Palatal flap with retromolar and tuberosity surgery- Review

Question 1

Due to the location of the palate, there are important histological differences and anatomic landmarks to be aware of during flap procedures:

Answer 1

Palatal flap

Question 2

What histological differences that you must be aware of when performing a palatal flap:

Answer 2

1. keratinized tissue - bound down and not movable so cannot be apically positioned
2. Thickness of CT varies (thickest at premolar area)

Question 3

What anatomic landmarks should be considered when performing a palatal flap?

Answer 3

1. palatine foramen and associated blood vessels
2. rugae
3. incisive papilla with vessels
4. greater palatine forame
5. palatal form varies (high vault, low vault)

Question 4

When performing a palatal flap procedure the amount of soft tissue that is removed is determined by:

Answer 4

the inital probing depth- usually the first incision made at the level of 2/3 the probing depth

Question 5

T/F: The first incision when performing a palatal flap is determined by the initial probing depth. This incision is made at the level of 1/2 the probing depth

Answer 5

S1- T
S2- F (2/3)

Question 6

Palatal flap technique is a ____ incision technique

Answer 6

4

Question 7

For a palatal flap the primary incision =

Answer 7

Trace incison

Question 8

For a palatal flap, the primary (trace) incision may be:

Answer 8

scalloped or straight

Question 9

For a palatal flap, the secondary incison =

Answer 9

Undermining or thinning of tissue with incision direction toward long access of tooth

Question 10

For a palatal flap, the tertiaary incision =

Answer 10

Scalpel makes contact with bone

Question 11

For a palatal flap, the fourth incision =

Answer 11

Intrasulcular incision that releases tissue from neck of tooth

Question 12

What is the function of the fourth incision in a palatal flap (the intrasulcular incision that releases tissue from neck of tooth):

Answer 12

Functions =

1. tissue removal
2. granulatin tissue removal
3. defect and root debridement

Question 13

List the complications of a palatal flap: (5)

Answer 13

1. position of rugae or incisive papilla
2. vertical palatal incision contour
3. “long” or “short” flap (flap necrosis results from a “short” flap)
4. hemorrhage
5. recurrent herpetic outbreak

Question 14

Due to compromised blood supply due to the other-thinning of the flap:

Answer 14

Flap necrosis

Question 15

-Describe the source of healing for a flap:

-Which one is most prominent?

Answer 15

-PDL (biggest source)
-Flap margin
-Underlying bone

Question 16

Factors predisposing the retromolar and tuberosity areas to periodontal breakdown: (3)

Answer 16

1. bulk of soft tissue mass
2. inaccessibility to oral hygiene
3. contours favoring plaque retention

Question 17

Factors affecting the retromolar area (mandibular):

Answer 17

1. external oblique ridge
2. lingual bony ridge
3. proximity of the ascending ramus to the terminal tooth
4. presence of impacted or partially impacted third molars

Question 18

Factors affecting the tuberosity area (maxillary):

Answer 18

1. presence of exostosis on the palatal aspect (40%)
2. similar exostosis on the buccal aspect
3. presence of impacted or partially impacted third molars

Question 19

Subtractive/taking away:

Answer 19

Resection

Question 20

What are the advantages of resection?

Answer 20

Easier & quicker

Question 21

What are the disadvantages of resection?

Answer 21

1. cannot gain access to osseous defects
2. incision often ends in mucosa
3. extremely broad wound
4. exostoses are often exposed

Question 22

Advantages and indications of a distal wedge include:

Answer 22

1. management of pockets
2. keratinized tissue access to osseous defects
3. access for exostosis removal
4. less post-op discomfort due to primary closure

Question 23

Disadvantages of distal wedge include:

Answer 23

harder and more time consuming

Question 24

Contraindications for distal wedge:

Answer 24

1. flat plane
2. limited distal space
3. no osseous defect exists

Question 25

Types of distal wedges include:

Answer 25

1. triangular
2. square
3. linear
4. trap door

Question 26

List the steps in a triangular distal wedge:

Answer 26

1. bone sounding
2. primary incisions
3. secondary incisions
4. wedge removal
5. osseous access (if required)
6. closure/suture

Question 27

List the steps in square distal wedge:

Answer 27

1. primary incisons
2. secondary incisons
3. wedge removal
4. closure

Question 28

List the steps in a trap door distal wedge:

Answer 28

1. primary incisions
2. secondary incsions
3. wedge removal
4. closure

Question 29

What is another name for trap door distal wedge:

Answer 29

Oshsenbein & Ross

Question 30

When no distal wedge is required, proceed with:

Answer 30

SRP