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Perio II > Periodontal flaps > Flashcards

Periodontal flaps Flashcards

1
Q

which are the types of tissue attachment healing

A
  • regeneration
  • new attachment
  • reattachment
  • repair
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2
Q

what is regeneration

A

reproduction or reconstitution of a lost or injured part
- new alveolar bone, cementum and PDL are formed restoring new architecture and function of the attachment aparatus

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3
Q

what is an example of regeneration

A

bone replacement grafting

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4
Q

what is new attachment healing

A

the union of connective tissue with a root surface that has been deprived of its original attachment apparatus
- reunion of CT with a root surface which has been pathologically exposed

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5
Q

what is an example of healing through new attachment

A

a CT graft to cover an area of root recession

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6
Q

what is reattachment

A

the reunion of CT with a root surface on which viable periodontal ligament tissue is presentw

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7
Q

what is an example of reattachment healing

A

the reunion of CT with a root surface on which viable periodontal ligament tissue is present

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8
Q

what is an example of healing through reattachment

A

where biologic width (now termed supracrestal tissue attachment) existed before a flap was reflected and when the flap is replaced, reattachment occurs with the intact CT fibers

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9
Q

describe repair

A

the healing of a wound that does not fully restore the architecture or function of the part

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10
Q

what is an example of repair

A

healing of a long JE

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11
Q

what is the purpose of long JE

A

this is the body’s protective healing to prevent ankylosis and root resorption

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12
Q

what is the most commonly used flap

A

full thickness

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12
Q

what is a full thickness flap

A

all soft tissue including the periosteum is reflected exposing the underlying bone

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13
Q

what is another name for the full thickness flap

A

mucoperiosteal flap

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14
Q

what is a partial (split) thickness flap

A

epithelium and some CT is reflected leaving periosteum and some CT tissue overlying the bone

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15
Q

what are the principles of tissue attachment

A
  • preparation of soft tissue wall
  • preparation of root surfaces
  • debridement of bony defects
  • adaptation of soft tissue to root surface
  • control of etiology pre and post surgery
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16
Q

when is preparation of soft tissue done

A
  • not as a separate procedure
  • done in conjunction with scaling
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17
Q

what are the root changes that hinder tissue attachment

A
  • foreign body nature of exposed diseased root surfaces ( presence of endotoxin)
  • endotoxin adsorbed on and into cementum
  • pathologic changes in root surface- hypo and hypercalcification areas
  • decreased organic material in exposed cementum (loss of fibers and alterations in the organic material related to endotoxin)
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18
Q

what is the therapeutic endpoint indicating success

A

a functional, comfortable, healthy dentition with stable probing attachment levels

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19
Q

how do you decide what procedure to use

A
  • diagnosis
  • know your end point- regneration, pocket elimination, pocket reduction
  • know indications and contraindications
  • maintenance
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20
Q

what is curettage

A

removal of the connective and epithelial attachment circumferentially with a curette

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21
Q

what is ENAP

A

removal of the connective and epithelial attachment circumferentially with a scalpel

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22
Q

define gingivectomy

A

the excision of the soft tissue wall of the periodontal pocket. the incision forms an external bevel or surface that is exposed to the oral cavity

23
Q

define gingivoplasty

A

gingival deformities are reshaped and reduced to create a normal and functional form. the incision creates an external bevel

24
Q

what are the indications for a gingivectomy

A
  • elimination of suprabony pockets which cant be adequately debrided without tissue removal
  • elimination of suprabony pockets if the pocket wall is fibrous and firm and therefore will not shrink after non surgical therapy
  • access for restorative with suprabony pockets
  • elimination of gingival enlargements
  • elimination of asymmetrical or unesthetic gingival topography
  • exposure of unerupted teeth when adequate keratinized tissue is present
25
Q

the 3 indications for gingivectomy with suprabony considerations are usually corrected by:

A

flap surgery for access

26
Q

what is the most common indication for gingivectomy

A

elimination of gingival enlargements

27
Q

what are the contraindications for gingivectomy

A
  • access is needed to infrabony defects
  • base of pocket is apical to MG junction, or when keratinized tissue is inadequate so that a gingivectomy would remove all the keratinized tisue
  • severely inflamed tissue (needs scaling and root planing)
  • esthetics (anterior maxilla)
  • anatomical preclusion (lack of keratinized tissue)
28
Q

what are the advantages of gingivectomy

A

relatively simple and fast

29
Q

what are the disadvantages of gingivecomy

A
  • limited applicability ( suprabony defects)
  • longer healing period (4-5 weeks)
  • more post operative discomfort
  • less effective than flap surgery ( no access to osseous defects)
30
Q

describe the gingivectomy technique

A
  • marking of the pocket depth
  • resection of the gingiva with incision starting apical to the pocket base and externally beveled at a 45 degree angle
  • bone exposure is to be avoided
  • complete removal of pocket if possible
  • thick tissue will require a more apical start of the incision
  • can do via internal bevel incision but it is more difficult to accomplish
31
Q

what are the 3 major steps to gingivectomy

A
  • removal of tissue
  • debridement of any granulation tissue and root debridement
  • post surgical control of bleeding
32
Q

how can hemostasis be achieved after surgery

A

pressure or external clotting aid

33
Q

______ may be needed for tissue protection during post- op function

A

periodontal pack

34
Q

what is open flap debridement

A

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

35
Q

what are the modifications to open flap debridement

A
  • modified widman
  • curtain procedure (maxillary anteriors)
36
Q

what are the open flap objectives

A
  • access to root surface and osseous defects
  • preserve osseous support
  • reduction or elimination of periodontal pockets
  • minimize post surgical pain, root sensitivity, and esthetic compromise
  • improved access for better patient home care
37
Q

what are the open flap indications

A
  • advanced disease where access is needed to root surfaces and osseous defects
  • where regeneration may be possible
  • to preserve tissue for esthetics
  • as an exploratory procedure or as part of the non surgical phase of treatment for fibrous tissue
  • less post operative discomfort
38
Q

what are the open flap contraindications

A
  • 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
39
Q

what is the open flap technique

A
  • intrasulcular incisions (step-back incisions not indicated since they are ineffective)
  • papillas are thinned to a uniform thickness
  • mucoperiosteal flap is reflected
  • vertical incisions can be used
  • palatal incision are placed dependent on the extent of the defects and amount of pocket reduction planned
40
Q

what are the 3 main steps in open flap technique

A
  • root surface and osseous defect debridement
  • flap closure with apically positioning
  • suturing
41
Q

what are the modifications for the open flap technique

A
  • minimal osteoplasty to improve flap adaptation
  • positioning of flaps in relation to the osseous crest for either pocket reduction or elimination
42
Q

what is flap necrosis due to

A

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

43
Q

what is the source of healing in flap necrosis

A

PDL, flap margin, and underlying bone

44
Q

what is the modified widman flap

A

a modification of subgingival curettage with flap retention

45
Q

what are the objectives of the modified widman flap

A
  • minimal tissue recession by not reflecting past the alveolar crest
  • conservation of alveolar bone- no osteoplasty or ostectomy
  • new attachment- long JE is the result
46
Q

what are the indications for the modified widman

A
  • moderate disease
  • infrabony defects
  • patient with high caries rate or root sensitivity
    -anterior esthetic areas
47
Q

what are the contraindications for modified widman

A

severe disease and greater access needed

48
Q

what are the advantages and disadvantages to the modifed widman

A
  • advantages: access to root surfaces, esthetics, minimal recession, primary closure
  • disadvantages: flat or concave post operative tissue contours
49
Q

what is the modified widman technique?

A
  • first incision: started -0.5-1mm apical to the gingival margin and aimed at the alveolar crest. minimal removal of interproximal tissues for primary closure
  • full thickness flap elevated to alveolar crest
  • second incision: is intrasulcular
  • third incision: made following the alveolar crest
50
Q

what is the objective of the anterior curtain

A

to gain access to interproximal defects in the maxillary anterior region with minimal recession

51
Q

what is the technique for the anterior curtain

A
  • palatal flap
  • incisions only in the facial interproximal areas, with no direct facial incisions
  • debridement and then closure
52
Q

what are the indications and contraindications for the anterior curtain

A
  • indications: maxillary anterior region with interproximal or palatal osseous defects and no facial bone loss, esthetic concern
  • contraindications: facial bone loss
53
Q

goal of all surgery is to:

A

access to defects

54
Q

what should be considered when deciding which procedure is to be done

A
  • diagnosis
  • goal of therapy
  • limitations of each technique
  • personalized therapy
55
Q

success of all surgical procedures is dependent on:

A

the patient’s home care and maintenance

56
Q
A

Perio II (6 decks)

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