May cause attachment loss due to surgery. This will allow the clinician to retain the maximum amount of gingival tissue, including the papilla, which is essential for graft or membrane coverage. Two types of horizontal incisions have been recommended: the internal bevel incision. 2)Wenow employ aK#{252}ntscher-type nailslightly bent forward inits upper part, allowing easier removal when indicated. Frenectomy-frenal relocation-vestibuloplasty. Incisions used in papilla preservation flap using primary and secondary incisions. Contents available in the book .. The root surfaces are checked and then scaled and planed, if needed (Figure 59-3, G and H). The horizontal incisions are used to separate the gingiva from the root surfaces of teeth. Otherwise, the periodontal dressing may be placed. Signs and symptoms may include continuous flow, oozing or expectoration of blood or copious pink saliva. In non-esthetic areas with moderate to deep pockets and for crown lengthening, this incision is indicated. 15 scalpel blade is used to make a triangular incision distal to the molar on retromolar pad area or the maxillary tuberosity. One incision is now placed perpendicular to these parallel incisions at their distal end. Suturing is then performed to stabilize the flaps in their position. 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 . Trombelli L, Farina R. Flap designs for periodontal healing. ), 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. Contents available in the book . When bone is stripped of its periosteum, a loss of marginal bone occurs, and this loss is prevented when the periosteum is left on the bone.4 Although this is usually not clinically significant,7 the differences may be significant in some cases (Figure 57-2). The periodontal flap is one of the most frequently employed procedures, particularly for moderate and deep pockets in posterior areas (see, Increase accessibility to root deposits for scaling and root planing, Eliminate or reduce pocket depth via resection of the pocket wall, Gain access for osseous resective surgery, if necessary, Expose the area for the performance of regenerative methods, Technique for Access and Pocket Depth Reduction or Elimination, All three flap techniques that were just discussed involve the use of the basic incisions described in. The most likely etiologic factor is local anesthetic, secondary to an inferior alveolar nerve block that penetrates the medial pterygoid muscle. Henry H. Takei, Fermin A. Carranza and Kitetsu Shin. May increase the risk of root caries. It is indicated where complete access to the bone is required, for example, in the case of osseous resective surgeries. A detailed description of the historical aspect of various flap surgeries has been given in the previous chapter. Care should be taken to insert the blade in such a way that the papilla is left with a thickness similar to that of the remaining facial flap. (2010) Factor V Leiden Mutation and Thrombotic Occlusion of Microsurgical Anastomosis After Free TRAM Flap. The intrasulcular incision is given using No. (1995, 1999) 29, 30 described . The square . The distance of the primary incision from the gingival margin depends on the thickness of the gingiva. This approach was described by Staffileno (1969) 23. Access flap for guided tissue regeneration. The granulomatous tissue is then removed and the deposits on the root surfaces are removed by scaling. b. 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 triangular wedge of the tissue, hence formed is removed. They are also useful for treating moderate to deep periodontal pockets in the posterior regions. Contents available in the book . 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? The distance of the incision from the gingival margin (thickness of the incision) varies according to the pocket depth, the thickness of the gingiva, width of the attached gingiva, shape and contour of gingival margins and whether or not the operative area is in the esthetic zone. Chlorhexidine rinse 0.2% bid . Contents available in the book .. See Page 1 The information presented in this website has been collected from various leading journals, books and websites. Incisions can be divided into two types: the horizontal and vertical incisions 7. Ahmad Syaify, Sp.Perio (K) Spesialis Konsultan Bedah Perio & Estetik. 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. Modified flap operation, 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. 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). The full-thickness mucoperiosteal flap procedure is the same as that described for the buccal and lingual aspects. 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. The factors that are associated with post-operative swelling include the type of the incision, its extension, tissue manipulation during the surgery and the duration of surgery. Normal interincisal opening is approximately 35-45mm, with mild, Periobasics A Textbook of Periodontics and Implantology, Text Book of Basic Sciences for MDS Students, History of surgical periodontal pocket therapy and osseous resective surgeries. 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. Therefore, the two anatomic landmarksthe pocket depth and the location of the mucogingival junctionmust be considered to evaluate the amount of attached gingiva that will remain after the surgery has been completed. However, to do so, the attached gingiva must be totally separated from the underlying bone, thereby enabling the unattached portion of the gingiva to be movable. It does not attempt to reduce the pocket depth, but it does eliminate the pocket lining. It enhances the potential for effective periodontal maintenance and preservation of attachment levels. In areas with deep periodontal pockets and bone defects. The periodontal flap surgeries have been practiced for more than one hundred years now, since their introduction in the early 1900s. The partial-thickness flap may be necessary when the crestal bone margin is thin and exposed with an apically placed flap or when dehiscences or fenestrations are present. Preservation of good blood supply to the flap is another important consideration. Step 2: The initial, or internal bevel, incision is made. With this incision, the gingiva containing pocket lining is separated from the tooth surface. 1. This incision causes extensive loss of tissue and is indicated only in cases of gingival overgrowth. 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. b. Papilla preservation flap. The scalloping of the incision may not be accentuated as the flap has to be apically displaced and is not adapted interdentally. In this flap, only epithelium and the underlying connective tissue are reflected, leaving the periosteum intact. With the conventional flap, the interdental papilla is split beneath the contact point of the two approximating teeth to allow for the reflection of the buccal and lingual flaps. For flap placement after surgery, flaps are classified as either (1) nondisplaced flaps, when the flap is returned and sutured in its original position, or (2) displaced flaps, which are placed apically, coronally, or laterally to their original position. preservation flap ) papila interdental tidak terpotong karena tercakup ke salah satu flep (gambar 2C). After the flap is reflected, a third incision is made in the interdental spaces coronal to the bone with a curette or an interproximal knife, and the gingival collar is removed (, Tissue tags and granulation tissue are removed with a curette. This suturing causes the apical positioning of the facial papilla, thus creating open gingival embrasures (black holes). 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. The following outline of this technique: The esthetic and functional demands of maxillofacial reconstruction have driven the evolution of an array of options. What is a periodontal flap? Eliminate or reduce pocket depth via resection of the pocket wall, 3. Increase accessibility to root deposits for scaling and root planing, 2. The patient is then recalled for suture removal after one week. This flap procedure causes the greatest probing depth reduction. Under no circumstances, the incision should be made in the middle of the papilla. The Orban knife is usually used for this incision. Fibrous enlargement is most common in areas of maxillary and mandibular . If the tissue is too thick, the flap margin should be thinned with the initial incision. The most apical end of the internal bevel incision is exposed and visible. These techniques are described in detail in Chapter 59. 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. The objectives for the other two flap proceduresthe undisplaced flap and the apically displaced flapinclude root surface access and the reduction or elimination of the pocket depth. 15c or No. For regenerative procedures, such as bone grafting and guided tissue regeneration. Contents available in the book .. This website is a small attempt to create an easy approach to understand periodontology for the students who are facing difficulties during the graduation and the post-graduation courses in our field. THE UNDISPLACED FLAP TECHNIQUE Step 1: Measure pockets by periodontal probe,and a bleeding point is produced on the outer surface of the gingiva by pocket marker. Then sharp periodontal curettes are used to remove the granulomatous tissue and tissue tags. The area is then irrigated with an antimicrobial solution. Following is the description of step by step procedure followed while doing a modified Widman flap surgery. (1985) 26 modified this procedure to preserve anterior esthetics after flap surgery. This is essentially an excisional procedure of the gingiva. - Undisplaced flap - Apicaliy displaced flap - All of the above - Modified Widman flap. More is the thickness of the gingiva, farther is the incision placed to include more tissue which needs to be removed. 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. 15 scalpel blade, parallel to each other beginning at the distal end of the edentulous area, continued to the tooth. The soft tissue is then retracted with tissue forceps and the scoring incision is given to separate the periosteum from 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, The base of the flap should be wider than the flap margin so that the blood supply to the flap is not jeopardized. The flap was repositioned and sutured [Figure 6]. Step 3: Crevicular incision is made from the bottom of the . 34. In this technique no. The apically displaced flap is. By doing this, the periosteum is cut and it becomes easy to remove the secondary flap from the bone. Contents available in the book .. The following steps outline the undisplaced flap technique: Step 1: The pockets are measured with the periodontal probe. Expose the area for the performance of regenerative methods. The root surfaces are checked and then scaled and planed, if needed (. 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.
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