W2 - Flaps - Sharma

Question 1

What are the 3 ways perio flaps are classified

Answer 1

1. Bone Exposure after flap reflection
2. Placement of the flap after surgery
3. Management of the papilla

Question 2

Two types of bone exposure after flap reflection

Answer 2

A - Full thickness - “mucoperiosteal”

Bone exposure

B - Partial thickness - “mucosal”

No bone exposure

Question 3

2 Types of flap placement after surgery

Answer 3

1. Nondisplaced - flap returned and sutured in original position
2. Displaced / repositioned flaps

Question 4

For displaced flaps, where should the flap be repositioned? (3)

Answer 4

1. Apically displaced flap - for pocket therapy
2. Coronally displaced flap - for recession
3. Laterally displaced flap - for recession

Question 5

What are the 2 methods / flaps managing the papilla

Answer 5

Conventional flap - interdental papilla is split in the middle between the contact point of teeth

Papilla Preservation flap - incorporates the entire papilla onto one side of the flaps

Question 6

Answer 6

Conventional flap managing the papilla

• cuts along the middle between teeth

Question 7

Answer 7

Papilla preservation flap

Question 8

What is an Open Flap Debridement (OFD)

Answer 8

Debridement with improved visibility and accessibility for subgingival instrumentation of both hard and soft root surface deposits

Question 9

Answer 9

Open Flap Debridement

aka

Replaced flap

Access flap

Question 10

Open Flap Debridement Technique

Answer 10

1. Intra-sulcular incisions and full-thickness mucoperiosteal flaps (buccal + palatal)
2. Remove granulation tissue and debride root surface
3. Replace flap margins to original position and suture
4. Complete coverage of alveolar bone at end of tx

Question 11

When should papilla preservation be used

Answer 11

Anterior teeth

• However can be used anywhere

Question 12

Objective of modified widman flap

Answer 12

Excise marginal tissue cuff for direct post op pocket reduction

Question 13

Disadvantage of modified widman flap (MWF) (2)

Answer 13

Recession

Black triangles

Question 14

Technique of Modified Widman Flap (MWF)

Answer 14

1. Internal bevel 1 mm from gingival margin, parallel to long axis of tooth
2. Sulcular incision to bone crest → separates tissue collar from root surface
3. Removal of soft tissue collar
4. Removal of granulation tissue, mechanical instrumentation of root surface // debridement
5. Bone re-contouring (optional)
6. Replacement of the flap and suture

Question 15

Answer 15

Modified Widman Flap

Question 16

Objective of the Apically Repositioned Flap (2)

Answer 16

Reduce the pocket

Maintain adequate zone of attached gingiva

Question 17

Technique of Apically Repositioned Flap

Answer 17

1. Internal bevel
2. Sulcular incision
3. Remove tissue collar
4. Vertical release incisions extending to the mucogingival junction → displacing the whole soft tissue complex
5. Exposure of bone margins and possible reshaping
6. Reposition flaps at apical level and suture (MWF replaces at original level)

Question 18

Which is more common nowadays - MWF or Apical Repositioning Flap? Why?

Answer 18

Apical Repositioning Flap more common

MWF leads to black triangles

Question 19

Answer 19

Apically Repositioned Flap

*notice the vertical releasing incisions