The Periodontal Flap Flashcards
Define slap and its classifications
The periodontal flap
A periodontal flap is a section of gingiva & / mucosa surgically separated from the underlying tissue to provide visibility of & access to the bone & root surface.
Classification of flaps
- Bone exposure after flap reflection
- placement of the flap after surgery.
- Management of the papilla.
Talk about bone exposure after flap reflection, types, indications
The flaps are classified as; Full- thickness (mucoperiosteal flap) all the soft tissues including the periostium is elevated . This complete exposure of & access to the underlying bone
Indication of full thickness flap : when resective osseous surgery is contemplated.
the partial –thickness flap (mucosal )(split -2 :–thickness) flaps includes only the epithelium &a layer of underlying connective tissue .The bone remains covered by a layer of connective . tissue, including the periostium
Indication of partially thickness flap :when the flap is to be positioned apically or presence of dehiscence& fenestrations or when the operator does not wont to .expose bone
Talk about placement of the flap after surgery
- non displaced flap: the flap is returned & sutured . in it is original position.
- displaced flap ,which are placed apically ,coronally or laterally to their original position
• Both full thickness & partial thickness flaps can be displaced ,but palatal flaps cannot be displaced because of the absence of unattached gingiv.
Based on management of the papilla how many types we have and their indication
- conventional flaps : the interdental papilla is split beneath the contact point of two approximating teeth to allow reflection of .buccal & lingual flaps
The incision is usually scalloped to maintain gingival morphology and retain as much as much papilla as possible
Indication of conventional flap
1- when interdental spaces are too narrow.
2- when the flap is to be displaced.
Conventional flaps include the modified Widman flap (MWF) ,the undisplaced flap , the apically displaced flap,& the flap for reconstructive procedures.
- papilla preservation flaps : Entire papilla is incorporated in to one of the flaps.
Indications of papilla preservation flap A- where esthetic is of concern B- when bone regeneration technique are attempted
Talk a boat horizontal incision and its types
Horizontal incisions:
Directed along the margin of the gingiva in a mesial or distal direction .
Talk about internal bevel incision and its objectives
1-internal bevel incision(first incision)(reverse bevel incision) :
It starts at a distance from the gingival margin & is aimed at the bone crest
It is basic to most periodontal flap procedures.
It is the incision from which the flap is reflected to expose the underlying bone & root.
• The #11 or #15 surgical scalpel is used most often to make this incision.
Talk about cerivicalar incision
2-Crevicular incision (second incision) Is made from the base of the pocket to the crest of bone,& it carried .around the entire tooth - The beak-shaped # 12 D blade is used. Crevicular incision ,together with the internal bevel incision ,forms a V- shaped wedge ending at or near the crest of bone ; this wedge of tissue contains inflamed & granulomatous areas that constitute the lateral wall of the pocket, as well as junctional epithelium and the connective tissue fibers that still persist between the bottom of the pocket & crest of the bone.
A periosteal elevator is inserted into the initial Internal bevel incision ,and the flap is separated from the bone .With this access ,the surgeon is able to make , the third or interdental incision (performed after the flap is reflected) to separate the collar of the gingiva that is left around the tooth by Orban knife .A curette or large scaler can be used to remove the gingiva . around the tooth
Talk about vertical incision and its indications
Vertical incision Vertical or oblique releasing incision can be done on one or both ends of the horizontal incision , depending on the design & purpose of the flap .
- Vertical incisions at both ends of flap are necessary If the flap is to be apically displaced.
- Vertical incisions must extend beyond the mucogingival line ,to allow for the release of the flap to be displaced .
- Vertical incision are avoided In lingual or palatal areas.
- facial vertical incisions should not be made in The center of interdental papilla or over the radicular surface of the tooth.
- Incisions should be made at the line angles of a tooth either to include the papilla In the flap or to avoided it completely.
Talk about elevation of flap
Elevation of the flap When a full thickness of the flap is desired ,reflection of the flap is accomplished by blunt dissection (periosteal elevator )
When a partial thickness of the flap is desired ,reflection of the flap is accomplished by sharp dissection surgical scalpel (# 15)is used. A combination of full -thickness and partial- thickness flaps may be indicated to obtain the advantages of both. The flap is started as a full-thickness procedure ,then a partial-thickness flap is made at the apical portion .In this way the coronal portion of the bone ,which may be object to osseous remodeling ,is exposed while the remaining bone is protected by the periostium.
Talk about suturing techniques
Suturing technique
- The purpose of suturing is to maintain the flap in the desired position until healing has progressed .
- There are many types of sutures ,suture needles, & materials.
- Suture materials may be either non resorbable or resorbable.
The needle is held with needle holder & should enter the tissue at right angles & no less than 2-3mm from the incision.
Talk about ligation and its types
Ligation
1- Interdental ligation: two types
A /direct loop used when close apposition of the scalloped incision is required , when bone graft are used
B/figure- eight used when the flap are not in close apposition .
2- Sling ligation Used when the flap on one surface of a tooth that involves two interdental space
What’s advantage of Apically displaced flaps?
• Apically displaced flaps have advantage of preserving the outer portion of the pocket wall and transforming it into attached gingiva .Therefore these flaps accomplish the double objective of eliminating the pocket and increasing the width of the attached gingiva.
Internal bevel incision accomplish three important objectives:
Internal bevel incision accomplish three important objectives:
- remove pocket lining
- conseves relatively uninvolved outer surface of the gingiva
- it produces a sharp ,thin flap .margin for adaptation to tooth
