Periodontal Flap

Question 1

Indications

Answer 1

Increase accessibility to the underlying structures for
debridement/degranulation of root deposit, alveolar bone & soft
tissue
 Eliminate or reduce moderate and deep PD pockets in
inaccessible areas
 Gain access to perform regenerative procedure (bone graft,
GTR), crown lengthening, root resection, implants, ridge
augmentation and MG procedures
 Elimination of gingival enlargement when gingivectomy is not
indicated or place gingival margins at desire position during
suturing

Question 2

Rationale for surgery

Answer 2

It may be difficult and even impossible to resolve periodontal
inflammation completely with nonsurgical therapy alone in
moderate to advanced cases, and in cases with furcation invasion
and infrabony defects
To enhances access for root instrumentation and allows for
reduction of periodontal pockets and correction of osseous defects

Question 3

Periodontal access surgery frequently results in

Answer 3

Periodontal access surgery frequently results in gingival recession
and loss of interdental papillae in the anterior maxilla

Question 4

If vertical incisions are not made and only horizontal
incision, the flap is called an

Answer 4

Envelope flap

Question 5

Perio surgery involves use of

Answer 5

Periodontal surgery involves the use of:
 Horizontal (mesial-distal) incision
 Vertical (occlusal-apical) incisions
Surgical blade is used most often to make these incisions

Question 6

Horizontal incision is from

Answer 6

margin of the gingiva in mesial or distal direction
 A. Internal bevel incision
 B. Crevicular incision
 C. Interdental incision

Question 7

External bevel or bevel incision; starts
at the

Answer 7

External bevel or bevel incision; starts
at the surface of the gingiva apical to
the periodontal pocket and is directed
coronally toward the tooth apical to the
bottom of the periodontal pocket.

Question 8

Use of external bevel

Answer 8

gingivectomy, can be made with a
scalpel or a knife

Question 9

Scalloped Incisions; follows the scalloped
morphology of the gingival architecture
Straight incision; follows a straight line
Uses; both

Answer 9

Uses; both gingivectomy and flap surgery
to eliminate the interdental tissue

Question 10

Why is scalloped advantageous

Answer 10

The scalloped incision is advantageous in
preserving the interdental architecture in gingivectomy and
creating surgical papillae and
preserving soft tissue over the interdental areas

Question 11

Internal or reverse bevel incision or inverse
bevel incision; Start from the

Answer 11

designated area on the surface of the gingiva & directed
apically to the bone crest. It is the incision
from which the flap is reflected to expose the
underlying bone and root

Question 12

Uses of internal bevel incision

Answer 12

Remove the pocket lining
Produce a sharp, thin flap margins
Conserves the relative uninvolved outer surface of
the gingiva - becomes AG if placed apically

Question 13

Crevicular, intercrevicular, intracrevicular, sulcular,
intrasulcular incision, intersulcular incision; starts

Answer 13

gingival crevice and is directed apically through the junctional
epithelium and connective tissue attachment and down to the
bone

Question 14

Crestal incision or marginal incision; . starts

Answer 14

at the surface of the gingiva at the gingival margin and is directed apically
down through the epithelium and connective tissue to the bone

Question 15

Crestal incision is used to

Answer 15

remove the granulation and
inflamed tissue on the lateral surface
and between the bottom of pocket & crest of the bone

Question 16

Why do you use
Interdental incision?

Answer 16

Remove the V shaped wedge that contains granulation area

Question 17

Vertical Incisions must extend beyond the

Answer 17

beyond the mucogingival junction to reach
the alveolar mucosa(release of the flap to be displaced
 Usually on Facial surface and avoided in the lingual & palatal

Question 18

Facial vertical incisions should not be made in

Answer 18

Facial vertical incisions should not be made in the center of an
interdental papilla or over the radicular surface of a tooth

 Incisions should be made at the line angles of a tooth either to
include the papilla in the flap or to avoid it completely.
 Avoid long (coronal-apical) and narrow (mesial-distal) flaps, and
(jeopardize the blood supply to the flap)

Question 19

FULL THICKNESS FLAP is

Answer 19

Soft tissue with mucoperiosteum is reflected leaving
denueded underlying bone surface by blunt dissection

Question 20

Uses of full thickness flap

Answer 20

Open flap curettage,
Osseous surgery,
Bone graft,
GTR and
Implants

Question 21

Advantages of full thickness flap

Answer 21

Primary wound closure
Improved visibility& exposure
Less bleeding & post operative pain

Question 22

PARTIAL THICKNESS FLAP is

Answer 22

Overlying gingival mucosa is sharply dissected off from the
underlying bone to leave a layer of lamina propria & periostium
still overlying the bone surface - normally limited to buccal
surface

Question 23

Uses of partial thickness

Answer 23

Uses;
 Free gingival or pedical graft
 Apical positioned flap.
 To prevent uncovering the bone in fenestration & dehiscence
 or prominent roots.

Question 24

CLASSIFICATION OF FLAP
According to the Flap Placement

Answer 24

According to the flap placement; To allow the gingiva to
displaced in different location
Displaced - apical – coronal – lateral – double papilla
(vertical releasing incision)
Non-displaced flap – Envelope (no releasing incision)
Papilla Preservation Flap; Based on management of the
papilla;

Question 25

Flap closure

Answer 25

The flap should remain in this position without tension
 It is convenient to keep the flap in place with light pressure via
the use of a piece of gauze to allow the blood clot to form
 The purpose of suturing is to maintain the flap in the desired
position until healing has progressed

Question 26

Non absorbable sutures

Answer 26

Non absorbable sutures; 3-0 ,4-0 or 5-0
Black braided silk,
Nylon (monofilament),
EPTfe (monofilament),
Polyester (ethibond)

Question 27

Absorbable; suture

Answer 27

Absorbable;
Surgical (gut) - 3-0 or 5-0 suture; Plain gut (30 days)
Chromic gut (45-60 days)
Synthetic; Polyglycolic- braided (16 -20 days),
Polyglecaprone–monofilament 90-120 days

Question 28

Plain gut takes

Answer 28

30 days

Question 29

Chronic gut takes

Answer 29

45-60 days

Question 30

Polyglycolic- braided takes

Answer 30

16-20 days

Question 31

Polyglecaprone–monofilament

Answer 31

90-120 days

Question 32

Suturing Technique

Answer 32

The needle is held with the needle holder, and it enter the tissues
at right angles and be no less than 2 to 3 mm from the incision
 The needle is then carried through the tissue to follows the needle’s
curvature
 The knot should not be placed over the incision
 Flap is closed either with independent sutures or with continuous
independent sling sutures (anchor for the flaps)

Question 33

KNOTS

Answer 33

To join 2 ends of the suture

Question 34

Overhand knot

Answer 34

Overhand knot – One knot only

Question 35

 Slip knot or granny knot-

Answer 35

 Slip knot or granny knot- Two over head knot each in same
direction

Question 36

 Square knot-

Answer 36

 Square knot- Two over head knot each in opposite
direction

Question 37

Surgeon’s knot-

Answer 37

Surgeon’s knot- Two overhead knot in one direction and one
in opposite direction

Question 38

Chronic Periodontal abscess

Answer 38

Periodontal Flap Surgery

Question 39

Soft gingival tissues with altered gingival color are usually
caused by

Answer 39

Edema and cellular infiltration

Question 40

Chronic inflammatory gingival enlargements with significant
fibrotic component that does not undergo shrinkage after scaling
and root planning

Answer 40

Surgical removal is the treatment of choice:
Two techniques exist for this purpose: gingivectomy and the flap
operation

Question 41

Papilla preservation flap incorporates

Answer 41

the entire papilla in
one of the flap by means of cervical interdental incision to
sever the connective tissue attachment and horizontal or
Semiluner incision at the base of papilla in palatal or lingual
aspect. Dissect the papilla from the lingual or palatal aspect
and elevated intact with the facial flap

Question 42

Flap Design depend upon the

Answer 42

objectives of the operation,
bone loss &
position of placement after surgery and
blood supply to the flap

Question 43

Two basic flap design are used depending on the interdental
papilla

Answer 43

Two basic flap design are used depending on the interdental
papilla
 Conventional flap; Split the papilla into facial half and
lingual half with incision reach the top of interdental
papilla. Coronally/Apically displaced flap, flap for
regenerative procedures
 Papillae preservation incision / flap