periodontal flap surgery 2
Post on 23-Aug-2014
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Variations in Flap Design
• Thinned palatal flaps• Wedges
– Distal wedge– Proximal wedge– Edentulous area
• Conservative flap approaches
Thinned palatal flap Pre-treatment considerations
Designing a thinned palatal flap• Probe depths• Gingival contour• Pocket location• Objective
– Pocket elimination (resection)– Regeneration
• Underlying tissues– Soft tissue – Osseous tissues
Palatal flap views
Initial incisions
Removal of tissue collar
Undermining incisions
Tissue removal
Flap closure
Pre-treatment Primary incisions
Soft tissue removed Osseous resection
Sutured Healed
Distal Wedge Designs
Distal Wedge
• A periodontal surgical procedure for removal of excessive soft tissue distal to a terminal tooth in an arch
• A “wedge” refers to internal thinning by removal of a block of tissue
Special areas for wedges
• Maxillary tuberosity• Mandibular retromolar area• Edentulous ridges
Distal wedge advantages
• Provide access to bone and furcations• Allow internal thinning of bulky tissue• It is possible to obtain primary closure of
the wound after reduction of bulky tissue
Anatomical limitations
• Access• Vasculature and nerves
– Lingual nerve (mandibular)– Greater palatine foramen (maxillary)– Loose connective tissues, raphe
Distal wedge designs
• Triangular: least difficult, least invasive• Square cut: provides best access • Linear: most effective at preserving
keratinized gingiva
triangular square
linear
Proximal wedges are similar in design to square cut distal wedges
Conservative Flap Designs
• Intended to minimize recession• Good for maxillary anterior teeth• Types
– Flap curettage (open flap debridement/ flap curettage)
– Modified Widman Flap– Excisional New Attachment Procedure
(ENAP)
Modified Widman Flap
• Provides access for root planing• Requires primary closure of the flap
Initial incision has 0.5 to 1 mm scallop, but may also be intrasulcular
The modified Widman flap is elevated only 2 to 3 mm apical to the alveolar crest
Intrasulcular incision
Interdental incision
Soft tissue debridement and root planing
With conservative flaps, there is little or no bone resection. The flap is adapted to obtain primary
closure
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