Displaced flap: Step 2:The gingiva is reflected with a periosteal elevator (Figure 59-3, D). Because the alveolar bone is partially exposed, there is minimum post-operative pain and swelling. Periodontal flap surgery with conventional incision commonly results in gingival recession and loss of interdental papillae after treatment. The coronally directed incision is designated as external bevel incision whereas the apically directed incisions are the internal bevel and sulcular incision. The local anesthetic agent is delivered to achieve profound anesthesia. Under no circumstances, the incision should be made in the middle of the papilla. 5. This flap procedure allows complete access to the root surfaces allowing their mechanical debridement and decontamination under direct vision. 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. Coronally displaced flap. It is most commonly caused due to infection and sloughing of blood vessels. Contents available in the book .. Suturing is then performed to stabilize the flaps in their position. 3. The blade should be kept on the vertical height of the alveolus so that palatal artery is not injured. 4. The undisplaced flap and gingivectomy are the two techniques that surgically removed the pocket wall. Two basic flap designs are used. As already discussed in, History of surgical periodontal pocket therapy and osseous resective surgeries the original Widman flap was presented to the Scandinavian Dental Association in 1916 by Leonard Widman which was later published in 1918. 2. After healing, the resultant architecture of the area should enhance the ease and effectiveness of self-performed oral hygiene measures by the patient. 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? With this incision, the gingiva containing pocket lining is separated from the tooth surface. 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. The scalloping of the incision may not be accentuated as the flap has to be apically displaced and is not adapted interdentally. Our main aim of doing so is to get complete access to the root surfaces of the teeth and bone defects around the teeth. To evaluate clinical and radiological outcomes after surgical treatment of scaphoid nonunion in adolescents with a vascularized thumb metacarpal periosteal pedicled flap (VTMPF). Tooth with extremely unfavorable clinical crown/root ratio. The periodontal flap is one of the most frequently employed procedures, particularly for moderate and deep pockets in posterior areas (see Chapter 57). Preservation of good blood supply to the flap is another important consideration. 5. Platelets rich fibrin (PRF) preparation and application in the . B. Contents available in the book .. Contents available in the book . Both full-thickness and partial-thickness flaps can also be displaced. 4. Apically displaced flap can be done with or without osseous resection. Several techniques can be used for the treatment of periodontal pockets. 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. Contents available in the book . Modified Widman flap and apically repositioned flap. The following steps outline the modified Widman flap technique. 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. 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. ), Only gold members can continue reading. It must be noted that if there is no significant bleeding and flaps are closely adapted, periodontal dressing is not required. Sutures are removed after one week and the area is irrigated with normal saline. Palatal flaps cannot be displaced because of the absence of unattached gingiva. As described in History of surgical periodontal pocket therapy and osseous resective surgeries the palatal approach for . These incisions are made in a horizontal direction and may be coronally or apically directed. The secondary. 15c or No. Contents available in the book .. 19. The term gingival ablation indicates? Background: Three-dimensional (3D) printing technology is increasingly commercially viable for pre-surgical planning, intraoperative templating, jig creation and customised implant manufacture. 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. The granulomatous tissue is then removed and the deposits on the root surfaces are removed by scaling. 15c, 11 or 12d. Diagram showing the location of two different areas where the internal bevel incision is made in an undisplaced flap. Ahmad Syaify, Sp.Perio (K) Spesialis Konsultan Bedah Perio & Estetik. 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. 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. The present systematic review analysed the clinical outcomes of resective surgery versus access flap procedures in subjects with periodontitis stages II-III (previously termed moderate to advanced periodontitis), in order to support the development of evidence-based guidelines for periodontal therapy. Pockets around the teeth in which a complete removal of root irritants is not clinically possible without gaining complete access to the root surfaces. May increase the risk of root caries. For the management of the papilla, flaps can be conventional or papilla preservation flaps. Although some details may be modified during the actual performance of the procedure, detailed planning allows for a better clinical result. Contents available in the book . 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 A detailed description of the historical aspect of various flap surgeries has been given in the previous chapter. Tooth movement and implant esthetics. Later on Cortellini et al. 3) The insertion of the guide-wire presents This is especially important because, on the palatal aspect, osseous deformities such as heavy bone ledges and exostoses are commonly seen. Periodontal flap surgeries are also done for the establishment of . 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. The partial-thickness flap is indicated when the flap is to be positioned apically or when the operator does not want to expose bone. Different Flap techniques for treatment of gingival recession (Lateral-coronal-double papilla-semilunar-tunnel-apical). DESCRIPTION. 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). 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. 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. Because the pocket wall is not displaced apically, the initial incision should eliminate the pocket wall. The interdental incision is then made to severe the inter-dental fiber attachment. techniques revealed that 67.52% undergone kirkland flap, 20.51% undergone modified widman flap, 5.21% had papilla preservation flap, 2.25% had undisplaced flap, 1.55% had apically displaced flap and very less undergone distal wedge procedure which depicts that most commonly used flap technique was kirkland flap among other techniques. As discussed in, Periodontal treatment of medically compromised patients, antibiotic prophylaxis is must in patients with medical conditions such as rheumatic heart disease. According to flap reflection or tissue content: C. According to flap placement after surgery: Diagram showing full-thickness and partial-thickness 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 Figure 59-1). 2011 Sep;25(1):4-15. In case where the soft tissue is quite thick, this incision. These, 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, 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 pockets in severe periodontal disease. 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 modified Widman flap has been described for exposing the root surfaces for meticulous instrumentation and for the removal of the pocket lining.6 Again, it is not intended to eliminate or reduce pocket depth, except for the reduction that occurs during healing as a result of tissue shrinkage. Sulcular incision is now made around the tooth to facilitate flap elevation. This flap procedure may be regarded as internal bevel gingivectomy because the first incision or the internal bevel incision given during this procedure is placed at the level of pocket depth (Figure 62.1), thus including all the soft tissue containing and supporting periodontal pocket. Possibility of exposure of furcations and roots, which complicates postoperative supragingival plaque control. Patients at high risk for caries. Mitral facies or malar flush There is a tapping apex beat which is undisplaced. In case, where osseous recontouring is done the flap margins may be re-scalloped and trimmed to adapt to the root bone junction. 7. To improve esthetics as well as treat periodontal disease the method of choice remains is undisplaced flap surgery [12, 13]. Contents available in the book . With the migration of these cells in the healing area, the process of re-establishment of the dentogingival unit progresses. This procedure was aimed to provide maximum protection to osseous and transplant recipient sites. Loss of marginal bone as a result of uncovering the osseous crest. 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. Contents available in the book . Depending on how the interdental papilla is managed, flaps can either split the papilla (conventional flap) or preserve it (papilla preservation flap). The triangular wedge of the tissue, hence formed is removed. It is also known as the mucoperiosteal (mucosal tissue + periosteum) flap. 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. This flap procedure is indicated in areas that do not have esthetic concerns and areas where a greater reduction in pocket depth is desired. It is also known as a partial-thickness flap. Another important objective of periodontal flap surgery is to regenerate the lost periodontal apparatus. 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 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.