With this access, the surgeon is able to make the third incision, which is also known as the interdental incision, to separate the collar of gingiva that is left around the tooth. Give local anaesthetic for 2 weeks and recall C. Recall for follow up after 6 weeks D. 13- Which is the technique that will anesthetize both hard and soft tissues of the lower posterior teeth region in one injection A. Gow gates***** B. This incision is placed through the gingival sulcus. 2. The root surfaces are checked and then scaled and planed, if needed (Figure 59-3, G and H). 35. Flap for regenerative procedures. The flap is then elevated with the help of a small periosteal elevator. 6. It reduces mouth opening, is commonly associated with pain and causes difficulty in mastication. It conserves the relatively uninvolved outer surface of the gingiva. Contents available in the book .. Contents available in the book .. The continuous sling suture has an advantage that it uses tooth as an anchor and thus, facilitates to hold the flap edges at the root-bone junction. These techniques are described in detail in Chapter 59. The most apical end of the internal bevel incision is exposed and visible. Periodontal flap surgeries are also done for the establishment of . 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 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. This drawback of conventional flap techniques led to the development of this flap technique which intended to spare the papilla instead of splitting it. The internal beveled incision for the modified Widman flap closely follows the scalloped outline of the dentition to minimize the loss of the attached keratinized gingiva. Signs and symptoms may include continuous flow, oozing or expectoration of blood or copious pink saliva. Endodontic Topics. Contents available in the book . Also, complicated or prolonged surgical procedures that require full-thickness mucoperiosteal flaps with resultant edema can lead to trismus. The information presented in this website has been collected from various leading journals, books and websites. 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. A. 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. Contents available in the book .. 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 this technique in palatal areas is considered in the discussion that follows this list. Apically displaced flaps have the important advantage of preserving the outer portion of the pocket wall and transforming it into attached gingiva. Frenectomy-frenal relocation-vestibuloplasty. 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. Fundamental principles in periodontal plastic surgery and mucosal augmentationa narrative review. Contents available in the book .. The apically displaced flap technique is selected for cases that present a minimal amount of keratinized, attached gingiva. The para-marginal internal bevel incision accomplishes three important objectives. Contents available in the book .. It allows the vertical incision to be sutured without stretching the flap over the cervical convexity of the tooth. In these flaps, the entire papilla is incorporated into one of the flaps. Before we go into the details of the periodontal flap surgeries, let us discuss the incisions used in surgical periodontal therapy. Crown lengthening procedures to expose restoration margins. It is contraindicated in the areas where treatment for an osseous defect with the mucogingival problem is not required, in areas with thin periodontal tissue with probable osseous dehiscence or osseous fenestration and in areas where the alveolar bone is thin. After the area to be operated is irrigated with an anti-microbial solution, local anesthesia is applied and the area is isolated after profound anesthesia has been achieved. Once the bone sounding has been done and the thickness of the gingiva has been established, the design of the flap is decided. The primary incision is placed with the help of 15c blade, but in case of limited access, blade 12 d can be used. Contents available in the book .. Undisplaced (replaced) flap This type of periodontal flap Apically positions pocket wall and preserves keratinized gingiva by apically positioning Apically displaced (positioned) flap This type of incision is used for what type of flap? 1. It is also known as the mucoperiosteal (mucosal tissue + periosteum) flap. 61: Periodontal Regeneration and Reconstructive Surgery, 63: Periodontal Plastic and Esthetic Surgery, 55: General Principles of Periodontal Surgery, 30: Significance of Clinical and Biologic Information. Conflicting data surround the advisability of uncovering the bone when this is not actually needed. 7. Contents available in the book .. 3. 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. This approach was described by Staffileno (1969) 23. 5. The undisplaced flap is therefore considered an internal bevel gingivectomy. While doing laterally displaced flap for root coverage, the vertical incision is made at an acute angle to the horizontal incision, in the direction toward which the flap will move, placing the base of the pedicle at the recipient site. The researchers reported similar results for each of the three methods tested. Contents available in the book .. They are also useful for treating moderate to deep periodontal pockets in the posterior regions. In the present discussion, we shall study in detail, the current concepts and advances in various periodontal flap surgeries. The triangular wedge of the tissue, hence formed is removed. The internal bevel incision in an undisplaced flap procedure is started at the same point where an external bevel incision is started in agingivectomyprocedure. Takei et al. 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. Areas where post-operative maintenance can be most effectively done by doing this procedure. The periodontal flap is one of the most frequently employed procedures, particularly for moderate and deep pockets in posterior areas (see Chapter 57). The key point to be remembered here is, more the thickness of the gingiva more scalloped is the incision. The vertical incision should be made in such a way that interdental papilla is completely preserved. The design of the flap is dictated by the surgical judgment of the operator, and it may depend on the objectives of the procedure. Burkhardt R, Lang NP. The blade is pushed into the sulcus till resistance is felt from the crestal bone crest. The vertical incision must extend beyond the mucogingival line, reaching the alveolar mucosa, to allow for the release of the flap to be displaced. 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. Flap design for a sulcular incision flap. The modified Widman flap facilitates instrumentation for root therapy. A full-thickness flap is then elevated to expose 1-2 mm of the marginal bone. This flap procedure is indicated in areas that do not have esthetic concerns and areas where a greater reduction in pocket depth is desired. Position of the knife to perform the internal bevel incision. One incision is now placed perpendicular to these parallel incisions at their distal end. 5. The following steps outline the modified Widman flap technique. 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. In this technique no. The flaps are then replaced to their original position and sutured using interrupted or continuous sling sutures. The following steps outline the undisplaced flap technique: Step 1: The pockets are measured with the periodontal probe. The book is usually delivered within one week anywhere in India and within three weeks anywhere throughout the world. 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). It is an access flap for the debridement of the root surfaces. The coronally directed incision is designated as external bevel incision whereas the apically directed incisions are the internal bevel and sulcular incision. May cause attachment loss due to surgery. 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. To evaluate clinical and radiological outcomes after surgical treatment of scaphoid nonunion in adolescents with a vascularized thumb metacarpal periosteal pedicled flap (VTMPF). Flaps are used for pocket therapy to accomplish the following: 1. Diagram showing the location of two different areas where the internal bevel incision is made in an undisplaced flap. See video of the surgery at: Modified flap operation. The flaps may be thinned to allow for close adaptation of the gingiva around the entire circumference of the tooth and to each other interproximally. Contents available in the book . 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). 7. The internal bevel incision should be scalloped into the interdental area to preserve the interdental papilla (see Figure 59-2). Click this link to watch video of the surgery: Areas where greater probing depth reduction is required.