Periodontal Flap Surgery: Variaitons

Question 1

Palatal Flap Definision

Answer 1

A thinned palatal flap is the method for achieving optimal surgical tissue contours and flap adaptations through internal incisions that are extending apical to the crest of bone on the palate

Question 2

How do probe depths effect the scalloping of incisions for palatal flaps?

Answer 2

More depth = more scalloping

Question 3

How do gingival contours effect the scalloping of incisions for palatal flaps?

Answer 3

If architecture is flat, more scalloping is needed?

Question 4

What are palatal flaps used for?

Answer 4

Pocket elimination, regenerative or conservative

Question 5

What determines the amount of internal thinning with palatal slaps?

Answer 5

Thickness of soft tissue

Thickness of osseous tissue

Question 6

Distal wedge Definition

Answer 6

Periodontal surgical procedure for removal of excessive soft tissue distal to a terminal tooth

Question 7

What is the purpose of a distal wedge?

Answer 7

It is designed to treat pockets through internal thinning, while gaining access to bone of the distal aspect of terminal teeth

Question 8

What are the advantages of a distal wedge?

Answer 8

Close wound permits healing by primary intention
Permits access to bone and furcations
May preserve the zone of keratinized tissue

Question 9

What are the indications of a distal wedge?

Answer 9

Deep pocket distal to terminal tooth with need to:

• gain access to bone
• gain access to a furcation
• have a wound closure

Deep bony pocket in an area with thin or absent keratinized gingiva

Question 10

What are the different types of distal wedges?

Answer 10

Square
Triangular
Linear

Question 11

What are the advantages of a square distal wedge?

Answer 11

Provides the best access

Question 12

What are the advantages to a triangular distal wedge?

Answer 12

Easier to accomplish

Less invasive

Question 13

What are the advantages to a linear distal wedge?

Answer 13

Preserves the tissue the best

Question 14

What is the technique/steps for using a distal wedge?

Answer 14

1) Initial incision
2) Undermining of wedge
3) Removal of wedge
4) Root planing
5) Osseous Surgery
6) Closure (suturing)

Question 15

What are the objectives for a Conservative Flap Approach

Answer 15

Access to debride roots
Primary Closure
Pocket reduction through the resolution of inflammation and long junctional epithelium
Minimal gingival recession

Question 16

What are the indications for a Conservative Flap Approach?

Answer 16

Treatment of periodontal pockets where recession must be minimized (esthetic zones/max anterior)
Areas not amenable to a more definitive approach

Question 17

What are the contraindications for a Conservative Flap Approach?

Answer 17

If a more definitive procedure is feasible

Question 18

What is an example of a Conservative Flap?

Answer 18

Modified Wideman Flap

Question 19

Modified Wideman Flap

Answer 19

A scalloped, replaced, mucoperosteal (full thickness) flap
Accomplished with an internal bevel incision
Provides access for root planing

Question 20

What is the technique/step for a Modified Wideman Flap?

Answer 20

Initial incision is located 0.5-1.0mm from FGM or intrasulcular
Flap is elevated approx. 2-3 mm from the alveolar crest
Intrasulcular incision free margin tissue is to be removed
Interdental incisions free interproximal tissue to be removed
Soft tissue removal
Root planning
Flap adaptation
Primary closure via sutures