Eliminate or reduce pocket depth via resection of the pocket wall, 3. To preserve the present attached gingiva or even to establish an adequate strip of it, where it is narrow or absent. Ahmad Syaify, Sp.Perio (K) Spesialis Konsultan Bedah Perio & Estetik. Contents available in the book .. Tooth with extremely unfavorable clinical crown/root ratio. The vertical incisions are extended far enough apically so that they are at least 3 mm apical to the margin of the interproximal bony defect and 5 mm from the gingival margin. Undisplaced flap, Several techniques such as gingivectomy, undisplaced flap with or without osseous surgery, apically repositioned flap with or without resective osseous surgery, and orthodontic forced eruption with or without fibrotomy have been proposed for clinical crown lengthening. The following steps outline the undisplaced flap technique. The gingival margin is removed, and the flap is reflected to gain access for root therapy. Therefore, these flaps accomplish the double objective of eliminating the pocket and increasing the width of the attached gingiva. 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. Care should be taken to insert the blade in such a way that the papilla is left with a thickness similar to that of the remaining facial flap. Currently, the undisplaced flap may be the most frequently performed type of periodontal surgery. Although some details may be modified during the actual performance of the procedure, detailed planning allows for a better clinical result. Unrealistic patient expectations or desires. It is caused by trauma or spasm to the muscles of mastication. The periodontal dressing is not required if the flap has been adapted adequately to cover the interdental area. Minimally invasive techniques have recently been described for the reduction of the isolated anterior frontal sinus fracture via a closed approach. After these three incisions are made correctly, a triangular wedge of the tissue is obtained containing the inflamed connective. Contents available in the book .. 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 (Figure 57-6). Enter the email address you signed up with and we'll email you a reset link. ), Only gold members can continue reading. It is discarded after the crevicular (second) and interdental (third) incisions are performed (Figure 57-5). 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. 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). 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. A periosteal elevator is inserted into the initial internal bevel incision, and the flap is separated from the bone. The scalloping of the incision may not be accentuated as the flap has to be apically displaced and is not adapted interdentally. Contents available in the book .. 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). This procedure was aimed to provide maximum protection to osseous and transplant recipient sites. Conventional flaps include the modified Widman flap, the undisplaced flap, the apically displaced flap, and the flap for reconstructive procedures. The papilla preservation flap incorporates the entire papilla in one of the flaps by means of crevicular interdental incisions to sever the connective tissue attachment as well as a horizontal incision at the base of the papilla to leave it connected to one of the flaps. After the area to be operated is irrigated with an anti-microbial solution, local anesthesia is applied and the area is isolated after profound anesthesia has been achieved. This incision is made on the buccal aspect of the tooth till the desired level, sparing the interdental gingiva. The para-marginal internal bevel incision accomplishes three important objectives. Full-thickness or partial thickness flap may be elevated depending on the objectives of the surgery. The incisions made should be reverse bevel to achieve thinning of tissue so that an adequate final approximation of the flaps can be achieved. Alveolar crest reduction following full and partial thickness flaps. The researchers reported similar results for each of the three methods tested. The apically displaced flap is. During the initial phase of healing, inflammatory cells are attracted by platelet and complement derived mediators and aggregate around the blood clot. Normal interincisal opening is approximately 35-45mm, with mild . With the conventional flap, the interdental papilla is split beneath the contact point of the two approximating teeth to allow for the reflection of the buccal and lingual flaps. An interdental (third) incision along the horizontal lines seen in the interdental spaces will sever these connections. 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. Technique-The technique that weusehas been reported previously (Zucman and Maurer 1965). that still persist between the bottom of the pocket and the crest of the bone. Intrabony pockets on distal areas of last molars. 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. This wedge of tissue contains most of the inflamed and granulomatous areas that constitute the lateral wall of the pocket as well as the junctional epithelium and the connective tissue fibers that still persist between the bottom of the pocket and the crest of the bone. 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. Coronally displaced flap. As already stated, depending on the thickness of the gingiva, any of the following approaches can be used. The root surfaces are checked and then scaled and planed, if needed (. Henry H. Takei, Fermin A. Carranza and Kitetsu Shin. The periodontal flap surgeries have been practiced for more than one hundred years now, since their introduction in the early 1900s. The modified Widman flap is indicated in cases of perio-dontitis with pocket depths of 5-7 mm. 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. Contents available in the book . 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. 12 or no. It was described by Kirkland in 1931 31. In this technique no. . Preservation of good blood supply to the flap is another important consideration. Re-inspection of the operated area is done to check for any deposits on the root surfaces, remaining granulation tissue or tissue tags which are removed, if detected. Contents available in the book .. Contents available in the book .. Deep intrabony defects. With the help of Ochsenbein chisels (no. A progressive brous enlargement of the gingiva is a facet of idiopathic brous hyperplasia of the gingiva (Carranza and Hogan,; Gorlinetal., ).Itisdescribedvariouslyas bromatosisgingivae,gingivostomatitis,hereditarygingival bromatosis, idiopathic bromatosis, familial elephantiasis, and di use broma . The most likely etiologic factor is local anesthetic, secondary to an inferior alveolar nerve block that penetrates the medial pterygoid muscle. 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. Two types of horizontal incisions have been recommended: the internal bevel incision. 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). Contents available in the book .. A detailed description of the historical aspect of various flap surgeries has been given in the previous chapter. 2. Step 3: Crevicular incision is made from the bottom of the . Conventional flaps include the. A Technique to Obtain Primary Intention Healing in Pocket Elimination Adjacent to an Edentulous Area Article Jan 1964 G. Kramer M. Schwarz View Mucogingival Surgery: The Apically Repositioned. If extensive osseous recontouring is planned, an exaggerated incision is given. Trismus is the inability to open the mouth. drg. The granulomatous tissue is then removed and the deposits on the root surfaces are removed by scaling. 3. Different Flap techniques for treatment of gingival recession (Lateral-coronal-double papilla-semilunar-tunnel-apical). Loss of marginal bone as a result of uncovering the osseous crest. 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). 1. Step 5:Tissue tags and granulation tissue are removed with a curette. It is caused by trauma or spasm to the muscles of mastication. 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. 6. Crown lengthening procedures to expose restoration margins. What are the steps involved in the Apically Displaced flap technique? The first step . The area is anesthetized and bone sounding is done to evaluate the osseous topography, pocket depth, and thickness of the gingiva. The meniscus comma sign has been described for displaced flap tears of the meniscus. 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. Placement of the vertical incisions is absolutely essential in cases where the flap has to be re-positioned coronally (coronally displaced flap) or apically (apically displaced flap) from its original position. This type of incision, starting just below the bleeding points, removes the pocket wall completely. There is no need to determine where the bottom of the pocket is in relation to the incision for the apically displaced flap as one would for the undisplaced flap. The first step, Trismus is the inability to open the mouth. Sutures are removed after one week and the area is irrigated with normal saline. This flap procedure is indicated in areas that do not have esthetic concerns and areas where a greater reduction in pocket depth is desired. To fulfill these purposes, several flap techniques are available and in current use. 12 or no. 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. Journal of periodontology. Periodontal therapy, flap, periodontal flap, full thickness flap, partial thickness flap, nondisplaced flap, displaced flap, conventional flaps, papilla preservation . For the management of the papilla, flaps can be conventional or papilla preservation flaps. (1995, 1999) 29, 30 described . The surgical approaches that split the papilla cause shrinkage and decrease in the height of the interdental papilla leading to the exposure of interproximal embrasures. However, there are important variations in the way these incisions are performed for the different types of flaps (Figures 59-1 and 59-2). One incision is now placed perpendicular to these parallel incisions at their distal end. 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. After this, the second or the sulcular incision is made from the bottom of the pocket till the crest of the alveolar bone. 5. In the following discussion, we shall study in detail, the surgical techniques that are followed in various flap procedures. Disain flep ini memberikan estetis pasca bedah yang lebih baik, dan memberikan perlindungan yang lebih baik terhadap tulang interdental, hal mana penting sekali dalam tehnik bedah yang mengharapkan terjadinya regenerasi jaringan periodontium. The patient is then recalled for suture removal after one week. 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.
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