Palatal Flap with retromolar and tuberosity surgery- Review Flashcards
Due to location of the palate, there are important histological differences and anatomical landmarks to be aware of during flap procedures:
palatal flap
What are the histological differences that you must be aware of when performing a palatal flap
- keratinized tissue- bound down and non-moveable so cannot be apically positioned
- Thickness of connective tissue varies (thickest at premolar area)
What anatomical landmarks should be considered when performing a palatal flap:
- palatine foramen and associated blood vessels
- rugae
- incisive papilla with vessels
- great palatine foramen
- palatal form varies (high vault vs. low vault)
When performing a palatal flap procedure, the amount of soft tissue that is removed is determined by:
the initial probing depth- usually the first incision is made at the level of of 2/3 the probing depth
T/F: The first incision when performing a palatal flap is determined by the initial probing depth. This first incision is made at the level of 1/2 the probing depth
s1 true
s2 false- 2/3 the probing depth usually
A palatal flap technique is a ____ incision technique
4 incision
For a palatal flap, the primary incision =
trace incision
For a palatal flap, the primary (trace incision) may be:
scalloped or straight
For a palatal flap, the secondary incision =
undermining or thinking of tissue with incision direction towards long access of tooth
For a palatal flap, the tertiary incision =
scalpel makes contact with bone
For a palatal flap, the fourth incision =
intrasulcular incision that releases tissues from neck of tooth
What is the function of the fourth incision in a palatal flap (the intrasulcular incision that releases tissues from neck of tooth)?
Function=
- tissue removal
- granulation tissue removal
- defect and root debridement
List the complications of a palatal flap: (5)
- position of rugae or incisive papilla
- vertical palatal incision contour
- “long” or “short” flap (flap necrosis results in “short flap”
- hemmorhage
- recurrent herpetic outbreak
Due to compromised blood supply due to the over-thinning of the flap.
Flap necrosis
Describe the sources of healing of a flap, which is most prominent?
- PDL (biggest source)
- flap margin
- underlying bone
Factors predisposing the retromolar and tuberosity areas to periodontal breakdown: (3)
- bulk of soft tissue mass
- inaccessibility to oral hygiene
- counters favoring plaque retention
Factors affecting the retromolar area (mandibular)
- external oblique ridge
- lingual bony ridge
- proximity of the ascending ramus to the terminal tooth
- presences of impacted or partially impacted 3rd molars
Factors affecting the tuberosity area (maxillary)
- presence of exostosis on the palatal aspect (40%)
- similar exostoses in the buccal aspect
- presence of impacted or partially impacted 3rd molars
Subtractive/ taking away:
resection
What are the advantages of resection?
Easier and quicker
What are disadvantages of resection?
- cannot gain access to osseous defects
- incision often ends in mucosa
- extremely broad wound
- exostoses are often exposed
Advantages and indications of a distal wedge include:
- management of pockets
- keratinized tissue access to osseous defects
- access for exostoses removal
- less post-op discomfort due to primary closure
Disadvantages of distal wedge include:
harder and more time consuming
Contraindications of distal wedge include:
- flat plane
- limited distal space
- no osseous defect exists
Types of distal wedges include:
- triangular
- square
- linear
- trap-door
List the steps in a triangular distal wedge:
- bone sounding
- primary incisions
- secondary incisions
- wedge removal
- osseous access (if required)
- closure/suture
List the steps in a square distal wedge:
- primary incisions
- secondary incisions
- wedge removal
- closure
List the steps in a trap door distal wedge:
- primary incisions
- secondary incisions
- wedge removal
- closure
What is another name for trap door distal wedge?
Oshsenbein & Ross
When no distal wedge is require, proceed with:
SRP