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Periodontal Flap
Surgical Procedures
Chapter 57
Lecture Outline
Periodontal Flap
Periodontal Flap
Definition:
A section of gingiva and/or mucosa surgically separated
from the underlying tissues
Advantages:
(mucoperiosteal)
Partial-thickness (mucosal/split)
flaps
Full-thickness Flap
All soft tissue is reflected
Indicated in resective osseous surgery.
Contraindicated
if
treatment
for
tissue
with
probable
Partial-thickness Flap
Periosteum covers the bone.
Indicated if the flap has to be
positioned
apically
and
bone
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Nondisplaced flap:
The flap is returned & sutured in its original position.
Displaced flap:
The flap is placed apically, coronally, or laterally to its original
position. It can be a full-thickness or partial-thickness flap.
Note:
Nondisplaced Flap
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15
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Management of Papilla
Conventional flap
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Conventional Flap
Indications:
Types:
Modified Widman flap
Nondisplaced flap
Apically displaced flap
The flap for reconstructive procedures.
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Incisions
Incisions
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Horizontal incisions:
Can be used without vertical incisions if the flap reflection
Horizontal Incisions
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Horizontal Incisions
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Second (crevicular)
incision
Third (interdental)
incision.
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Crevicular Incision
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Incision Procedure
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Vertical Incisions
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Vertical Incisions
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Flap Design
Flap Design
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Depends on:
Surgical judgment of the operator
Objectives of the procedure.
Necessary degree of access to the underlying bone and root
Final position of the flap
Good blood supply
Requires:
Careful planning that includes the type of flap, exact location,
type of incisions, management of the underlying bone, and final
closure of the flap and sutures.
Flap Design
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Pedicle Flap:
Two vertical releasing incisions are included in the flap design
Triangular Flap:
One vertical releasing incision is included in the flap design.
Flap Design
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Sharp dissection with surgical scalpel # 11 or # 15
For reflection of partial thickness flap
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Healing Process
Blood clot
Epithelial cells migration on the tooth.
Epithelial attachment to the root by hemidesmosomes & basal lamina. The blood clot is
replaced by granulation tissue derived from
gingival connective tissue, bone marrow & PDL.
2 weeks
One month
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In full-thickness flaps:
Superficial bone necrosis (at 1 to 3 days)
osteoclastic resorption
(peak at 4 to 6 days) resulting in > 1 mm bone loss if the bone is thin.
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