Flap design for a conventional or traditional flap technique. Otherwise, the periodontal dressing may be placed. Access flap for guided tissue regeneration. See video of the surgery at: Modified flap operation. Palatal flaps cannot be displaced because of the absence of unattached gingiva. 7. Scaling, root planing and osseous recontouring (if required) are carried out. The modified Widman flap procedure involves placement of three incisions: the initial internal bevel/ reverse bevel incision (first incision), the sulcular/crevicular incision (second incision) and the horizontal/interdental incision (third incision). Pocket depth was initially similar for all methods, but it was maintained at shallower levels with the Widman flap; the attachment level remained higher with the Widman flap. For the undisplaced flap, the internal bevel incision is initiated at or near a point just coronal to where the bottom of the pocket is projected on the outer surface of the gingiva (see Figure 59-1). After the removal of the secondary flap, scaling and root planing is done and the flap is adapted to its position. a. 4. Fractures of the frontal sinus are a common maxillofacial trauma and constitute 5-15% of all maxillofacial fractures. Areas where greater probing depth reduction is required. 19. Step 3:A crevicular incision is made from the bottom of the pocket to the bone in such a way that it circumscribes the triangular wedge of tissue that contains the pocket lining. The periosteum left on the bone may also be used for suturing the flap when it is displaced apically. This incision is made from the crest of the gingival margin till the crest of alveolar bone. Within the first few days, monocytes and macrophages start populating the area 37. Bone architecture is not corrected unless it prevents good tissue adaptation to the necks of the teeth. Later on Cortellini et al. 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 distal wedge operation. Contents available in the book .. Both full-thickness and partial-thickness flaps can also be displaced. Two types of horizontal incisions have been recommended: the internal bevel incision,6 which starts at a distance from the gingival margin and which is aimed at the bone crest, and the crevicular incision, which starts at the bottom of the pocket and which is directed to the bone margin. 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. Periodontal flap surgery with conventional incision commonly results in gingival recession and loss of interdental papillae after treatment. As discussed in, Periodontal treatment of medically compromised patients, antibiotic prophylaxis is must in patients with medical conditions such as rheumatic heart disease. The primary goal of this flap procedure is not necessarily pocket elimination, but healing (by regeneration or by the formation of a long junctional epithelium) of the periodontal pocket with minimum tissue loss. 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 apically displaced flap technique is selected for cases that present a minimal amount of keratinized, attached gingiva. After these three incisions are made correctly, a triangular wedge of the tissue is obtained containing the inflamed connective. ious techniques such as gingivectomy, undisplaced flap with/without bone surgery, apical resected flap with/without bone resection, and forced eruption with/without fiberotomy have been proposed for crown lengthening procedures.2-4 Selecting the technique depends on various factors like esthetics, crown-to-root ratio, root morphology, furcation Inferior alveolar nerve block C. PSA 14- A patient comes with . 5. Undisplaced flap Palatal Flap The surgical approach is different here because of the nature of the palatal tissue which is attached, keratinized tissue and has no elastic properties associated with other gingival tissues, hence no displacement and no partial thickness flaps. Contents available in the book . Practically, it is very difficult to put this incision because firstly, it is very difficult to keep the cutting edge of the blade at the gingival margin and secondly, the blade easily slips down into the pocket because of its close proximity to the tooth surface. In a full-thickness flap, all of the soft tissue, including the periosteum, is reflected to expose the underlying bone. Contents available in the book . Contents available in the book .. The most apical end of the internal bevel incision is exposed and visible. Furthermore, the access to the bone defects facilitates the execution of various regenerative procedures. This preview shows page 166 - 168 out of 197 pages.. View full document. 6. The flap also allows the gingiva to be displaced to a different location in patients with mucogingival involvement. Contents available in the book .. The internal bevel incision starts from a designated area on the gingiva, and it is then directed to an area at or near the crest of the bone (. This is a commonly used incision during periodontal flap surgeries. Contents available in the book .. A periosteal elevator is inserted into the initial internal bevel incision, and the flap is separated from the bone. As already stated, depending on the thickness of the gingiva, any of the following approaches can be used. See Page 1 If extensive osseous recontouring is planned, an exaggerated incision is given. Most commonly done suturing is the interrupted suturing. This is especially important because, on the palatal aspect, osseous deformities such as heavy bone ledges and exostoses are commonly seen. Contents available in the book .. UNDISPLACEDFLAP |Also known as internal bevel gingivectomy |Differs from the modified widman flap inthat pocket wall is removed with the initial incision TECHNIQUE |Pockets are measured with a pocket marker & a bleeding point is created THE INITIAL INTERNAL BEVEL INCISION IS CARRIED APICAL TO THE CREST OF BONE CONTD. The periodontal dressing is not required if the flap has been adapted adequately to cover the interdental area. The blade should be kept on the vertical height of the alveolus so that palatal artery is not injured. Contents available in the book .. As the flap is to be placed in an apical position, vertical incisions are made extending beyond the mucogingival junction. Therefore, these flaps accomplish the double objective of eliminating the pocket and increasing the width of the attached gingiva. The granulation tissue and the pocket lining may be then separated from the inner surface of the reflected flap with the help of surgical scissors and a scalpel. Coronally displaced flap. It is most commonly caused due to infection and sloughing of blood vessels. In this flap procedure, no ostectomy is performed; however, minor osetoplasty may be done to modify the undesired bony architecture. Full-thickness or partial thickness flap may be elevated depending on the objectives of the surgery. Rough handling of the tissue and long duration of the surgery commonly result in post-operative swelling. FLAP Flap yaitu suatu lembaran jaringan mukosa yang terdiri dari jaringan gingiva, mukosa alveolar, dan atau jaringan periosteum yang dilepaskan/ dissection dari permukaan tulang alveolar. Step 7:Continuous, independent sling sutures are placed in both the facial and palatal areas (Figure 59-3, I and J) and covered with a periodontal surgical pack. 34. Re-inspection of the operated area is done to check for any deposits on the root surfaces, remaining granulation tissue or tissue tags which are removed, if detected. Although some details may be modified during the actual performance of the procedure, detailed planning allows for a better clinical result. The incision is usually started at the disto-palatal line angle of the last molar and continued forward using a scalloped, inverse-beveled, partial-thickness incision to create a thin partial-thickness flap. It is most commonly caused due to infection and sloughing of blood vessels. It enhances the potential for effective periodontal maintenance and preservation of attachment levels. Different Flap techniques for treatment of gingival recession (Lateral-coronal-double papilla-semilunar-tunnel-apical). This flap procedure is indicated in areas that do not have esthetic concerns and areas where a greater reduction in pocket depth is desired. Journal of periodontology. Contents available in the book .. Step 3: Crevicular incision is made from the bottom of the . Hemorrhage occurring after 7-14 days is secondary to trauma or surgery. Periodontal Flap Surgery Wendy Jeng 117.4k views 035. periodontal flap Dr.Jaffar Raza BDS 7.5k views 17.occlusal schemes anatomic and semiamatomic occlusion www.ffofr.org - Foundation for Oral Facial Rehabilitiation 1.1k views Suturing techniques involved in dental surgery Hasanain Alani Contents available in the book . In the upcoming chapters, we shall read about various regenerative procedures which are aimed at achieving regeneration of lost periodontal structures. It protects the interdental papilla adjacent to the surgical site. The flap was repositioned and sutured [Figure 6]. The cell surface components or adhesive molecules of bacteria that interact with a variety of host componentsand responsible for recognizing and binding to specific host cell receptors A. Cadherins B. Adhesins C. Cohesins D. Fimbriae Answer: B 2. These incisions are made in a horizontal direction and may be coronally or apically directed. A periodontal flap is a section of gingiva, mucosa, or both that is surgically separated from the underlying tissues to provide for the visibility of and access to the bone and root surface. Fugazzotto PA. This incision is not indicated unless the margin of the gingiva is quite thick. The buccal and palatal/lingual flaps are reflected with the help of a periosteal elevator. A vertical incision may be given unilaterally (at one end of the flap) or bilaterally (on both ends of the flap). The secondary. Now, after the completion of the partial-thickness flap, the scalpel blade is directed from the base of this incision towards the bone to give a scoring incision. Contents available in the book .. Chlorhexidine rinse 0.2% bid was prescribed for 2 weeks, along with analgesics and the patient was given appropriate . Tooth with marked mobility and severe attachment loss. These meniscus tears are displaced into the tibia or femoral recesses and can be often difficult to diagnose intraoperatively. Position of the knife to perform the internal bevel incision. In this technique no. Step 5:Tissue tags and granulation tissue are removed with a curette. 2. 7. Contents available in the book . The flap procedures on the palatal aspect require a different approach as compared to other areas because the palatal tissue is composed of a dense collagenous fiber network and there is no movable mucosa on the palatal aspect. In the present discussion, we discussed various flap procedures that are used to achieve these goals. Contents available in the book .. Unrealistic patient expectations or desires. Unsuitable for treatment of deep periodontal pockets. These landmarks establish the presence and width of the attached gingiva, which is the basis for the decision. The main advantages of this procedure are the preservation of maximum healthy tissue and minimum post-operative discomfort to the patient. APICALLY REPOSITIONED FLAP/ PERIODONTAL FLAP SURGICAL TECHNIQUE/ DR. ANKITA KOTECHA 17,228 views Jul 30, 2020 This video is about APICALLY REPOSITIONED FLAP .more Dislike Share dental studies. Contents available in the book .. Takei et al. A study made before and 18 years after the use of apically displaced flaps failed to show a permanent relocation of the mucogingival junction.1. ), Only gold members can continue reading. May cause attachment loss due to surgery. In Figure 2, the frequency of the types of flap surgical techniques followed were analyzed. Internal bevel and is 0.5-1.0mm from gingival margin Modified Widman Flap For this reason, the internal bevel incision should be made as close to the tooth as possible (i.e., 0.5mm to 1.0mm) (see, For the undisplaced flap, the internal bevel incision is initiated at or near a point just coronal to where the bottom of the pocket is projected on the outer surface of the gingiva (see, The techniques that are used to achieve reconstructive and regenerative objectives are the, The initial incision is an internal bevel incision to the alveolar crest starting 0.5mm to 1mm away from the gingival margin (, The gingiva is reflected with a periosteal elevator (. In this technique no. Contents available in the book . A periodontal flap is a section of gingiva and/or mucosa surgically separated from the underlying tissue to provide visibility and access to the bone and root surfaces, Periodontal flap surgeries are also done for the establishment of. After administration of local anesthesia, bone sounding is done to assess the thickness of gingiva and underlying osseous topography. Pockets around the teeth in which a complete removal of root irritants is not clinically possible without gaining complete access to the root surfaces. In other words, we can say that. Because the pocket wall is not displaced apically, the initial incision should eliminate the pocket wall. The clinical outcomes of early internal fixation for undisplaced . (1995, 1999) 29, 30 described . 2011 Sep;25(1):4-15. The modified Widman flap procedure involves placement of three incisions: the initial internal bevel/ reverse bevel incision (first incision), the sulcular/crevicular incision (second incision) and the horizontal/interdental incision (third incision). 4. The flap is placed at the toothbone junction by apically displacing the flap. Which of the following mucogingival surgical techniques is indicated in areas of narrow gingival recession adjacent to a wide band of attached gingiva that can be used as a donor site? free gingival autograft double papilla flap modified Widman flap laterally displaced (positioned . 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. It is indicated where complete access to the bone is required, for example, in the case of osseous resective surgeries. Depending on the purpose, it can be a full . Wood DL, Hoag PM, Donnenfeld OW, Rosenfeld LD. Enter the email address you signed up with and we'll email you a reset link. Then sharp periodontal curettes are used to remove the granulomatous tissue and tissue tags. For the management of the papilla, flaps can be conventional or papilla preservation flaps. The location of the primary incision is based on the thickness of the gingiva, width of attached gingiva, the contour of the gingival margins, surgical objectives, and esthetic considerations. The modified Widman flap is indicated in cases of perio-dontitis with pocket depths of 5-7 mm. Flap for regenerative procedures. After one week, the sutures are removed and the area is irrigated with normal saline solution. Incisions used in papilla preservation flap using primary, secondary and tertiary incisions. These techniques are described in detail in Chapter 59. Contents available in the book .. This technique offers the possibility of establishing an intimate postoperative adaptation of healthy collagenous connective tissue to tooth surfaces,2,3,5,6 and it provides access for adequate instrumentation of the root surfaces and immediate closure of the area. Loss of marginal bone as a result of uncovering the osseous crest. 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. Irrespective of performing any of the above stated surgical procedures, periodontal wound healing always begins with a blood clot in the space maintained by the closed flap after suturing 36. 3. The papillae are then carefully pushed back through the interdental embrasures to palatal or lingual aspect. According to management of papilla: Undisplaced femoral neck fractures in children have a high risk of secondary displacement. The incision is carried around the entire tooth. Contents available in the book . 6. 2. The most apical end of the internal bevel incision is exposed and visible. The primary incision is placed at the outer margin of the gingivectomy incision starting at the disto-palatal line angle of the last molar and continued forward.