For the treatment of periodontal pockets with minimal osseous defects, a procedure without or minimal osseous resection is done, whereas, in case of moderate osseous defects and crown lengthening procedures, osseous resection is done with the flap procedure. The techniques that are used to achieve reconstructive and regenerative objectives are the papilla preservation flap8 and the conventional flap, which involve only crevicular or pocket incisions. The design of the flap is dictated by the surgical judgment of the operator, and it may depend on the objectives of the procedure. Conventional flap. Contents available in the book . After this, the second or the sulcular incision is made from the bottom of the pocket till the crest of the alveolar bone. Sutures are placed to secure the flaps in their position. Apically displaced flap. This is especially important because, on the palatal aspect, osseous deformities such as heavy bone ledges and exostoses are commonly seen. The margins of the flap are then placed at the root bone junction. The three different categories of flap techniques used in periodontal flap surgery are as follows: (1) the modified Widman flap; (2) the undisplaced flap; and (3) the apically displaced flap. One technique includes semilunar incisions which are . 7. 1. It is better to graft an infrabony defect than not grafting. The coronally directed incision is designated as external bevel incision whereas the apically directed incisions are the internal bevel and sulcular incision. Conventional flaps include the modified Widman flap, the undisplaced flap, the apically displaced flap, and the flap for reconstructive procedures. Before we go into the details of the periodontal flap surgeries, let us discuss the incisions used in surgical periodontal therapy. Perio-flap pptx - . - Muhadharaty (1985) 26 modified this procedure to preserve anterior esthetics after flap surgery. 6. One incision is now placed perpendicular to these parallel incisions at their distal end. 2. Suturing is then performed to stabilize the flaps in their position. The apically displaced flap technique is selected for cases that present a minimal amount of keratinized, attached gingiva. 1972 Mar;43(3):141-4. Coronally displaced flap. Incisions can be divided into two types: the horizontal and vertical incisions, Basic incisions used in periodontal surgeries, This internal bevel incision is placed at a distance from the gingival margin, directed towards the alveolar crest. After these three incisions are made correctly, a triangular wedge of the tissue is obtained containing the inflamed connective. The basic clinical steps followed during this flap procedure are as follows. 3. Contents available in the book .. b. Split-thickness flap. 1. The blood clot provides a framework for the proliferation and migration of cells from surrounding tissues including gingiva, periodontal ligament (PDL), cementum, and alveolar bone 38. The horizontal or interdental incision is then made using a small knife (Orban 1 or 2), severing the supracrestal gingival fibers. Clinical crown lengthening in multiple teeth. Preservation of good blood supply to the flap is another important consideration. If detected, they are removed. PDF Periodontics . Flap Surgery Contents available in the book .. Sixth day: (10 am-6pm); "Perio-restorative surgery" 12 or no. May cause hypersensitivity. (Courtesy Dr. Silvia Oreamuno, San Jose, Costa Rica. A progressive brous enlargement of the gingiva is a facet of idiopathic brous hyperplasia of the gingiva (Carranza and Hogan,; Gorlinetal., ).Itisdescribedvariouslyas bromatosisgingivae,gingivostomatitis,hereditarygingival bromatosis, idiopathic bromatosis, familial elephantiasis, and di use broma . After this, partial elevation of the flap is done with the help of a small periosteal elevator. The internal bevel incisions are typically used in periodontal flap surgeries. The necessary degree of access to the underlying bone and root surfaces and the final position of the flap must be considered when designing the flap. Every effort is made to adapt the facial and lingual interproximal tissue adjacent to each other in such a way that no interproximal bone remains exposed at the time of suturing. The blade should be kept on the vertical height of the alveolus so that palatal artery is not injured. PDF F LAP TECHNIQUES FOR POCKET THERAPY - Aligarh Muslim University Fundamental principles in periodontal plastic surgery and mucosal augmentationa narrative review. This incision is not indicated unless the margin of the gingiva is quite thick. Which is the best method of brushing technique preferred for the patient with orthodontic appliance: ? It enhances the potential for effective periodontal maintenance and preservation of attachment levels. The undisplaced (unrepositioned) flap improves accessibility for instrumentation, but it also removes the pocket wall, thereby reducing or eliminating the pocket. At last periodontal dressing may be applied to cover the operated area. 2. Contents available in the book .. Repair Technique for Displaced Meniscal Flap Tears Indicated by MRI In addition, the interdental incision is performed after the flap is elevated to remove the interdental tissue. B. For the correction of bone morphology (osteoplasty, osseous resection). As described in History of surgical periodontal pocket therapy and osseous resective surgeries the palatal approach for . The incision is usually carried to a point apical to the alveolar crest, depending on the thickness of the tissue. Incisions used in papilla preservation flap using primary, secondary and tertiary incisions. Periodontal flaps can be classified on the basis of the following: For bone exposure after reflection, the flaps are classified as either full-thickness (mucoperiosteal) or partial-thickness (mucosal) flaps (Figure 57-1). The secondary incision is given from the depth of the periodontal pocket till the alveolar crest. After pushing the papillae buccally, both the flap and the papilla are reflected off the bone with a periosteal elevator. The incision is then carried out till the line angle of the tooth blending it into the gingival crevice. 2. After this, the second incision or the sulcular incision is made from the bottom of the pocket to the crest of the alveolar bone. The book is usually delivered within one week anywhere in India and within three weeks anywhere throughout the world. The full-thickness mucoperiosteal flap procedure is the same as that described for the buccal and lingual aspects. To perform this technique without creating a mucogingival problem, the clinician should determine that enough attached gingiva will remain after removal of the pocket wall. A. This incision is made from the crest of the gingival margin till the crest of alveolar bone. 4. Ahmad Syaify, Sp.Perio (K) Spesialis Konsultan Bedah Perio & Estetik. After the primary incision, tissue can now be retracted with the help of rat-tail pliers. The scalloping of the incision may not be accentuated as the flap has to be apically displaced and is not adapted interdentally. With the migration of these cells in the healing area, the process of re-establishment of the dentogingival unit progresses. Our main aim of doing so is to get complete access to the root surfaces of the teeth and bone defects around the teeth. Trochleoplasty with a flexible osteochondral flap; The role of the width of the forefoot in the development of Morton's neuroma; February. The first documented report of papilla preservation procedure was by. These, Historically, gingivectomy was the treatment of choice for these areas until 1966, when Robinson 32 addressed this problem and gave a separate surgical procedure for these areas which he termed, The triangular wedge technique is used in cases where the adequate zone of attached gingiva is present and in cases of short or small tuberosity. The esthetic and functional demands of maxillofacial reconstruction have driven the evolution of an array of options. Therefore, these flaps accomplish the double objective of eliminating the pocket and increasing the width of the attached gingiva. Alveolar crest reduction following full and partial thickness flaps. The crevicular incision is then placed from the bottom of the pocket till the alveolar crest. 2)Wenow employ aK#{252}ntscher-type nailslightly bent forward inits upper part, allowing easier removal when indicated. The modified Widman flap has been described for exposing the root surfaces for meticulous instrumentation and for the removal of the pocket lining.6 Again, it is not intended to eliminate or reduce pocket depth, except for the reduction that occurs during healing as a result of tissue shrinkage. The entire surgical procedure should be planned in every detail before the procedure is initiated. Hereditary Gingival Fibromatosis - A Case Report As already stated, depending on the thickness of the gingiva, any of the following approaches can be used. Contents available in the book .. A new technique for arthroscopic meniscectomy using a traction suture, , 2015-02, ()KCI . 3) The insertion of the guide-wire presents Step 3: Crevicular incision is made from the bottom of the . After administrating local anesthesia, profound anesthesia is achieved in the area to be operated. This incision is placed through the gingival sulcus. This should include the type of flap, the exact location and type of incisions, the management of the underlying bone, and the final closure of the flap and sutures. This flap procedure may be regarded as internal bevel gingivectomy because the first incision or the internal bevel incision given during this procedure is placed at the level of pocket depth (Figure 62.1), thus including all the soft tissue containing and supporting periodontal pocket. This is also known as. The internal bevel incision should be scalloped into the interdental area to preserve the interdental papilla (see Figure 59-2). The flap also allows the gingiva to be displaced to a different location in patients with mucogingival involvement. During this whole procedure, the placement of the primary incision is very important because if improperly given it may become short, leaving exposed bone or may become longer requiring further trimming which is difficult. 5. The first, second and third incisions are placed in the same way as in case of modified Widman flap and the wedge of the infected tissue is removed. The use of continuous suturing in suture materials tearing through the flap edges and both plastic surgery (1) and periodontal surgery subsequent retraction of the flaps to less desirable has many advantages. Semiconductor chip assemblies, methods of making same and components for sameSemiconductor chip assemblies, methods of making same and components for same .. .. . The incision is usually scalloped to maintain gingival morphology and to retain as much papilla as possible. Pockets around the teeth in which a complete removal of root irritants is not clinically possible without gaining complete access to the root surfaces. Apically Repositioned Flap/ Periodontal Flap Surgical Technique/ Dr 2. Hence, this suturing is mainly indicated in posterior areas where esthetics. Frenectomy-frenal relocation-vestibuloplasty. When the flap is returned and sutured in its original position. Also, complicated or prolonged surgical procedures that require full-thickness mucoperiosteal flaps with resultant edema can lead to trismus. The modified Widman flap is indicated in cases of perio-dontitis with pocket depths of 5-7 mm. This is especially important in maxillary and mandibular anterior areas which have a prime esthetic concern. It is most commonly caused due to infection and sloughing of blood vessels. Periodontal pockets in severe periodontal disease. This type of incision, starting just below the bleeding points, removes the pocket wall completely. The incisions made should be reverse bevel to achieve thinning of tissue so that an adequate final approximation of the flaps can be achieved. ), Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on 59: The Flap Technique for Pocket Therapy, Several techniques can be used for the treatment of periodontal pockets.