Swelling hinders routine working life of patient usually during the first 3 days after surgery 41. Contents available in the book . May cause hypersensitivity. Different Flap techniques for treatment of gingival recession (Lateral-coronal-double papilla-semilunar-tunnel-apical). Ramfjord and Nissle 8 in 1974, modified the original Widman flap procedure . 12 or no. This is essentially an excisional procedure of the gingiva. Contents available in the book .. 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. Rough handling of the tissue and long duration of the surgery commonly result in post-operative swelling. Inferior alveolar nerve block C. PSA 14- A patient comes with . The original intent of the surgery was to access the root surface for scaling and root planing. The starting point on the gingiva is determined by whether the flap is apically displaced or not displaced (Figure 57-7). Possibility of exposure of furcations and roots, which complicates postoperative supragingival plaque control. Step 1:The pockets are measured with the periodontal probe, and a bleeding point is produced on the outer surface of the gingiva to mark the pocket bottom. If the tissue is too thick, the flap margin should be thinned with the initial incision. This is a modification of the partial thickness palatal flap procedure in which gingivectomy is done prior to the placement of primary and the secondary incision. If the surgeon contemplates osseous surgery, the first incision should be placed in such a way to compensate for the removal of the bone tissue so that the flap can be placed at the toothbone junction. 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. It allows the vertical incision to be sutured without stretching the flap over the cervical convexity of the tooth. The blade should be kept on the vertical height of the alveolus so that palatal artery is not injured. Contents available in the book . The square, 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. The incisions given are the same as in case of modified Widman flap procedure. The base of the flap should be wider than the flap margin so that the blood supply to the flap is not jeopardized. The modified Widman flap is indicated in cases of perio-dontitis with pocket depths of 5-7 mm. The flap is then elevated with the help of a small periosteal elevator. Contents available in the book . 2. 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. Modified flap operation, They are also useful for treating moderate to deep periodontal pockets in the posterior regions. The first documented report of papilla preservation procedure was by. 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. This incision is placed through the gingival sulcus. The first documented report of papilla preservation procedure was by Kromer 24 in 1956, which was designed to retain osseous implants. Mitral facies or malar flush There is a tapping apex beat which is undisplaced. 11 or 15c blade. The primary incision or the internal bevel incision is then made with the help of No. Contents available in the book .. In case of generalized chronic periodontitis with localized gingival overgrow th,undisplaced flap with internal bevel incision has given better results esthetically and structurally .Thus with th is approach there is improvement in periodontal health along with good esthetics. Tooth with extremely unfavorable clinical crown/root ratio. 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. The first step . a. Non-displaced flap. 6. Contents available in the book .. 12 or no. After one week, the sutures are removed and the area is irrigated with normal saline solution. Laparoscopic technique for secondary vaginoplasty in male to female transsexuals using a modified . After pushing the papillae buccally, both the flap and the papilla are reflected off the bone with a periosteal elevator. Takei et al. Sutures are removed after one week and the area is irrigated with normal saline. 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. The triangular wedge of the tissue, hence formed is removed. Step 2: The mucogingival junction is assessed to determine the amount of keratinized tissue. 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). Gain access for osseous resective surgery, if necessary, 4. The following steps outline the undisplaced flap technique: Step 1: The pockets are measured with the periodontal probe. It enhances the potential for effective periodontal maintenance and preservation of attachment levels. The area is anesthetized and bone sounding is done to evaluate the osseous topography, pocket depth, and thickness of the gingiva. 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 1. Log In or, (Courtesy Dr. Kitetsu Shin, Saitama, Japan. 6. The flap is sutured with interrupted or continuous sling sutures. The apically displaced flap is. This flap procedure is indicated in areas that do not have esthetic concerns and areas where a greater reduction in pocket depth is desired. 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. Undisplaced flap, This technique offers the possibility ol establishing an intimate postoperative adaptation ol healthy collagenous connective tissue to tooth surlaces " and provides access for adequate instrumentation ol the root surtaces and immediate closure ol the area the following is an outline of this technique: Conventional flaps include: The modified Widman flap, The undisplaced flap, The apically displaced flap, The flap for regenerative procedures. 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. Henry H. Takei, Fermin A. Carranza and Jonathan H. Do. This will allow the clinician to retain the maximum amount of gingival tissue, including the papilla, which is essential for graft or membrane coverage. 2. News & Perspective Drugs & Diseases CME & Education ), Only gold members can continue reading. With the migration of these cells in the healing area, the process of re-establishment of the dentogingival unit progresses. The aim of this review is to determine the use of 3D printed technologies in the treatment of scaphoid fractures. 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. The full-thickness mucoperiosteal flap procedure is the same as that described for the buccal and lingual aspects. Contents available in the book .. The modified Widman flap. 35. Conventional flaps include the modified Widman flap, the undisplaced flap, the apically displaced flap, and the flap for reconstructive procedures. 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. Which is the best method of brushing technique preferred for the patient with orthodontic appliance: ? 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. - Charter's method - Bass method - Still man method - Both a and b correct . Intrabony pockets on distal areas of last molars. This incision is indicated in the following situations. Undisplaced femoral neck fractures in children have a high risk of secondary displacement. Journal of periodontology. Flap for regenerative procedures. Also, complicated or prolonged surgical procedures that require full-thickness mucoperiosteal flaps with resultant edema can lead to trismus. Contents available in the book .. that still persist between the bottom of the pocket and the crest of the bone. Full-thickness or partial thickness flap may be elevated depending on the objectives of the surgery. 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. ), 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. A. Once the bone sounding has been done and the thickness of the gingiva has been established, the design of the flap is decided. Clinical crown lengthening in multiple teeth. Flaps in which the interdental papilla is split beneath the contact of two approximating teeth, allowing the reflection of buccal and lingual flaps, are described as the conventional flaps. To preserve the present attached gingiva or even to establish an adequate strip of it, where it is narrow or absent. To evaluate clinical and radiological outcomes after surgical treatment of scaphoid nonunion in adolescents with a vascularized thumb metacarpal periosteal pedicled flap (VTMPF). To perform this technique without creating a mucogingival problem it should be determined that enough attached gingiva will remain after after removal of pocket wall. The incision is carried around the entire tooth. Contents available in the book .. After the primary incision, tissue can now be retracted with the help of rat-tail pliers. 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. 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. After removing the wedge of the tissue the margins of the flap are undermined with the help of scalpel blades . The local anesthetic agent is delivered to achieve profound anesthesia. Following is the description of step by step procedure followed while doing a modified Widman flap surgery. Unsuitable for treatment of deep periodontal pockets. The clearly visible root surfaces and osseous defects are then debrided with the help of hand (curettes) and ultrasonic (ultrasonic scalers) instruments. An interdental (third) incision along the horizontal lines seen in the interdental spaces will sever these connections. This incision is indicated in the following situations. 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. Contents available in the book . It is discarded after the crevicular (second) and interdental (third) incisions are performed (Figure 57-5). The periodontal dressing is not required if the flap has been adapted adequately to cover the interdental area. May cause attachment loss due to surgery. It must be noted that if there is no significant bleeding and flaps are closely adapted, periodontal dressing is not required. Before we go into the details of the periodontal flap surgeries, let us discuss the incisions used in surgical periodontal therapy. 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. 15 scalpel blade, parallel to each other beginning at the distal end of the edentulous area, continued to the tooth. Patients at high risk for caries. The presence of thin gingiva which does not allow placement of adequate initial internal bevel incision. In the present discussion, we shall study in detail, the current concepts and advances in various periodontal flap surgeries. The secondary incision is given from the depth of the periodontal pocket till the alveolar crest. These meniscus tears are displaced into the tibia or femoral recesses and can be often difficult to diagnose intraoperatively. The following steps outline the undisplaced flap technique. As soon the granulation tissue is removed, the clear bone margins and root surfaces are visible. 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. 2. Connective tissue grafting harvesting techniques as well as free gingival graft. Step 2: The initial, internal bevel incision is made after the scalloping of the bleeding marks on the gingiva. Periodontal flap surgery with conventional incision commonly results in gingival recession and loss of interdental papillae after treatment. Normal interincisal opening is approximately 35-45mm, with mild . A detailed description of the historical aspect of various flap surgeries has been given in the previous chapter. The narrow width of attached gingiva which may further reduce post-operatively. After suturing, the flap is adapted around the neck of the teeth with the help of moistened gauze. Conventional flap. Clin Appl Thromb Hemost. Expose the area for the performance of regenerative methods. b. The area is then irrigated with normal saline and flaps are adapted back in position. Contents available in the book .. Persistent inflammation in areas with moderate to deep pockets. Contents available in the book . This flap procedure allows complete access to the root surfaces allowing their mechanical debridement and decontamination under direct vision. 2)Wenow employ aK#{252}ntscher-type nailslightly bent forward inits upper part, allowing easier removal when indicated. The horizontal or interdental incision is then made using a small knife (Orban 1 or 2), severing the supracrestal gingival fibers. 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. Tooth movement and implant esthetics. As described in, Image showing primay and secondary incisions used in ledge and wedge technique. 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. 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 (. These techniques are described in detail in. The partial-thickness flap is indicated when the flap is to be positioned apically or when the operator does not want to expose bone. 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 . 12 or no. Trombelli L, Farina R. Flap designs for periodontal healing. 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. 15 scalpel blade is used to make a triangular incision distal to the molar on retromolar pad area or the maxillary tuberosity. The patient is recalled after one week for suture removal. The buccal and the lingual/palatal flaps are then elevated to expose the diseased root surfaces and the marginal bone. The first step, Trismus is the inability to open the mouth. a. Full-thickness flap. Areas with sufficient band of attached gingiva. According to flap reflection or tissue content: C. According to flap placement after surgery: Diagram showing full-thickness and partial-thickness flap. This approach was described by Staffileno (1969) 23. Click this link to watch video of the surgery: Modified Widman Flap surgery. 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. Contents available in the book .. With some variants, the apically displaced flap technique can be used for (1) pocket eradication and/or (2) widening the zone of attached gingiva. Two basic flap designs are used. Endodontic Topics. Thus, an incision should not be made too close to the tooth, because it will not eliminate the pocket wall, and it may result in the re-creation of the soft-tissue pocket. In the upcoming chapters, we shall read about various regenerative procedures which are aimed at achieving regeneration of lost periodontal structures. The internal bevel incisions are typically used in periodontal flap surgeries. A small periosteal elevator or Molt 2/4 curette can be used for this purpose. A vertical incision may be given unilaterally (at one end of the flap) or bilaterally (on both ends of the flap). 7. 1. In non-esthetic areas with moderate to deep pockets and for crown lengthening, this incision is indicated. Kirkland flap method was the most commonly followed (60.47%), then it was modified widman flap (29.65%), undisplaced flap (6.39%) and distal wedge which was the lowest (3.48%). 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). References are available in the hard-copy of the website. After these three incisions are made correctly, a triangular wedge of the tissue is obtained containing the inflamed connective . 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? Contents available in the book .. HGF is characterized as a benign, slowly progressive, nonhemorrhagic, fibrous enlargement of keratinized gingiva.It can cover teeth in various degrees, and can lead to aesthetic disfigurement. DESCRIPTION. Clinical crown lengthening in multiple teeth. Once bone sounding has been done, a gingivectomy incision without bevel is given using a periodontal knife to remove the tissue above the alveolar crest.

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