Contents available in the book …….. The periodontal dressing is not required if the flap has been adapted adequately to cover the interdental area. After the administration of local anesthesia, bone sounding is performed to identify the exact thickness of the gingiva. 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. 12 blade on both the buccal and the lingual/palatal aspects continuing it interdentally extending it in the mesial and distal direction. With the help of Ochsenbein chisels (no. The full-thickness mucoperiosteal flap procedure is the same as that described for the buccal and lingual aspects. After the patient has been thoroughly evaluated and pre-pared with non-surgical periodontal therapy, quadrant or area to be operated is selected. 3. Full-thickness or partial thickness flap may be elevated depending on the objectives of the surgery. 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 Goals of Flap Surgery . Fundamental principles in periodontal plastic surgery and mucosal augmentation–a narrative review. Contents available in the book …….. Another important objective of periodontal flap surgery is to regenerate the lost periodontal apparatus. Stem cells are mobilized from the bloodstream, the periodontal ligament, and the surrounding bone. When advanced gum disease (periodontitis) develops, your teeth are in danger: At this stage, the ligaments and bone tissue that surround them are being destroyed, and you could even begin losing teeth! The incision is made ……. After administrating local anesthesia, profound anesthesia is achieved in the area to be operated. Contents available in the book …….. These bacteria cause inflammation of the tissues, resulting in sensitivity, bleeding, and pain. The area to be operated is then isolated with the help of gauge. This is also known as “Ledge-and-wedge technique”. 12 or no. Pocket reduction surgery is an attempt to alleviate this destructive cycle and reduce the depth of the bacteria-harboring pockets. 15c or No. 6. 3. The main disadvantage of this procedure is that healing in the interdental areas takes place by secondary intention. Ramfjord and Nissle 8 in 1974, modified the original Widman flap procedure ……. Placing periodontal depressing is optional. This is especially important in maxillary and mandibular anterior areas which have a prime esthetic concern. Triangular The interdental incision is then made to severe the inter-dental fiber attachment. It enhances the potential for effective periodontal maintenance and preservation of attachment levels. After these three incisions are made correctly, a triangular wedge of the tissue is obtained containing the inflamed connective. It is also known as a partial-thickness flap. 2006 Aug;77(8):1452-7. Some clinicians prefer curettes (Molt 2 curette) or chisels (Ochsenbein No. This drawback of conventional flap techniques led to the development of this flap technique which intended to spare the papilla instead of splitting it. The incision is usually started at the disto-palatal line angle of the last molar and continued forward using a scalloped, inverse-beveled, partial-thickness incision to create a thin partial-thickness flap. Unsuitable for treatment of deep periodontal pockets. The interdental incision is then given to remove the wedge of tissue that contains the pocket wall. 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. PERIODONTAL FLAP SURGERY FRENECTOMY IMPLANT SUPPORTED DENTURES SCALING AND ROOT PLANING PATIENTS POST-OP Folder: CONTACT. 6. The long-term goal of periodontal surgery is to help increase the life expectancy of the teeth. What is Periodontal Flap Surgery? And even if you're prone to gum disease, proper professional treatment and regular care at home can help keep your teeth healthy for as long as possible. Later on Cortellini et al. The first incision or the internal bevel incision is then made from the bleeding points directed at an apical level to the alveolar crest. 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. 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. May cause esthetic problems due to root exposure. The incision is then carried out till the line angle of the tooth blending it into the gingival crevice. It is also known as the mucoperiosteal (mucosal tissue + periosteum) flap. Areas where post-operative maintenance can be most effectively done by doing this procedure. 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. 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 Goals of Flap Surgery . Root planing is done followed by osseous surgery if needed. Severe hypersensitivity. To preserve the present attached gingiva or even to establish an adequate strip of it, where it is narrow or absent. Periodontal surgery includes access flap procedures, resective procedures, and regenerative procedures. What is periodontal flap surgery? Patients at high risk for caries.      Flap for regenerative procedures. Contents available in the book ……. It enhances the potential for effective periodontal maintenance and preservation of attachment levels. 4.      Undisplaced flap, After thorough debridement, the area is then inspected for any remaining deposits on the root surfaces, granulation tissue or tissue tags. 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 modified Widman flap. 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. 2. The first step ……. In non-esthetic areas with moderate to deep pockets and for crown lengthening, this incision is indicated. PATIENTS DOCTORS COVID-19 HEALTHY LIVING BOOK APPOINTMENT Meet the Team. The Goals of Flap Surgery . This procedure is commonly used when pockets have been created in the gums, allowing plaque and debris to accumulate below the gumline. Contents available in the book …….. These vertical incisions are now joined with a horizontal incision as shown in the following figure. Periodontal pockets in severe periodontal disease. Flap surgery is helpful for people who have tartar buildup that is in deep pockets. Following is the description of step by step procedure followed while doing a modified Widman flap surgery. In this technique no. After these three incisions are made correctly, a triangular wedge of the tissue is obtained containing the inflamed connective ……. It is not a cure, but rather creates an environment that makes it easier to maintain health. Periodontitis is a disease that attacks the supporting tissues of the tooth. The intrasulcular incision is given using No. Osseous surgical procedures with very deep osseous defects and irregular bone loss, facially and lingually/ palatally. The cells responsible for initiating wound healing are known as stem cells. The flap also allows the gingiva to be displaced to a different location in patients with mucogingival involvement. 2011 Sep;25(1):4-15. 1. This suturing causes the apical positioning of the facial papilla, thus creating open gingival embrasures (black holes). Furthermore, the access to the bone defects facilitates the execution of various regenerative procedures. periodontal flap: A section of soft tissue surgically separated from underlying bone and removed or repositioned to eliminate periodontal pockets or to correct mucogingival defects. 7. 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. Ramfjord SP, Nissle RR. Areas which do not have an esthetic concern. Contents available in the book ……….. Before we go into the details of the periodontal flap surgeries, let us discuss the incisions used in surgical periodontal therapy. The Goals of Flap Surgery . After one week, the sutures are removed and the area is irrigated with normal saline solution. Otherwise, the periodontal dressing may be placed.      Modified flap operation, The area is anesthetized and bone sounding is done to evaluate the osseous topography, pocket depth, and thickness of the gingiva. Today's highly sophisticated and meticulous techniques allow the periodontal surgeon to reconstitute, regenerate, and reconstruct lost and destroyed tissues. This flap procedure is indicated in areas that do not have esthetic concerns and areas where a greater reduction in pocket depth is desired. 11 or 15c blade. This flap procedure utilizes two incisions referred to as primary and secondary incisions which contain tissue which has to be removed. “Pocketing” is the end result of inflammation and infection that causes the loss of tissue attachment to the teeth, one common consequence of periodontal (gum) disease. Gingival flap surgery treats periodontal disease by separating the gums from the teeth to allow the dentist to scrape tartar and plaque from the roots and bone. They are areas below the gum line where gum tissue has detached from the teeth, resulting in an uncleansable space where harmful bacteria can proliferate. The blade is pushed into the sulcus till resistance is felt from the crestal bone crest. If the disease can't be controlled by non-surgical treatments like cleaning and scaling, then periodontal flap surgery may be your best treatment option. This flap procedure causes the greatest probing depth reduction. In these flaps, the entire papilla is incorporated into one of the flaps. The apically displaced flap is. Conventional flaps include the. Burkhardt R, Lang NP. 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. Contents available in the book ……. Scaling, root planing and osseous recontouring (if required) are carried out. 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. Crown lengthening procedures to expose restoration margins. In areas with deep periodontal pockets and bone defects. The initial or the first incision is the internal bevel incision given not more than 1 mm from the crest of the gingiva and directed to the crest of the bone. The buccal and the lingual/palatal flaps are then elevated to expose the diseased root surfaces and the marginal bone. It must be noted that if there is no significant bleeding and flaps are closely adapted, periodontal dressing is not required. Contents available in the book …….. For regenerative procedures, such as bone grafting and guided tissue regeneration. Contents available in the book ……….. In this flap procedure, all the soft tissue, including the periosteum is reflected to expose the underlying bone. The procedure involves lifting the gums off of the teeth to remove tartar buildup. As described in, Image showing primay and secondary incisions used in ledge and wedge technique. After the primary incision, tissue can now be retracted with the help of rat-tail pliers. 2. If the incisions have been made correctly, the flap will be at the crest of the bone with the scalloped papillae positioned interproximally, thus permitting its primary closure. The periodontal flap surgeries have been practiced for more than one hundred years now, since their introduction in the early 1900’s.      a. Non-displaced flap. The soft tissue is then retracted with tissue forceps and the scoring incision is given to separate the periosteum from the bone. The interdental papilla is then freed from the underlying bone and is completely mobilized. Contents available in the book …….      a. Full-thickness flap. The square ……. 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”. Contents available in the book …….. To facilitate the close approximation of the flap, judicious osteoplasty, if required, is performed. Periodontal Flap Surgery Most surgical patients are surprised by how comfortable the experience of flap surgery is and how painless it is afterward. 2. Periodontal maintenance (Supportive periodontal therapy), Orthodontic-periodontal interrelationship, Piezosurgery in periodontics and oral implantology. To preserve the present attached gingiva or even to establish an adequate strip of it, where it is narrow or absent. The cost of periodontal surgery varies greatly depending on the type of procedure and the severity of your disease. What are these “pockets?” They are areas below the gum line where gum tissue has detached from the teeth, resulting in an uncleansable space where harmful bacteria can proliferate. After this, the second incision or the sulcular incision is made from the bottom of the pocket to the crest of the alveolar bone. This incision is indicated in the following situations. Gum flap surgery, also called periodontal flap surgery, is a popular procedure that treats and repairs periodontal pockets. The book is usually delivered within one week anywhere in India and within three weeks anywhere throughout the world. 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. By doing this, the periosteum is cut and it becomes easy to remove the secondary flap from the bone. 5. Sutures are removed after one week and the area is irrigated with normal saline. Contents available in the book ……….. 12 or no. Contents available in the book ……. The presence of thin gingiva which does not allow placement of adequate initial internal bevel incision. Periodontal flap surgery with conventional incision commonly results in gingival recession and loss of interdental papillae after treatment. After this, partial elevation of the flap is done with the help of a small periosteal elevator. The area is then debrided for all the granulation tissue present and scaling and root planing of the root surfaces are carried out. The flap is then elevated with the help of a small periosteal elevator. 5. In 1973, App 25 reported a similar technique and termed it as ‘Intact Papilla Flap’ which retained the interdental gingiva in the buccal flap. Flap adaptation is then done with the help of moistened gauze and any excess blood is expressed. And even if you're prone to gum disease, proper professional treatment and regular care at home can help keep your teeth healthy for as long as possible. Contents available in the book ……….. After reflection, the dentist removes granulation tissue and performs scaling and root planing. In this technique no. One of the most common complication after periodontal flap surgery is post-operative bleeding. 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. Contents available in the book …….. The granulation tissue is removed from the area and scaling and root planing is done. 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. Contents available in the book ……. Swelling hinders routine working life of patient usually during the first 3 days after surgery 41. Normal interincisal opening is approximately 35-45 mm, with mild ……. There have been a lot of modifications and improvisations in various periodontal surgical techniques during this period. 1972 Mar;43(3):141-4. 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. The basic clinical steps followed during this flap procedure are as follows. Vigilance in home care and regular periodontal recall cleanings and monitoring are necessary to ensure success. This is mainly because of the reason that all the lateral blood supply to ……. After removing the wedge of the tissue the margins of the flap are undermined with the help of scalpel blades ……. Areas where greater probing depth reduction is required. This approach allows: Regenerate periodontal tissues and their (re)-attachment to the teeth. Journal of periodontology. What are these pockets? Following is the description of marginal and para-marginal internal bevel incisions. Following is the description of these flaps. Laterally displaced flap. The vertical incisions are made from the center of palatal/lingual surfaces of teeth extending palatally/lingually. The process of healing progresses through various phases of ……. Contents available in the book …….. In the present discussion, we shall study in detail, the current concepts and advances in various periodontal flap surgeries. Contents available in the book ……….. No incision is made through the interdental papillae. The main advantages of this procedure are the preservation of maximum healthy tissue and minimum post-operative discomfort to the patient. This incision causes extensive loss of tissue and is indicated only in cases of gingival overgrowth. May cause hypersensitivity. Periodontal pockets in severe periodontal disease. 15 scalpel blade, parallel to each other beginning at the distal end of the edentulous area, continued to the tooth. Contents available in the book …….. This approach was described by Staffileno (1969) 23. The modified Widman flap is indicated in cases of perio-dontitis with pocket depths of 5-7 mm. Contents available in the book ……. Contents available in the book ……. C. According to flap placement after surgery: 1. Contents available in the book ……….. It is most commonly caused due to infection and sloughing of blood vessels. Conventional flap. After removing the wedge of the tissue the margins of the flap are undermined with the help of scalpel blades, In this technique, two incisions are made with the help of no. Contents available in the book …….. The flap is sutured with interrupted or continuous sling sutures. The vertical incision must extend beyond the mucogingival line, reaching the alveolar mucosa, to allow for the release of the flap to be displaced. The modified Widman flap procedure involves placement of three incisions: the initial internal bevel/ reverse bevel incision (first incision), the sulcular/crevicular incision (second incision) and the horizontal/interdental incision (third incision). 2. • Soft tissue pocket wall is removed with the initial incision. This procedure was aimed to provide maximum protection to osseous and transplant recipient sites. Journal of clinical periodontology. A detailed description of the historical aspect of various flap surgeries has been given in the previous chapter. The coronally directed incision is designated as external bevel incision whereas the apically directed incisions are the internal bevel and sulcular incision. And even if you're prone to gum disease, proper professional treatment and regular care at home can help keep your teeth healthy for as long as possible. Its attack is at the bone level and the damage involved is irreversible. The procedure involves lifting the gums off of the teeth to remove tartar buildup. Takei et al. In the upcoming chapters, we shall read about various regenerative procedures which are aimed at achieving regeneration of lost periodontal structures. Click this link to watch video of the surgery: Areas where greater probing depth reduction is required. The buccal and palatal/lingual flaps are reflected with the help of a periosteal elevator. As already stated, this technique is utilized when thicker gingiva is present. In case, where osseous recontouring is done the flap margins may be re-scalloped and trimmed to adapt to the root bone junction. These incisions are made in a horizontal direction and may be coronally or apically directed. Modified Widman flap, To overcome the problem of recession, papilla preservation flap design is used in these areas. Contents available in the book ……. The para-marginal internal bevel incision accomplishes three important objectives. Then sharp periodontal curettes are used to remove the granulomatous tissue and tissue tags. 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. Contents available in the book …….. Rough handling of the tissue and long duration of the surgery commonly result in post-operative swelling. (adsbygoogle = window.adsbygoogle || []).push({}); The external bevel incision is typically used in gingivectomy procedures. The bleeding may range from a minor leakage or oozing, to extensive or frank bleeding at the surgical site. Signs and symptoms may include continuous flow, oozing or expectoration of blood or copious pink saliva. 12 or no. The area is then irrigated with an antimicrobial solution. For the treatment of periodontal pockets with minimal osseous defects, a procedure without or minimal osseous resection is done, whereas, in case of moderate osseous defects and crown lengthening procedures, osseous resection is done with the flap procedure.