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    Flap Surgery

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    Septimiu Tiplica
    This document provides information about flap surgery procedures. It discusses the purposes of flap surgery, which include gaining access to deeper periodontal structures, relocating the frenulum, maintaining attached tissue, and eliminating pockets and promoting regeneration. It outlines indications such as pockets over 5mm and bony lesions, and contraindications like shallow pockets. Advantages include direct vision and ability to reposition flaps, while disadvantages include potential for postoperative sensitivity. It describes instruments used and principles of flap design such as base width and blood supply. Common flap types include modified Widman flaps, apically positioned flaps, and palatal flaps. Suturing techniques are also covered.

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    Flap Surgery

    Uploaded by

    Septimiu Tiplica
    90 views61 pages
    This document provides information about flap surgery procedures. It discusses the purposes of flap surgery, which include gaining access to deeper periodontal structures, relocating the frenulum, maintaining attached tissue, and eliminating pockets and promoting regeneration. It outlines indications such as pockets over 5mm and bony lesions, and contraindications like shallow pockets. Advantages include direct vision and ability to reposition flaps, while disadvantages include potential for postoperative sensitivity. It describes instruments used and principles of flap design such as base width and blood supply. Common flap types include modified Widman flaps, apically positioned flaps, and palatal flaps. Suturing techniques are also covered.

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    This document provides information about flap surgery procedures. It discusses the purposes of flap surgery, which include gaining access to deeper periodontal structures, relocating the frenulum, maintaining attached tissue, and eliminating pockets and promoting regeneration. It outlines indications such as pockets over 5mm and bony lesions, and contraindications like shallow pockets. Advantages include direct vision and ability to reposition flaps, while disadvantages include potential for postoperative sensitivity. It describes instruments used and principles of flap design such as base width and blood supply. Common flap types include modified Widman flaps, apically positioned flaps, and palatal flaps. Suturing techniques are also covered.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    90 views61 pages

    Flap Surgery

    Uploaded by

    Septimiu Tiplica
    This document provides information about flap surgery procedures. It discusses the purposes of flap surgery, which include gaining access to deeper periodontal structures, relocating the frenulum, maintaining attached tissue, and eliminating pockets and promoting regeneration. It outlines indications such as pockets over 5mm and bony lesions, and contraindications like shallow pockets. Advantages include direct vision and ability to reposition flaps, while disadvantages include potential for postoperative sensitivity. It describes instruments used and principles of flap design such as base width and blood supply. Common flap types include modified Widman flaps, apically positioned flaps, and palatal flaps. Suturing techniques are also covered.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 61

    Flap Surgery

    Presenter: R2 鄭瑋之 Instructor: Dr. 陳娟娟 2012/11/14


    Purpose

    1. To gain access to deeper periodontal


    structures with direct vision.
    2. Relocation of the frenulum
    3. Maintenance of the attached tissue
    4. Pocket elimination and regeneration
    Indications

    • Pockets > 5mm persisting after phase I therapy


    • Bony pockets and interdental craters
    • Bony lesions in the furcations
    • Need for surgical crown lengthening
    • When to open up a flap? complicated
    morphology like:
    – Deep and narrow pocket
    – Difficult to achieve the correct angle
    Contraindications

    • Shallow, supraalveolar pockets


    – subgingival scaling/rootplaning
    • Esthetically sensitive areas
    • Fibrous thickened gingiva
    – gingivectomy  more favorable morphology
    Advantages Disadvantages

    • Direct vision • Apical resposition 


    • Pocket epi. is entirely postoperative sensitivity
    removed by the internal and esthetics
    bevel incision
    • Flaps can be repositioned
    • Interdental bone or
    infrabony defects can be
    covered
    • No open wound
    • Little periodontal tissue is
    lost
    Comparison of open vs. closed
    Instruments
    Instruments

    Small elevators for


    mobilization of the
    mucoperiosteal flap
    Instruments
    Principles of Flap Design

    • Local flap
    1.outlined by a surgical incision
    2.carries its own blood supply
    3.allows surgical access to underlying tissues
    4.can be replaced in the original position
    5.can be maintained with sutures and is expected
    to heal
     Used in oral surgical, periodontic, and
    endodontic procedures to gain access.
    Principles of Flap Design

    • Complications
    A. Flap necrosis
    B. Flap Dehiscence
    C. Flap Tearing
    D. Injury to Local Structures
    Principles of Flap Design
    A. Flap necrosis
    1. Base > Free margin
    • to preserve an adequate blood supply
    • unless a major artery is present in the base
    2. Width of Base > Length of Flap*2
    • less critical in oral cavity, but length < width
    • a long, straight incision with adequate flap reflection
    heals more rapidly than a short, torn incision.
    3. An axial blood supply in the base
    4. Hold the flap with a retractor resting on intact
    bone to prevent tension.
    Principles of Flap Design
    B. Flap Dehiscence
    1. The incisions must be made over intact bone
    2. If the pathologic condition has eroded the
    buccocortical plate, the incision must be at least 6 or 8
    mm away from it.
    3. The incision is 6 to 8 mm away from the bony defect
    created by surgery.
    4. Gently handle the flap's edges
    5. Do not place the flap under tension
    6. Do not cross bony prominences, ex: canine eminence
    Principles of Flap Design
    B. Flap Dehiscence
    Principles of Flap Design
    C. Flap Tearing
    • Envelope flaps
    – an incision around the necks of several teeth.
    – extends 2 teeth anterior and 1 tooth posterior.
    If not provide sufficient access…
    • Vertical (oblique) releasing incisions:
    – extends 1 tooth anterior and 1 tooth posterior.
    – started at the line angle of a tooth.
    – carried obliquely apically into the unattached gingiva.
    – If cross the papilla  localized periodontal problems
    Principles of Flap Design
    D. Injury to Local Structures
    • Mandible: lingual n. & mental n.
    Principles of Flap Design
    D. Injury to Local Structures
    • Maxilla: greater palatine a. & nasopalatine n./a.
    Basic Incisions

    • Can be sulcular, crestal, or inverse bevel

    Full • adequate vascular supply


    thickness and regeneration
    (mucoperiosteal) • gingiva+mucosa+periosteum

    Split/partial
    thickness • gingiva+mucosa
    (mucosal)
    Basic Incisions
    Full
    thickness
    (mucoperiosteal)

    a: sulcular
    Depending on b: crestal
    the amount of
    attached tissue
    present
    Basic Incisions
    Split/partial
    thickness
    (mucosal)

    In areas of thin
    bony plates and
    for mucogingival
    procedures
    Basic Incisions
    2. inversebeveled
    Modified flap
    incision to the crest
    (mucoperiosteal)
    of bone.

    Requires adequate 1. gingivectomy


    attached Incision for
    keratinized gingiva pocket reduction

    On the palate,
    enlarged tissue, or
    with limited access
    Comparison of full- vs. partial-
    Types of Mucoperiosteal Flaps

    1. Envelope/sulcular incision
    2. Envelope with one releasing incision (three-
    corner flap)
    3. Envelope with two releasing incisions (four-
    corner flap)

    Full-thickness
    mucoperiosteal flap
    Types of Mucoperiosteal Flaps

    1. Envelope/Sulcular flap
    2 teeth anterior
    1 tooth posterior
    Types of Mucoperiosteal Flaps

    2. Three-corner flap
    1 tooth anterior
    1 tooth posterior

    Greater access in an apical direction,


    especially in the posterior aspect of the
    mouth
    Types of Mucoperiosteal Flaps

    3. Four-corner flap
    1 tooth anterior
    1 tooth posterior

    rarely indicated
    Common Periodontal Flap

    •1 Modified Widman Flap

    • Apically positioned
    2
    (full-thickness)
    • Apically positioned
    3
    • (partial-thickness)

    •4 Palatal Flap
    •1 Modified Widman Flap

    1. Inverse bevel incision 0.5~2mm, extending to the alveolar


    crest. Thins gingival tissue and permits compete closure of
    the interdental osseous defects postoperatively.
    •1 Modified Widman Flap

    2. Flap reflection. Full thickness mucoperiosteal flap is


    reflected to permits visualization.
    •1 Modified Widman Flap

    3. Crevicular incision between the hard tooth and the


    diseased pocket epi., to the depth of the junctional epi.
    •1 Modified Widman Flap

    4. Horizontal incision carried along the alveolar crest


    •1 Modified Widman Flap

    5. Root planing with direct vision


    •1 Modified Widman Flap

    6. Complete coverage of interdental defects


    • Apically positioned
    2
    (full-thickness)

    1. Sulcularly, crestally, or full-thickness flap labially positioned


    inverse beveled incision to bone
    2. Flap completed, reflected off bone
    3. Flap is apically positioned and sutured
    • Apically positioned
    2
    (full-thickness)

    A: The internal bevelled,


    scalloped incision is used
    for pocket elimination
    through apical
    repositioning of the flap.

    B: The flap
    positioned apically for
    pocket elimination.
    • Apically positioned
    3
    • (partial-thickness)

    1. Crestal incision with blade, partial-thickness flap parallel to long


    axis of tooth
    2. Flap raised by sharp dissection, periosteum retained over bone
    3. Flap is apically positioned at or below alveolar crest
    •4 Palatal Flap

    1. No alveolar mucosa is
    present on the palate to
    permit apical positioning.
    2. Pocket elimination by
    palatal flap that just
    covers the contours of
    the bone to eliminate
    osseous defects.
    3. Requires skill and
    experience.
    Osteoplasty

    Osseous grooving,
    peprmits better
    adaption of flaps to
    facilitate plaque
    removal alter
    healing
    Osteoplasty
    Osteoplasty
    Suturing for Flap Surgery
    Simple Loop Modification of
    Interrupted
    Figure 8 Modification of Interrupted
    Vertical mattress suture
    Horizontal mattress suture
    Single Interrupted Sling
    Reference

    1. Contemporary Oral and Maxillofacial Surgery, 4th Edition, Larry J


    Peterson, DDS, MS, Edward Ellis, III, DDS, MS, James R Hupp, DMD, MD,
    JD, FACS and Myron R Tucker, DDS
    2. Peterson's principles of oral and maxillofacial surgery, Michael Miloro,G.
    E. Ghali,Peter Larsen,Peter Waite
    3. An atlas of minor oral surgery: principles and practice, David A.
    McGowan
    4. Manual of minor oral surgery for the general dentist, Karl R. Koerner
    5. Critical Decisions in Periodontology, 4th Edition, WALTER B. HALL, BA,
    DDS, MSD
    6. Color Atlas of Periodontology, Klaus H. & Edith M. Rateitschak
    7. Atlas of Cosmetic and Reconstructive Periodontal Surgery 3rd edition,
    EDWARD S. COHEN, DMD
    Thanks for your attention!

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