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Perio II > Palatal Flap Retromolar and Tuberosity Surgery > Flashcards

Palatal Flap Retromolar and Tuberosity Surgery Flashcards

1
Q

what are the histologic differences in the palatal flap

A
  • keratinized - cannot be apically positioned
  • thickness of the connective tissue - varies among areas and patients
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2
Q

what are the anatomic differences with the palatal flap

A
  • palatine foramen and blood vessels
  • rugae
  • incisive papilla with vessels
  • palatal exostosis
  • palatal form - high to shallow vault
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3
Q

what is the incidence of palatal exostoses

A

40%

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4
Q

what is the palatal form (high to shallow vault) related to

A

tissue thickness

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5
Q

what should be anticipated in palatal flap procedure

A
  • underlying bone morphology
  • palatal root configuration
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6
Q

what are the treatment goals of the palatal flap

A
  • regeneration
  • resection
  • combination
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7
Q

what is the amount of tissue removed determined by

A

the initial probing depth

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8
Q

where is the first incision made

A

at the level of 2/3 of the probing depth

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9
Q

how deep is the bevel on the scalpel blade

A

1mm deep

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10
Q

12 cuts which ways

A

front and back

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11
Q

what are the 4 types of incisions in a palatal flap

A
  • primary incision
  • secondary incision
  • tertiary incision
  • fourth incision
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12
Q

what is a primary incision

A
  • trace incision
  • scalloped incision versus straight incision
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13
Q

what is the secondary incision

A

undermining or thinning of tissue with incision in long axis of tooth

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14
Q

what is the tertiary incision

A
  • contact with bone
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15
Q

what is the fourth incision

A
  • intrasulcular
  • tissue removal
  • granulation tissue removal
  • defect and root debridement
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16
Q

goal of the flap surgery is:

A

access

17
Q

what are the goals of access

A
  • access to debride the root surface and the osseous defect
  • access to place any bone replacement graft
  • access for osseous correction if possible
18
Q

what are the palatal flap complications

A
  • position of rugae or incisive papilla
  • vertical palatal incision contour
  • long flap
  • short flap
  • flap necrosis
  • hemorrhage
  • recurrent herpetic outbreak
19
Q

what is the result of flap necrosis

A

a short flap

20
Q

what is flap necrosis due to

A

compromised blood supply due to over-thinning of flap or vascular compromise

21
Q

what is the source of healing in flap necrosis

A

PDL, flap margin and underlying bone

22
Q

what are the factors predisposing the retromolar and tuberosity areas to periodontal breakdown

A
  • bulk of soft tissue mass
  • inaccessibility to oral hygiene
  • contours favoring plaque retention
23
Q

what are the factors affecting retromolar area

A
  • external oblique ridge
  • lingual bony ridge
  • proximity of the ascending ramus to the terminal tooth
  • presence of impacted or partially impacted third molars
24
Q

what are the factors affecting the tuberosity area

A
  • presence of exostosis on the palatal aspect
  • similar exostosis on buccal aspect
  • presence of impacted or partially impacted third molars
25
Q

what are the advantages and disadvantages of resection

A
  • advantages: easier and quicker
  • disadvantages: cannot gain access to osseous defects, incision often ends in mucosa, extremely broad wound, exostoses are often exposed
26
Q

what are the advantages and indications of the distal wedge

A
  • management of pockets and keratinized tissue
  • access to osseous defects
  • access for exostosis removal
  • less post-operative discomfort due to primary closure
27
Q

what are the disadvantages of distal wedge

A

harder to do and time consuming

28
Q

what are the contraindications for the distal wedge

A
  • flat palate
  • limited distal space
  • when no osseous defect exists
29
Q

what is the triangular wedge surgical technique

A
  • bone sounding
  • primary incisions
  • secondary incisions
  • wedge removal
  • osseous access if required
  • closure
30
Q

what are the modifications of distal wedge

A
  • square distal wedge surgical technique
  • linear distal wedge surgical technique
  • ochsenbein and Ross (“trap door”) surgical technique
  • scaling and root planing
31
Q

what is the square distal wedge surgical technique

A
  • primary incisions
  • secondary incisions
  • wedge removal
  • closure
32
Q

what is the linear distal wedge surgical technique

A
  • primary incisions
  • secondary incisions
  • wedge removal
  • closure
33
Q

what is the ochsenbein and ross (“trap door”) surgical technique

A
  • primary incisions
  • secondary incisions
  • wedge removal
  • closure
34
Q

when is scaling and root planing done

A

when no distal wedge is required

35
Q
A

Perio II (13 decks)

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