Periodontal Surgery: Flap Procedures

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary objective of recontouring the alveolar bone crest during osseous surgery?

To recapture the normal form at a more apical level (correct)

To enhance tooth sensitivity

To eliminate the need for soft tissue coverage

To maintain the existing bone height

Which technique is modified to handle periodontal pockets on the palatal aspect of maxillary teeth?

Tunnel technique

Beveled flap technique (correct)

Traditional flap technique

Open flap curettage technique

What is one of the main disadvantages of the apically repositioned flap technique?

Potential for significant postoperative bone loss

Minimized soft tissue coverage

Elevated risk of gum recession (correct)

Increased pocket depths postoperatively

What is emphasized as an advantage of the apically repositioned flap procedure?

Controlled postoperative position of the gingival margin Signup and view all the answers

Which technique is described as being similar to the open flap curettage technique?

Modified Widman flap Signup and view all the answers

What is indicated to protect exposed bone and retain soft tissue after recontouring the alveolar bone crest?

Periodontal dressing Signup and view all the answers

What should ideally occur after healing from periodontal surgery involving the apically repositioned flap?

An adequate zone of gingiva preservation Signup and view all the answers

What procedure is performed after scaling and planing the exposed root surfaces?

Alveolar bone contouring Signup and view all the answers

What is the primary purpose of the modified flap operation?

To perform proper root debridement Signup and view all the answers

What is a key difference between the modified flap operation and the original Widman flap?

The modified flap operation does not remove non-inflamed tissues extensively Signup and view all the answers

During the modified flap operation, what is done with the angular bony defects?

They are curetted but no bone is removed Signup and view all the answers

How does the placement of soft tissue margins affect periodontal surgery outcomes?

It must be at the alveolar bone crest to prevent remaining pockets Signup and view all the answers

What effect does the modified flap operation have on potential bone regeneration in intrabony defects?

It promotes bone regeneration according to Kirkland's observations Signup and view all the answers

What type of incisions are made during the modified flap operation?

Pocket incisions on the labial and lingual aspects Signup and view all the answers

In the context of gingival preservation techniques, what is a disadvantage of apically repositioned flaps?

They can cause excessive gingival recession Signup and view all the answers

What role does careful instrumentation of exposed root surfaces play in periodontal surgery?

It aids in proper root debridement. Signup and view all the answers

What is a key objective of flap procedures in periodontal surgery?

To facilitate debridement of the root surfaces Signup and view all the answers

Which of the following is an advantage of flap operations over gingivectomy?

Preserves existing gingiva Signup and view all the answers

Which type of flap includes both epithelia and connective tissue but does not include the periosteum?

Partial thickness flap Signup and view all the answers

What is a critical feature of the original Widman flap procedure?

It allows for optimal cleaning of the root surfaces Signup and view all the answers

How do flap procedures affect alveolar bone contour compared to gingivectomy?

They allow for re-establishment of proper bone contour in angular defects Signup and view all the answers

What type of healing is associated with the original Widman flap procedure?

Healing by primary intention Signup and view all the answers

What is achieved through the exposure of furcation areas during flap procedures?

Identification of the degree of involvement and tooth-bone relationship Signup and view all the answers

What benefit does repositioning a flap at its original level provide?

It makes adjustment of the gingival margin possible Signup and view all the answers

Study Notes

Part 2: Periodontal Surgery - Flap Procedures

Main Objectives:
- Debridement of pocket epithelium and inflamed connective tissue.
- Elimination of deepened pockets (Widman).
- Minimal trauma and discomfort to patient.
Advantages of Flap Operations:
- Preserves existing gingiva.
- Exposes marginal alveolar bone for defect identification and treatment planning.
- Exposes furcation areas to assess involvement.
- Allows repositioning of the flap for optimal gingival margin adjustment.
- Preserves oral epithelium and surgical dressing can be used.
- Post-operative period is generally less uncomfortable than gingivectomy.

Types of Flaps

Full Thickness Flap: Includes epithelium, connective tissue, and periosteum reflected from underneath bone (mucoperiosteal flap).
Partial Thickness Flap: Includes epithelium and connective tissue reflected from bone and periosteum (split flap).

Original Widman Flap

Developed in 1918 by Leonard Widman.
Designed to remove pocket epithelium and inflamed connective tissue facilitating root surface cleaning.
Advantages reported include less patient discomfort due to healing by primary intention and re-establishment of proper alveolar bone contour in angular bony defects

Modified Flap Operation

Introduced as a modification to Widman's original technique.
Does not involve extensive removal of non-inflamed tissues or apical displacement of the gingival margin.
Useful for anterior regions for esthetic reasons or in cases of intrabony defects, allowing for potential bone regeneration.

Apically Repositioned Flap

Developed in the 1950s and 1960s.
Emphasizes maintaining an adequate zone of attached gingiva after surgery.
Nabers (1954) and Friedman (1962) described techniques and techniques for preserving gingiva and proposed this technique as a suitable alternative.

Technique Descriptions (Friedman 1962)

Incision: A reverse bevel incision made, using a scalpel. The depth and width of the incision is based on pocket depth and gingival thickness. Scalloped incisions are favored when a maximal interproximal bone coverage is intended.
Mucoperiosteal Flap Elevation: Raising the mucoperiosteal flap beyond the mucogingival junction to allow for apical repositioning.
Bone Crest Recontouring: Ensuring the alveolar bone crest is recontoured to its normal form at the apical level .
Flap Repositioning: Repositioning the flap to the level of the recontoured alveolar bone crest, and securing it in place.

Additional Flap Techniques

Modified Widman Flap (Ramfjord and Nissle 1974): An open flap curettage technique aimed at proper pocket elimination without extensive bone recontouring procedures. Focuses on minimizing trauma to bone and soft tissue while ensuring adequate soft-tissue coverage.
Papilla Preservation Flap (Takei et al. 1985): A technique aimed at soft-tissue preservation in interdental areas during surgery for osseous defects. Uses intrasulcular incisions (not through the papillae) as a means to preserve interdental tissue following surgical intervention.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the essential aspects of flap procedures in periodontal surgery, focusing on their objectives, types, and advantages. You will learn about the differences between full thickness and partial thickness flaps, as well as the significance of the Widman flap. Test your understanding of these vital surgical techniques and enhance your knowledge in periodontal care.