Periodontal Flap Surgery: Basic Concepts Flashcards
What are flaps useful for?
Gateway to bone and tooth
Important in treating periodontal defects and most crown lengthening procedures
Periodontal flap definition
A section of gingiva and/or mucosa is surgically separated from the underlying tissue (typically bone) to provide visibility and access for treatment
What is the difference in incisions between a flap and a gingivectomy?
Flap = internal incision Gingivectomy = external incision
What is required with an incision for a Full thickness flap?
The incision must reach the bony crest
How is a full thickness flap elevated?
With blunt dissection between the periosteum and bone
What is included in a full thickness flap?
Epithelium
Lamina propria of the CT
Periosteum
What is exposed with a full thickness flap?
Alveolar bone - which can lead to resoprtion
How does a full thickness flap compare to a partial thickness flap?
Easier
Harsher to the bone - more resorption could occur
Should be avoided in areas of dehiscence with CT attachment only
Partial thickness flap dissection plane
Sharply dissects through the CT
Therefore the dissection plane is within the CT
A portion of the CT and periosteum remains connected to the bone
What are the surgical steps for full thickness flaps?
1) Anethesia
2) Incision
3) Elevation
4) Debridement
5) Treatment of bony defects
6) Closure
7) Dressing (optional)
What determines the amount of scallop in our incision?
Amount of keratinized gingiva
Need for access to bone
PD
Intended position of the flap
What are the most common scalpel blades used in perio flap surgery?
BP15
BP15S
What direction do we make our incisions?
Distal to Mesial
What do we use to elevate flaps
Periosteal elevator
If a flap is going to be apically positioned, how do we elevate it?
Elevate it past the mucogingival junction - the elastic nature of the mucosa allows the flap to relax into the vestibule
What can cause potential issues with flap elevation
Exostoses
Incision doesn’t reach the alveolar bone
Thin bone of dehiscence
Potential damage to blood vessels and nerves
How can exostoses effect flap elevation?
Requires a direction of elevation that is almost horizontal
Flap is easy to tear
What can help flap elevation if we have a thin bone of dehiscence?
Vertical incisions
Once the flap is elevated, what does debridement involve?
Removal of fibrous CT
Removal of granulomatous tissue at the base of the pocket and in bony defects
Root planing
What instrument(s) are used to remove tissue facially and lingually?
Hoes
Curettes
What instrument(s) are used to remove tissue interproximally?
Scaler
What instrument(s) are used for final debridement?
Gracey Curette
Ultrasonics
Treatment of bony defects
Done after debridement
Can be treated by resection and regeneration
What is the outcome of partial thickness flaps?
Facilitates an increase in the width of the keratinized gingiva
What are vertical incisions helpful for?
Provide access without flap extension into adjacent areas
Help with flap positioning
Where should vertical incisions be placed?
Interproximally near line angles
NEVER over a root prominence
What happens if a vertical incision is placed over a root prominence?
It can be difficult to close the flaps
What are the different types of flap positions?
Replaced
Apically
Coronally
Laterally
Replaced flap position
Back to original position
For conservative flaps (minimal recession)
What are apically positioned flaps used for?
Pocket elimination or crown lengthening
What are coronally positioned flaps used for?
Regeneration or root coverage
What are common suture types used to secure flaps
Interrupted
Sling sutures
