Periodontal Flap Procedures Part II

Question 1

Surgical debridement of the root surface and removal of granulation tissue from osseous defects following reflection of a mucoperiosteal flap:

Answer 1

open flap debridement

Question 2

List the modifications of an open flap debridement:

Answer 2

1. modified Widman
2. curtain procedure (maxillary anteriors)

Question 3

The curtain procedure (modified open flap debridement) is used for:

Answer 3

maxillary anteriors

Question 4

What is the most important aspect of open flap debridement?

Answer 4

Access!

Question 5

What treatment would be indicated for the following scenario?

• Advanced disease where access is needed to root surfaces and osseous defects
• situations in which REGENERATION may be possible
• to preserve tissue for esthetics
• as an exploratory procedures or as part of the non-surgical phase of treatment for fibrous tissue

Answer 5

Open-flap debridement

Question 6

Open flap debridement allows for less:

Answer 6

post-op discomfort

Question 7

Give an example of when we may use an open flap debridement as an exploratory procedure?

Answer 7

the we think we have a fractured root and we need to get in there to see

Question 8

The following are contraindications for:

• patient is unable to tolerate a surgical procedure
• increased tissue recession may result in esthetic compromise
• potential of root caries and root sensitivity due to greater root exposure post-surgically

Answer 8

Open flap contraindications

Question 9

What type of incision is indicated for open-flap technique?

What type of incision is NOT indicated due to being ineffective?

Answer 9

Intrasulcular incision; step back

Question 10

In open flap debridement technique, ____ are thinned to a uniform thickness

Answer 10

papillas

Question 11

What type of flap is reflected in open-flap technique?

Answer 11

mucoperiosteal

Question 12

What type of incisions can be used in an open-flap technique?

Answer 12

vertical incisions

Question 13

In an open-flap technique, _____ are placed dependent on the extent of defects and amount of pocket reduction planned

Answer 13

palatal incisions

Question 14

What determines if palatal incisions are placed during open flap debridement technique?

Answer 14

extent of defects & amount of pocket reduction planned

Question 15

Flap necrosis may result from:

Answer 15

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

Question 16

What is the source of healing for an open-flap?

Answer 16

1. PDL
2. flap margin
3. underlying bone

Question 17

What is the primary source of healing for open-flap?

Answer 17

PDL

Question 18

A modification of subgingival curettage with flap reflection:

Answer 18

modified Widman

Question 19

Where is the FIRST incision started in the modified Widman technique?

Answer 19

First incision is started 0.5-1.0 mm apical to the gingival margin and “aimed” at alveolar crest

Question 20

In the modified Widman technique, minimal removal of interproximal tissues occurs for:

Answer 20

“primary closure”

Question 21

Where is the SECOND incision in the modified Widman technique?

Answer 21

intrasulcular

Question 22

Where is the THIRD incision in the modified Widman technique?

Answer 22

made following the alveolar crest

Question 23

Objective of this modified open flap technique procedure is to gain access to interproximal defects in the maxillary anterior region with minimal recession:

Answer 23

anterior curtain

Question 24

The technique for the anterior curtain procedure includes:

1. ____ flap
2. incisions ONLY in the ____ areas with no direct facilities incisions
3. _____ and then closure

Answer 24

1. palatal flap
2. facial interproximal areas
3. debridement

Question 25

What procedure would be indicated for the given situation?

• maxillary anterior region with interproximal or palatal osseous defects and no facial bone loss with esthetic concern

Answer 25

anterior curtain

Question 26

What is the ONLY contraindication for anterior curtain procedure?

Answer 26

facial bone loss

Question 27

When trying to determine the best treatment for your patient, you should consider: (4)

Answer 27

1. diagnosis
2. goal of therapy
3. limitations of each technique
4. personalized therapy

Question 28

The goal of all periodontal flap procedures is to:

Answer 28

access defects

Question 29

Success of all periodontal surgical procedures is dependent upon:

Answer 29

patients home care and maintenance