Periodontal Flap Surgery: Basic Concepts

Question 1

What is the purpose of a periodontal flap?

Answer 1

to provide visibility

Question 2

What are the contexts for using a periodontal flap?

Answer 2

• Resection (removal of hard or soft tissue)
• Conservative (For access only)
• Regeneration (New periodontal support)

Question 3

T or F Flaps preserve keratinized gingiva

Answer 3

True

Question 4

Describe Partial thickness vs Full thickness flap design…

Answer 4

Full thickness removes all the way to the bone (removes periosteum)

Partial thickness leaves periosteum intact

Question 5

What are the pros and cons to full thickness flaps?

Answer 5

Cons
- exposes bone to environment (Causes reposition)

Pros
- Easier to do and can be done with a blunt instrument

Question 6

What are the pros and cons to partial thickness flaps?

Answer 6

Pros
- Periosteum stays on bone and protects it from the oral environment and bone doesn’t resorb.

Cons
- Easier to screw up, requires a sharp instrument.

Question 7

What are the steps to a full thickness flap surgery?

Answer 7

1. Anesthetics
2. Incisions
3. Flap elevation
4. Debridement
5. Osseous surgery or regeneration
6. Flap placement
7. Suturing
8. Periodontal dressing (optional)
   * All Incas fall down old flat stairs periodically (your welcome for the mnemonic)

Question 8

What are the pretreatment considerations for flap surgery?

Answer 8

• Pocket depth
• Amount of Keratinized gingiva (want to preserve this unless there is way too much)
• intended position of flap

Question 9

What kind of incision should you make when preparing a flap?

Answer 9

a scalloped, submarginal incision starting at the distal and working to the mesial

Question 10

What is the appropriate blade orientation for the BP15 scalpel?

Answer 10

Blade should be aimed towards alveolar crest. (Tip of scalpel should touch alveolar crest)

Question 11

What is an undermining incision?

Answer 11

A secondary incision made to reduce the thickness of the sulcular gingiva and papilla. Also goes down to alveolar crest.

Question 12

Flap elevation should progress in a ____ and _____ direction.

Answer 12

Distal and apical direction

Question 13

How do you elevate the periosteum?

Answer 13

Place the elevator between bone and flap and apply gentle to moderate force working from mesial to distal and apically.

Question 14

What are some problem that you can run in to during flap elevation?

Answer 14

• Elevation is very difficult if the primary incision does not extend to bone.
• Excessive force or improper direction of elevation can result in tearing of the flap.
• Exostoses require special attention to direction of elevation.

Question 15

______ Facilitates an increase in the width of keratinized gingiva.

Answer 15

Partial thickness flap technique (The dissection plane is within the gingival CT)

Question 16

_____ is one of the most common reasons to use a split thickness flap.

Answer 16

Soft tissue graft (Uses partial thickness flap as a “bed” design)

Question 17

What is the purpose of a vertical Incision?

Answer 17

To provide access without flap extension to adjacent areas (helps with flap positioning)

Question 18

Where must vertical incisions be made?

Answer 18

Must be made inter proximally near line angles (never over root surface)
Should also diverge apically for vascular integrity.

Question 19

Describe the 3 flap positions…

Answer 19

1. Coronally positioned = for regeneration or root coverage.
2. Replaced = for conservative flaps (minimal recession)
3. Apically positioned = For pocket elimination or crown lengthening.