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This incision is made on the buccal aspect of the tooth till the desired level, sparing the interdental gingiva. 3. 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. The first documented report of papilla preservation procedure was by. Now, after the completion of the partial-thickness flap, the scalpel blade is directed from the base of this incision towards the bone to give a scoring incision. During crown lengthening, the shape of the para-marginal incision depends on the desired crown length. Contents available in the book . Currently, the undisplaced flap may be the most frequently performed type of periodontal surgery. Short anatomic crowns in the anterior region. PDF Clinical crown lengthening: A case report - Oral Journal See Page 1 12 or no. Which of the following mucogingival surgical techniques is indicated in areas of narrow gingival recession adjacent to a wide band of attached gingiva that can be used as a donor site? free gingival autograft double papilla flap modified Widman flap laterally displaced (positioned . 7. Minor osseous recontouring may be done and the flap is then adapted into the interdental areas. 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. Conventional flaps include: The modified Widman flap, The undisplaced flap, The apically displaced flap, The flap for regenerative procedures. Dentocrates The present systematic review analysed the clinical outcomes of resective surgery versus access flap procedures in subjects with periodontitis stages II-III (previously termed moderate to advanced periodontitis), in order to support the development of evidence-based guidelines for periodontal therapy. Expose the area for the performance of regenerative methods. The flaps may be thinned to allow for close adaptation of the gingiva around the entire circumference of the tooth and to each other interproximally. Step 3: The second, or crevicular, incision is made from the bottom of the pocket to the bone to detach the connective tissue from the bone. It is discarded after the crevicular (second) and interdental (third) incisions are performed (Figure 57-5). The modified Widman flap facilitates instrumentation for root therapy. 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. B. 61: Periodontal Regeneration and Reconstructive Surgery, 63: Periodontal Plastic and Esthetic Surgery, 59: The Flap Technique for Pocket Therapy, 55: General Principles of Periodontal Surgery, 31: Radiographic Aids in the Diagnosis of Periodontal Disease. In these flaps, the entire papilla is incorporated into one of the flaps. 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 following statements can be made regarding periodontal regeneration procedures. 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 Therefore, these flaps accomplish the double objective of eliminating the pocket and increasing the width of the attached gingiva. Periodontal pockets in severe periodontal disease. FLAP PERIODONTAL. Root planing is done followed by osseous surgery if needed. 14 - Osseous Surgery Flashcards | Quizlet The full-thickness mucoperiosteal flap procedure is the same as that described for the buccal and lingual aspects. References are available in the hard-copy of the website. The key point to be remembered here is, more the thickness of the gingiva more scalloped is the incision. The vertical incision must extend beyond the mucogingival line, reaching the alveolar mucosa, to allow for the release of the flap to be displaced. PDF F LAP TECHNIQUES FOR POCKET THERAPY - Aligarh Muslim University Different suture techniques Course Duration : 8,9,10,15,16,17 Mar Early registration fees before15/2: 5500 L.E . After the patient has been thoroughly evaluated and pre-pared with non-surgical periodontal therapy, quadrant or area to be operated is selected. This technique offers the possibility ol establishing an intimate postoperative adaptation ol healthy collagenous connective tissue to tooth surlaces " and provides access for adequate instrumentation ol the root surtaces and immediate closure ol the area the following is an outline of this technique: The granulation tissue, as well as tissue tags, are then removed. The partial-thickness flap is indicated when the flap is to be positioned apically or when the operator does not want to expose bone. Step 4:After the flap is reflected, a third incision is made in the interdental spaces coronal to the bone with a curette or an interproximal knife, and the gingival collar is removed (Figure 59-3, E and F). 1. 1972 Mar;43(3):141-4. Fundamental principles in periodontal plastic surgery and mucosal augmentationa narrative review. Unrealistic patient expectations or desires. According to management of papilla: According to flap reflection or tissue content: Areas where post-operative maintenance can be most effectively done by doing this procedure. Preservation of good blood supply to the flap is another important consideration. This incision is placed through the gingival sulcus. The main disadvantage of this procedure is that healing in the interdental areas takes place by secondary intention. With this access, the surgeon is able to make the. 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. Local anesthesia is administered to achieve profound anes-thesia in the area to be operated. When the flap is placed apically, coronally or laterally to its original position. This approach was described by Staffileno (1969) 23. 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. So, this procedure cannot be employed when modified Widman flap, excisional new attachment procedure and regenerative procedures such as osseous grafting are done because these procedures require primary closure. After healing, the resultant architecture of the area should enhance the ease and effectiveness of self-performed oral hygiene measures by the patient. The distance of the primary incision from the gingival margin depends on the thickness of the gingiva. PPTX Periodontal Flap - Tishk International University Conventional flaps include the modified Widman flap, the undisplaced flap, the apically displaced flap, and the flap for reconstructive procedures. Coronally displaced flap. Genon and Bender in 1984 27 also reported a similar technique indicated for esthetic purpose. 3) The insertion of the guide-wire presents The bleeding is frequently associated with pain. The internal bevel incision in an undisplaced flap procedure is started at the same point where an external bevel incision is started in agingivectomyprocedure. The apically displaced flap technique is selected for cases that present a minimal amount of keratinized, attached gingiva. Several techniques can be used for the treatment of periodontal pockets. Modified Widman flap and apically repositioned flap. Contents available in the book .. Contents available in the book .. Contents available in the book .. This incision is indicated in the following situations. (PDF) 50. The Periodontal Flap | Dr. Syed Wali Peeran - Academia.edu Conventional flaps include the. The square . Areas where greater probing depth reduction is required. Following is the description of step by step procedure followed while doing a modified Widman flap surgery. 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. 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. a. In this technique no. The partial-thickness flap may be necessary when the crestal bone margin is thin and exposed with an apically placed flap or when dehiscences or fenestrations are present. The undisplaced flap is therefore considered an internal bevel gingivectomy. Undisplaced (replaced) flap This type of periodontal flap Apically positions pocket wall and preserves keratinized gingiva by apically positioning Apically displaced (positioned) flap This type of incision is used for what type of flap? 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. It is most commonly caused due to infection and sloughing of blood vessels. In case where the soft tissue is quite thick, this incision. After this, partial elevation of the flap is done with the help of a small periosteal elevator. The first incision or the internal bevel incision is then made from the bleeding points directed at an apical level to the alveolar crest. 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. 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 influence of tooth location on the outcomes of multiple adjacent gingival recessions treated with coronally advanced flap: A multicenter ReAnalysis study Article Jun 2019 Giovanni Zucchelli. Management OF SOFT Tissues - MANAGEMENT OF SOFT TISSUES Tissue 12D blade is usually used for this incision. These incisions are made in a horizontal direction and may be coronally or apically directed. This incision is made 1mm to 2mm from the teeth. 15 scalpel blade is used to make a triangular incision distal to the molar on retromolar pad area or the maxillary tuberosity. 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. Sulcular incision is now made around the tooth to facilitate flap elevation. Horizontal incisions are directed along the margin of the gingiva in a mesial or distal direction. 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.