surgical technique
- primary incisions
- secondary incisions
- wedge removal
- closure
when is scaling and root planing done
when no distal wedge is required
