The main objective of periodontal flap surgical procedures is to allow access for the cleaning of the roots of teeth and the removal of the periodontal pocket lining, as well as to treat the irregularities of the alveolar bone, so that when gingiva is repositioned around the teeth, it will allow for the reduction of pockets, infections, and inflammation. Log In or, (Courtesy Dr. Kitetsu Shin, Saitama, Japan. Position of the knife to perform the internal bevel incision. Because the pocket wall is not displaced apically, the initial incision should eliminate the pocket wall. 3. 2)Wenow employ aK#{252}ntscher-type nailslightly bent forward inits upper part, allowing easier removal when indicated. Different Flap techniques for treatment of gingival recession (Lateral-coronal-double papilla-semilunar-tunnel-apical). 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. It enhances the potential for effective periodontal maintenance and preservation of attachment levels. This incision is made 1mm to 2mm from the teeth. Flap adaptation is then done with the help of moistened gauze and any excess blood is expressed. The internal bevel incision may be a marginal incision (from the top of gingival margin) or para-marginal incision (at a distance from the gingival margin). It is indicated when the flap has to be positioned apically and when the exposure of the bone is not required. Contents available in the book .. Periodontal flaps involve the use of horizontal (mesialdistal) and vertical (occlusalapical) incisions. Periodontal Flap - SlideShare Contents available in the book .. After the area to be operated has been irrigated with an antimicrobial solution and isolated, the local anesthetic agent is delivered to achieve profound anesthesia. 3. Contents available in the book .. 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. Step 2: The mucogingival junction is assessed to determine the amount of keratinized tissue. Conflicting data surround the advisability of uncovering the bone when this is not actually needed. A small periosteal elevator or Molt 2/4 curette can be used for this purpose. Conventional flaps include the modified Widman flap, the undisplaced flap, the apically displaced flap, and the flap for reconstructive procedures. In case of periodontitis with active pockets 5-6 mm deep or greater, that do not respond satisfactorily to the initial therapy. The first step . May cause hypersensitivity. 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. B. The beak-shaped no. 7. Areas which do not have an esthetic concern. Clinical crown lengthening in multiple teeth. Preservation of good blood supply to the flap is another important consideration. 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. Incisions used in papilla preservation flap using primary, secondary and tertiary incisions. Click this link to watch video of the surgery: Modified Widman Flap surgery. Modified Widman flap, Swelling hinders routine working life of patient usually during the first 3 days after surgery 41. It is most commonly caused due to infection and sloughing of blood vessels. 1. Periodontal pockets in severe periodontal disease. 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. This incision is made from the crest of the gingival margin till the crest of alveolar bone. Contents available in the book .. Perio-flap pptx - . - Muhadharaty Contents available in the book .. Later on Cortellini et al. After healing, the resultant architecture of the area should enhance the ease and effectiveness of self-performed oral hygiene measures by the patient. In Figure 2, the frequency of the types of flap surgical techniques followed were analyzed. Undisplaced flaps are one of the most common periodontal surgeries for correcting anatomical factors that predispose patients to predisposing periodontal disease, and makes it possible to improve aesthetics by eliminating obstacle of wearing a denture. a. So, this procedure cannot be employed when modified Widman flap, excisional new attachment procedure and regenerative procedures such as osseous grafting are done because these procedures require primary closure. Clinical crown lengthening in multiple teeth. Flaps are used for pocket therapy to accomplish the following: 1. Loss of marginal bone as a result of uncovering the osseous crest. Itisnecessary toemphasise thefollowing points: I)Reaming ofthemedullary cavity wasnever employed. The root surfaces are checked and then scaled and planed, if needed (Figure 59-3, G and H). Unsuitable for treatment of deep periodontal pockets. 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. A Technique to Obtain Primary Intention Healing in Pocket Elimination Adjacent to an Edentulous Area Article Jan 1964 G. Kramer M. Schwarz View Mucogingival Surgery: The Apically Repositioned. Pronounced gingival overgrowth, which is handled more efficiently by means of gingivectomy / gingivoplasty. For regenerative procedures, such as bone grafting and guided tissue regeneration. Alveolar crest reduction following full and partial thickness flaps. Conventional flaps include the modified Widman flap, the undisplaced flap, the apically displaced flap, and the flap for reconstructive procedures. Management OF SOFT Tissues - MANAGEMENT OF SOFT TISSUES Tissue Hence, this suturing is mainly indicated in posterior areas where esthetics. The blade is introduced into the sulcus or pocket and is inserted as far as possible into the interdental space around the tooth, keeping it close to the crown. Periodontal flap - SlideShare - Undisplaced flap - Apicaliy displaced flap - All of the above - Modified Widman flap. Smaller incisions usually cause less postoperative swelling and pain as compared to larger incisions. Two basic flap designs are used. Contents available in the book .. 2011 Sep;25(1):4-15. 6. Tooth with marked mobility and severe attachment loss. Access flap for guided tissue regeneration. 57: The Periodontal Flap | Pocket Dentistry What are the steps involved in the Apically Displaced flap technique? 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. Contents available in the book .. In areas with a narrow width of attached gingiva. Placing periodontal depressing is optional. Step 6:Bone architecture is not corrected unless it prevents good tissue adaptation to the necks of the teeth. 2. After it is removed there is minimum bleeding from the flaps as well as the exposed bone. ), Only gold members can continue reading. Contents available in the book .. Suturing techniques. Contents available in the book .. The periodontal flap is one of the most frequently employed procedures, particularly for moderate and deep pockets in posterior areas (see Chapter 57). Locations of the internal bevel incisions for the different types of flaps. There have been a lot of modifications and improvisations in various periodontal surgical techniques during this period. In addition, the interdental incision is performed after the flap is elevated to remove the interdental tissue. Placement of the vertical incisions is absolutely essential in cases where the flap has to be re-positioned coronally (coronally displaced flap) or apically (apically displaced flap) from its original position. This preview shows page 166 - 168 out of 197 pages.. View full document. Hemorrhage occurring after 7-14 days is secondary to trauma or surgery. in adults. This flap procedure allows complete access to the root surfaces allowing their mechanical debridement and decontamination under direct vision. Closed reduction of the isolated anterior frontal sinus fracture via This procedure cannot be done on the palatal aspect as it has attached gingiva which cannot be displaced apically. The periodontal pockets on the distal aspects of last molars, both in maxillary and the mandibular arches present a unique situation for which specific surgical designs have been advocated. Ramfjord and Nissle6 performed an extensive longitudinal study that compared the Widman procedure (as modified by them) with the curettage technique and the pocket elimination methods, which include bone contouring when needed. . Contents available in the book .. Local anesthesia is administered to achieve profound anes-thesia in the area to be operated. Contents available in the book . During the initial phase of healing, inflammatory cells are attracted by platelet and complement derived mediators and aggregate around the blood clot. Contents available in the book . Contents available in the book .. Gain access for osseous resective surgery, if necessary, 4. The granulation tissue, as well as tissue tags, are then removed. The flap also allows the gingiva to be displaced to a different location in patients with mucogingival involvement. Contents available in the book .. Table 1: showing thickness of gingiva in maxillary tooth region . The area is then irrigated with an antimicrobial solution. It differs from the modified Widman flap in that the soft-tissue pocket wall is removed with the initial incision; thus, it may be considered an internal bevel gingivectomy. The undisplaced flap and the gingivectomy are the two techniques that surgically remove the pocket wall. All the pocket epithelium and granulation tissue from the inner surfaces of the flaps is then eliminated using sharp curved scissors or Castroviejo scissors. 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 .. To improve esthetics as well as treat periodontal disease the method of choice remains is undisplaced flap surgery [12, 13]. This wedge of tissue contains most of the inflamed and granulomatous areas that constitute the lateral wall of the pocket as well as the junctional epithelium and the connective tissue fibers that still persist between the bottom of the pocket and the crest of the bone. This incision, together will the para-marginal internal bevel incision, forms a V-shaped wedge ending at or near the crest of bone, containing most of the inflamed and . They are also useful for treating moderate to deep periodontal pockets in the posterior regions. Also, complicated or prolonged surgical procedures that require full-thickness mucoperiosteal flaps with resultant edema can lead to trismus. This is essentially an excisional procedure of the gingiva. The esthetic and functional demands of maxillofacial reconstruction have driven the evolution of an array of options. 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. In this technique no. Contents available in the book . 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). A periosteal elevator is inserted into the initial internal bevel incision, and the flap is separated from the bone. Scalloping required for the different types of flaps (see, The apically displaced flap technique is selected for cases that present a minimal amount of keratinized, attached gingiva. The triangular wedge of the tissue, hence formed is removed. ), For the conventional flap procedure, the incisions for the facial and the lingual or palatal flap reach the tip of the interdental papilla or its vicinity, thereby splitting the papilla into a facial half and a lingual or palatal half (Figures 57-3 and. The surgical approaches that split the papilla cause shrinkage and decrease in the height of the interdental papilla leading to the exposure of interproximal embrasures. This incision is not indicated unless the margin of the gingiva is quite thick. The crevicular incision, which is also called the second incision, is made from the base of the pocket to the crest of the bone (Figure 57-8). 19. In this flap, only epithelium and the underlying connective tissue are reflected, leaving the periosteum intact. 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. It is contraindicated in areas where the width of attached gingiva would be reduced to < 3 mm. These are indicated in cases where interdental spaces are too narrow and when the flap needs to be displaced. The antibiotics should be started before the surg-ical procedure so that appropriate antibiotic levels are there in blood at the time of surgery to prevent spread of infection. Posterior spinal fusion for adolescent idiopathic scoliosis using a convex pedicle screw technique; . The internal bevel incisions are typically used in periodontal flap surgeries. Areas where greater probing depth reduction is required. 34. Therefore, these flaps accomplish the double objective of eliminating the pocket and increasing the width of the attached gingiva. 12D blade is usually used for this incision. Possibility of exposure of furcations and roots, which complicates postoperative supragingival plaque control. The key point to be remembered here is, more the thickness of the gingiva more scalloped is the incision. The aim of this study was to test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated by dental implants being inserted by a flapless surgical procedure versus the open flap technique, against the alternative hypothesis of a difference. By doing this, the periosteum is cut and it becomes easy to remove the secondary flap from the bone. Moreover, the palatal island flap is the only available flap that can provide keratinized mucosa for defect reconstruction. PPTX Periodontal Flap - Tishk International University 4. drg. The periodontal dressing is not required if the flap has been adapted adequately to cover the interdental area. The intrasulcular incision is given using No. Rough handling of the tissue and long duration of the surgery commonly result in post-operative swelling. Apically displaced flap. The classic treatment till today in developing countries is removal of excess gingival growth by scalpel but one should remember about the periodontal treatment which should be done before commencing the surgical part of . If the tissue is too thick, the flap margin should be thinned with the initial incision. 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 (Figure 57-6). The secondary. Contents available in the book . Contents available in the book .. This incision causes extensive loss of tissue and is indicated only in cases of gingival overgrowth. Following shapes of the distal wedge have been proposed which are, 1. However, there are important variations in the way these incisions are performed for the different types of flaps (Figures 59-1 and 59-2). Genon and Bender in 1984 27 also reported a similar technique indicated for esthetic purpose. With this incision, the gingiva containing pocket lining is separated from the tooth surface. It is the incision from which the flap is reflected to expose the underlying bone and root. Reconstruction of Distal Phalangeal Soft Tissue Defects with Reverse Homodigital Artery Island Flap, , 2014-11, () . The modified Widman flap is indicated in cases of perio-dontitis with pocket depths of 5-7 mm. Following is the description of step by step procedure followed while doing a modified Widman flap surgery. There is a loud S1 The murmur is a mid-diastolic rumbling heard best at . Another important objective of periodontal flap surgery is to regenerate the lost periodontal apparatus. 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. 74. The bleeding may range from a minor leakage or oozing, to extensive or frank bleeding at the surgical site. It produces a sharp, thin flap margin for adaptation to the bone-tooth junction. Contents available in the book .. Mitral facies or malar flush There is a tapping apex beat which is undisplaced. The apically displaced flap is. The step-by-step technique for the undisplaced flap is as follows: Step 1: The periodontal probe is inserted into the gingival crevice & penetrates the junctional epithelium & connective tissue down to bone. 7. PDF Clinical crown lengthening: A case report - Oral Journal 6. It differs from the modified Widman llap in that the soft tissue pocket wall is removed with the initial incision; thus it may be considered an internal bevel glngivectomy. 2. Minimally invasive techniques have recently been described for the reduction of the isolated anterior frontal sinus fracture via a closed approach. b. Split-thickness flap. Fractures of the frontal sinus are a common maxillofacial trauma and constitute 5-15% of all maxillofacial fractures. 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. Suturing is then done using a continuous sling suture. FLAP PERIODONTAL - [PPT Powerpoint] - vdocuments.site Minor osseous recontouring may be done and the flap is then adapted into the interdental areas. Contents available in the book .. It is also known as the mucoperiosteal (mucosal tissue + periosteum) flap. Apically displaced flap, and Step 2: The initial, internal bevel incision is made after the scalloping of the bleeding marks on the gingiva. Possibility of exposure of furcations and roots, which complicates postoperative supragingival plaque control. (1995, 1999) 29, 30 described . Its final position is not determined by the placement of the first incision. The thickness of the gingiva. One technique includes semilunar incisions which are . Step 3: Crevicular incision is made from the bottom of the . ( intently, the undisplaced flap is perhaps the most commonly performed type ol periodontal surgery. These landmarks establish the presence and width of the attached gingiva, which is the basis for the decision. The original intent of the surgery was to access the root surface for scaling and root planing. It conserves the relatively uninvolved outer surface of the gingiva. In case, where osseous recontouring is done the flap margins may be re-scalloped and trimmed to adapt to the root bone junction. This is especially important in maxillary and mandibular anterior areas which have a prime esthetic concern. Once the interdental papilla is mobile, a blunt instrument is used to carefully push the interdental papilla through the embrasure. Periodontal flaps can be classified as follows. The first step, Trismus is the inability to open the mouth. Conflicting data surround the advisability of uncovering the bone when this is not actually needed. Several techniques such as gingivectomy, undisplaced flap with or without osseous surgery, apically repositioned flap . The flaps are then apically positioned to just cover the alveolar crest. This incision is indicated in the following situations. The conventional flap is used (1) when the interdental spaces are too narrow, thereby precluding the possibility of preserving the papilla, and (2) when the flap is to be displaced. Something with epoxy resin what type of impression a Journal of periodontology. This procedure was aimed to provide maximum protection to osseous and transplant recipient sites. Contents available in the book .. There is no need to determine where the bottom of the pocket is in relation to the incision for the apically displaced flap as one would for the undisplaced flap. The secondary incision is given from the depth of the periodontal pocket till the alveolar crest. Sulcular incision is now made around the tooth to facilitate flap elevation. b. Papilla preservation flap. Because the alveolar bone is partially exposed, there is minimum post-operative pain and swelling. Otherwise, the periodontal dressing may be placed. preservation flap ) papila interdental tidak terpotong karena tercakup ke salah satu flep (gambar 2C). 1- initial internal bevel incision 2- crevicular incisions 3- initial elevation of the flap 4- vertical incisions extending beyond the mucogingival junction 5- SRP performed 6- flap is apically positioned 7- place periodontal dressing to ensure the flap remains apically displaced (PDF) 50. The Periodontal Flap | Dr. Syed Wali Peeran - Academia.edu Both full-thickness and partial-thickness flaps can also be displaced. Contents available in the book .. To evaluate clinical and radiological outcomes after surgical treatment of scaphoid nonunion in adolescents with a vascularized thumb metacarpal periosteal pedicled flap (VTMPF).
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