), 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. Click this link to watch video of the surgery: Areas where greater probing depth reduction is required. 30 Q . The periosteum left on the bone may also be used for suturing the flap when it is displaced apically. In another technique, vertical incisions and a horizontal incision are placed. 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). An intrasulcular incision is given all around the teeth to be involved in the surgical procedure. 5. Semiconductor chip assemblies, methods of making same and components It allows the vertical incision to be sutured without stretching the flap over the cervical convexity of the tooth. The initial or internal bevel incision is made (. If extensive osseous recontouring is planned, an exaggerated incision is given. Following are the steps followed during this procedure. Sixth day: (10 am-6pm); "Perio-restorative surgery" 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. Management OF SOFT Tissues - MANAGEMENT OF SOFT TISSUES Tissue May cause esthetic problems due to root exposure. 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). Contents available in the book .. 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. Contents available in the book . 12 blade on both the buccal and the lingual/palatal aspects continuing it interdentally extending it in the mesial and distal direction. 19. This incision is made 1mm to 2mm from the teeth. (PDF) 50. The Periodontal Flap | Dr. Syed Wali Peeran - Academia.edu The patient is then recalled for suture removal after one week. After the gingivectomy incision, primary and the secondary incisions are placed in the same way as described in the partial-thickness flap procedure. Later on Cortellini et al. The following outline of this technique: Step 3: Crevicular incision is made from the bottom of the . At last periodontal dressing may be applied to cover the operated area. Osseous surgical procedures with very deep osseous defects and irregular bone loss, facially and lingually/ palatally. These . The flap also allows the gingiva to be displaced to a different location in patients with mucogingival involvement. Dentocrates Contents available in the book .. PDF Effect of photobiomodulation on pain control after clinical crown Incisions can be divided into two types: the horizontal and vertical incisions 7. This is also known as. It is contraindicated in areas where the width of attached gingiva would be reduced to < 3 mm. The area is then irrigated with an antimicrobial solution. During the initial phase of healing, inflammatory cells are attracted by platelet and complement derived mediators and aggregate around the blood clot. The square . To preserve the present attached gingiva or even to establish an adequate strip of it, where it is narrow or absent. 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. Preservation of good blood supply to the flap is another important consideration. Flap reflection till alveolar mucosa to mobilize the flap causes more post-operative pain and discomfort. This is mainly because of the reason that all the lateral blood supply to. If the dressing has to be placed, a dry foil is first placed over the flap before covering it with the dressing so that the displacement of the pack under the flap is prevented. Which is the best method of brushing technique preferred for the patient with orthodontic appliance: ? 12D blade is usually used for this incision. Root planing is done followed by osseous surgery if needed. After it is removed there is minimum bleeding from the flaps as well as the exposed bone. This is termed. 2. Then sharp periodontal curettes are used to remove the granulomatous tissue and tissue tags. 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. Conventional flaps include the. Contents available in the book .. Contents available in the book .. Deep intrabony defects. 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. Expose the area for the performance of regenerative methods. As described in, Image showing primay and secondary incisions used in ledge and wedge technique. 4. 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 Contents available in the book .. Bone architecture is not corrected unless it prevents good tissue adaptation to the necks of the teeth. 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. 2011 Sep;25(1):4-15. Periodontal pockets in areas where esthetics is critical. Conventional flaps include: The modified Widman flap, The undisplaced flap, The apically displaced flap, The flap for regenerative procedures. Scaling, root planing and osseous recontouring (if required) are carried out. Another important objective of periodontal flap surgery is to regenerate the lost periodontal apparatus. The vertical incision should be made in such a way that interdental papilla is completely preserved. 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 . Apically displaced flap. The vertical incision should always be placed at the line angles of the teeth and never (except rare instances, such as a double papilla flap) over the height of contour of the root. The thicker the tissue is, the more apical the ending point of the incision (see Figure 59-4). 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. Areas where post-operative maintenance can be most effectively done by doing this procedure. 12 or no. 74. Full-thickness or partial thickness flap may be elevated depending on the objectives of the surgery. 3. The incision is made at the level of the pocket to discard the tissue coronal to the pocket if there is sufficient remaining attached gingiva. 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. Signs and symptoms may include continuous flow, oozing or expectoration of blood or copious pink saliva. After these three incisions are made correctly, a triangular wedge of the tissue is obtained containing the inflamed connective. 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. For regenerative procedures, such as bone grafting and guided tissue regeneration. 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. Unsuitable for treatment of deep periodontal pockets. The area is then irrigated with normal saline and flaps are adapted back in position. 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 It must be noted that if there is no significant bleeding and flaps are closely adapted, periodontal dressing is not required. A full-thickness flap is elevated with the help of a periosteal elevator whereas partial-thickness flap is elevated using sharp dissection with a Bard-Parker knife. Therefore, these flaps accomplish the double objective of eliminating the pocket and increasing the width of the attached gingiva. To overcome the problem of recession, papilla preservation flap design is used in these areas. Step 3: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. The blade is pushed into the sulcus till resistance is felt from the crestal bone crest. The efficacy of pocket elimination/reduction compared to access flap Also, complicated or prolonged surgical procedures that require full-thickness mucoperiosteal flaps with resultant edema can lead to trismus. Contents available in the book .. Contents available in the book . undisplaced flap technique Position of the knife to perform the crevicular (second) incision. 2. The primary incision or the internal bevel incision is then made with the help of No. Contents available in the book . Frenectomy-frenal relocation-vestibuloplasty. The apically displaced flap provides accessibility and eliminates the pocket, but it does the latter by apically positioning the soft-tissue wall of the pocket.2 Therefore, it preserves or increases the width of the attached gingiva by transforming the previously unattached keratinized pocket wall into attached tissue. Sutures are removed after one week and the area is irrigated with normal saline. These are indicated in cases where interdental spaces are too narrow and when the flap needs to be displaced. 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). After administration of local anesthesia, bone sounding is done to assess the thickness of gingiva and underlying osseous topography. Contents available in the book . Contents available in the book .. 4. 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. This incision is made on the buccal aspect of the tooth till the desired level, sparing the interdental gingiva. May cause attachment loss due to surgery. 12 or no. Refer to oral surgeon for biopsy ***** B. Contents available in the book .. The basic clinical steps followed during this flap procedure are as follows. Contents available in the book .. Modified flap operation, The triangular wedge of the tissue, hence formed is removed. Contents available in the book .. 2006 Aug;77(8):1452-7. 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. Contents available in the book .. The first step . 2. Step 2: The initial, or internal bevel, incision is made. There are two types of incisions that can be used to include interdental papillae in the facial flap: One technique includes semilunar incisions which are. Contents available in the book .. The apically displaced flap is. Suturing techniques for periodontal plastic surgery The main advantages of this procedure are maximum conservation of the keratinized tissue, maximum closure of the flaps and greater access to the underlying bony topography and the distal furcation. In areas with shallow periodontal pocket depth. The primary objective of the flap surgeries is to gain access to the root surfaces and bone defects so that the deposits on the root surfaces can be eliminated and the granulation tissue can be removed. The choice of which procedure to use depends on two important anatomic landmarks: the pocket depth and the location of the mucogingival junction. This is mainly because of the reason that all the lateral blood supply to . Following is the description of these flaps. 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 (. 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. The flaps are then apically positioned to just cover the alveolar crest. The most likely etiologic factor is local anesthetic, secondary to an inferior alveolar nerve block that penetrates the medial pterygoid muscle. The incision is carried around the entire tooth. 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. The buccal and the lingual/palatal flaps are then elevated to expose the diseased root surfaces and the marginal bone. Step 1:The initial incision is an internal bevel incision to the alveolar crest starting 0.5mm to 1mm away from the gingival margin (Figure 59-3, C). This is a commonly used incision during periodontal flap surgeries. Contents available in the book . In case where the soft tissue is quite thick, this incision. 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 interdental papilla is then freed from the underlying bone and is completely mobilized. 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. In case, where osseous recontouring is done the flap margins may be re-scalloped and trimmed to adapt to the root bone junction. Before we go into the details of the periodontal flap surgeries, let us discuss the incisions used in surgical periodontal therapy. Periodontal flaps can be classified as follows. In this flap procedure, no ostectomy is performed; however, minor osetoplasty may be done to modify the undesired bony architecture. The flap was repositioned and sutured [Figure 6]. Apically displaced flap can be done with or without osseous resection. In a full-thickness flap, all of the soft tissue, including the periosteum, is reflected to expose the underlying bone. 2)Wenow employ aK#{252}ntscher-type nailslightly bent forward inits upper part, allowing easier removal when indicated. Step 7:Continuous, independent sling sutures are placed in both the facial and palatal areas (Figure 59-3, I and J) and covered with a periodontal surgical pack. PDF BAB 13 BEDAH FLEP - Website Universitas Sumatera Utara It can be used in combination with other procedures such as osseous resection, regenerative procedures, hemisection procedure and procedures involving wedge excision. After the administration of local anesthesia, bone sounding is performed to identify the exact thickness of the gingiva. In other words, we can say that. When the flap is placed apically, coronally or laterally to its original position. One incision is now placed perpendicular to these parallel incisions at their distal end. To facilitate the close approximation of the flap, judicious osteoplasty, if required, is performed. It enhances the potential for effective periodontal maintenance and preservation of attachment levels. A. There have been a lot of modifications and improvisations in various periodontal surgical techniques during this period. Flap adaptation is then done with the help of moistened gauze and any excess blood is expressed. Semiconductor chip assemblies, methods of making same and components for sameSemiconductor chip assemblies, methods of making same and components for same .. .. . We describe the technique of diagnosis and treatment of a large displaced lateral meniscus flap tear, presenting as a meniscus comma sign. May cause attachment loss due to surgery. 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. Trochleoplasty with a flexible osteochondral flap; The role of the width of the forefoot in the development of Morton's neuroma; February. The Undisplaced Flap - Periodontal Disease - Click to Cure Cancer the.undisplaced flap and the gingivectomy. Contents available in the book .. Clin Appl Thromb Hemost. A periosteal elevator is inserted into the initial internal bevel incision, and the flap is separated from the bone. Step 2:The gingiva is reflected with a periosteal elevator (Figure 59-3, D). Ahmad Syaify, Sp.Perio (K) Spesialis Konsultan Bedah Perio & Estetik. 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. One incision is now placed perpendicular to these parallel incisions at their distal end. Contents available in the book . Apically displaced flaps have the important advantage of preserving the outer portion of the pocket wall and transforming it into attached gingiva. 1. 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 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. Pockets around the teeth in which a complete removal of root irritants is not clinically possible without gaining complete access to the root surfaces. Contents available in the book . During this whole procedure, the placement of the primary incision is very important because if improperly given it may become short, leaving exposed bone or may become longer requiring further trimming which is difficult. The modified Widman flap. 3. 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. 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. In addition, thinning of the flap should be performed with the initial incision, because it is easier to accomplish at this time than it is later with a loose, reflected flap that is difficult to manage. Minor osseous recontouring may be done and the flap is then adapted into the interdental areas. 2. The periodontal flap surgeries have been practiced for more than one hundred years now, since their introduction in the early 1900s. The operated area will be cleaner without dressing and will heal faster. Possibility of exposure of furcations and roots, which complicates postoperative supragingival plaque control. Periodontal flap - SlideShare With our innovative curriculum and cutting-edge training methods, we are committed to delivering the highest quality of dental education and expertise to our students. In areas with deep periodontal pockets and bone defects. 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. Contents available in the book . 1 and 2), the secondary inner flap is removed. 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. It reduces mouth opening, is commonly associated with pain and causes difficulty in mastication. 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. It conserves the relatively uninvolved outer surface of the gingiva. Laparoscopic technique for secondary vaginoplasty in male to female transsexuals using a modified . 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. A. Contents available in the book .. Repair Technique for Displaced Meniscal Flap Tears Indicated by MRI Contents available in the book .. in adults. Contents available in the book .. The Orban knife is usually used for this incision. 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. The deposits on the root surfaces are removed and root planing is done. This incision is indicated in the following situations. The papillae are then carefully pushed back through the interdental embrasures to palatal or lingual aspect. 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. The most apical end of the internal bevel incision is exposed and visible. Contents available in the book .. Following is the description of step by step procedure followed while doing a modified Widman flap surgery. The term gingival ablation indicates? The apically displaced flap technique is selected for cases that present a minimal amount of keratinized, attached gingiva. The incision is made around the entire circumference of the tooth using blade No. Sutures are placed to secure the flaps in their position. The area is anesthetized and bone sounding is done to evaluate the osseous topography, pocket depth, and thickness of the gingiva. 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). Hereditary gingival fibromatosis (HGF), also known as idiopathic gingival hyperplasia, is a rare condition of gingival overgrowth. The bone remains covered by a layer of connective tissue that includes the periosteum. 3) The insertion of the guide-wire presents Contents available in the book .. Step 5:Tissue tags and granulation tissue are removed with a curette. 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 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. 2. 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. That portion of the gingiva left around the tooth contains the epithelium of the pocket lining and the adjacent granulomatous tissue. After healing, the resultant architecture of the area should enhance the ease and effectiveness of self-performed oral hygiene measures by the patient. This incision is always accompanied by a sulcular incision which results in the formation of a collar of gingival tissue which contains the periodontal pocket lining. This preview shows page 166 - 168 out of 197 pages.. View full document. Laterally displaced flap. Within the first few days, monocytes and macrophages start populating the area, Post-operative complications after periodontal flap surgery, Hemorrhage occurring after 7-14 days is secondary to trauma or surgery. The three incisions necessary for flap surgery. A periosteal elevator is inserted into the initial internal bevel incision, and the flap is separated from the bone. 12D blade is usually used for this incision. In 1965, Morris4 revived a technique described early during the twentieth century in the periodontal literature; he called it the unrepositioned mucoperiosteal flap. Essentially, the same procedure was presented in 1974 by Ramfjord and Nissle,6 who called it the modified Widman flap (Figure 59-3). The most abundant cells during the initial healing phase are the neutrophils.

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