Week 2- Perio surgery flaps

Question 1

What is a periodontal flap?

Answer 1

Section of gingiva, mucosa, or both that is surgically separated from underlying tissue to provide visibility and access to bone and root surface

Question 2

How can periodontal flaps be classified?

Answer 2

• Bone exposure after flap retraction (full/partial thickness)
• Placement of flap after surgery (displaced/non-displaced)
• Management of papilla (conventional, papilla preservation)

Question 3

What are full-thickness vs partial-thickness flaps?

Answer 3

Full thickness/mucoperiosteal: exposes bone and uses periosteal elevators for retraction

Partial thickness/mucosal: part of connective tissue is intact

Question 4

What are non-displaced vs displaced flaps?

Answer 4

Non-displaced: flap is returned and sutured in original position

Displaced: flap is returned apically, coronally or laterally to original position.

Question 5

What are the 3 types of displaced flaps used for?

Answer 5

• Apically displaced: pocket therapy
• Coronally displaced: recession
• Laterally displaced: recession

Question 6

What is a conventional flap?

Answer 6

Interdental papilla is split beneath contact point of 2 approximating teeth

Question 7

What is a papilla preservation flap?

Answer 7

Incorporated entire papilla in one of the flaps

Question 8

What is an open flap debridement used for?

Answer 8

• To improve visibility and accessibility for subgingival instrumentation of both soft and hard root surface deposits.
• Can be combined with other procedures e.g. bone grafting

Question 9

What is the open flap debridemnt technique?

Answer 9

• Intra-sulcular incisions and full-thickness mucoperiosteal flaps
• Removal of granulation tissue and root surface debridement
• Replacement of flap margins to original position and place sutures
• Complete coverage of alveolar bone at end of surgery

Question 10

What is modified Widman flap?

Answer 10

Aims to excise inflamed marginal tissue cuff to facilitate direct post-op pocket depth reduction.

Question 11

What are the disadvantages of modified Widman flap?

Answer 11

Recession and black triangles due to loss of soft tissue

Question 12

What is the modified Widman technique?

Answer 12

1. Internal bevel and sulcular incision to remove collar tissue
2. Removal of granulation tissue, mechanical instrumentation of root surface.
3. Optional bone recontouring
4. Replacement of flap and suture

Question 13

What is the objective of apically repositioned flap?

Answer 13

Reduce pocket, maintaining adequate zone of attached gingiva by displacing flap with soft tissue (gingival and mucosa) in apical direction.

Question 14

What are the steps involved in apically repositioned flap?

Answer 14

1. Internal bevel and sulcular incision to remove collar tissue
2. Vertical release incisions extending to MGJ
3. Exposure of bone margins and possible bone reshaping
4. Repositioning of flaps at apical level and secure its position with suturing

Question 15

What are optional techniques for open flap debridement?

Answer 15

• Papilla preservation for anterior teeth
• Vertical relieving incisions can improve access but can reduce blood supply and stability of the flap