Wedges and Flaps

Question 1

Distal Wedge Anatomical Limitations

Answer 1

Lingual N (Mandible)
Greater Palatine Foramen (Maxilla)
Loose CT, raphe
Limited distal space (small mes-dist length on tuberosity)

Question 2

Distal Wedge Designs

Answer 2

Triangular
Square
Linear

Question 3

Triangular Distal Wedge

Answer 3

Least difficult, least invasive

Question 4

Square Distal Wedge

Answer 4

Provides best access

Question 5

Linear Distal Wedge

Answer 5

Most effective at preserving keratinized ginigiva

Question 6

Conservative Flap Designs

Answer 6

Minimize recession
Good for Maxillary Anteriors, esthetic zones
Types : Modified Widman
Flap curretage

Question 7

Modified Widman Flap

Answer 7

Scalloped, replaced mucoperiosteal flap
Use internal bevel
Primary Purpose: For access for SRP
Permits primary closure of flap

Question 8

Amount of scalloping for Widman Flap

Answer 8

MINIMAL - initial incision 0.5-1 mm scallop

Just getting enough opening for root planning

Question 9

Amount of elevation for Widman Flap

Answer 9

LITTLE- only 2-3 mm apical to alveolar creast

Question 10

Palatal Flap Considerations

Answer 10

Must frequently be thinned internally

Apical positioning is NOT possible- so need precise design

Question 11

Palatal Flap- Indications for greater amount of scalloping

Answer 11

Deeper Probing Depths
Flat architecture/gingival contours
If doing resective rather than regenerative of conservative
Depending on location of pockets- palatal or interprox
Less thinning - If have a lot of thinning–> less scalloping needed

Question 12

Designs for Thinned Palatal Flaps

Answer 12

Direct Inverse Bevel Method

Two-Step Thinning Method

Question 13

Incision to remove free marginal tissue in Widman Flap

Answer 13

Intrasulcular incision

Question 14

Incision to remove free interproximal tissue in Widman Flap

Answer 14

Interdental incision