Which is the best method of brushing technique preferred for the patient with orthodontic appliance: ? Henry H. Takei, Fermin A. Carranza and Jonathan H. Do. Laterally displaced flap. There have been a lot of modifications and improvisations in various periodontal surgical techniques during this period. The flaps are then replaced to their original position and sutured using interrupted or continuous sling sutures. An intact papilla should be either excluded or included in the flap. 12 or no. Contents available in the book . There are two types of incisions that can be used to include interdental papillae in the facial flap: One technique includes semilunar incisions which are. The following steps outline the undisplaced flap technique. Reconstruction of Distal Phalangeal Soft Tissue Defects with Reverse Homodigital Artery Island Flap, , 2014-11, () . 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. The blade is pushed into the sulcus till resistance is felt from the crestal bone crest. Signs and symptoms may include continuous flow, oozing or expectoration of blood or copious pink saliva. Click this link to watch video of the surgery: Modified Widman Flap surgery. Within the first few days, monocytes and macrophages start populating the area, Post-operative complications after periodontal flap surgery, Hemorrhage occurring after 7-14 days is secondary to trauma or surgery. This flap procedure allows complete access to the root surfaces allowing their mechanical debridement and decontamination under direct vision. Clinical crown lengthening in multiple teeth. Areas where post-operative maintenance can be most effectively done by doing this procedure. Chlorhexidine rinse 0.2% bid . 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 incision is made. Flap for regenerative procedures. Normal interincisal opening is approximately 35-45mm, with mild . Ahmad Syaify, Sp.Perio (K) Spesialis Konsultan Bedah Perio & Estetik. 35. Contents available in the book .. It reduces mouth opening, is commonly associated with pain and causes difficulty in mastication. The incisions given are the same as in case of modified Widman flap procedure. Ramfjord and Nissle 8 in 1974, modified the original Widman flap procedure . The vertical incisions are made from the center of palatal/lingual surfaces of teeth extending palatally/lingually. The incision is usually scalloped to maintain gingival morphology and to retain as much papilla as possible. 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. Contents available in the book .. The granulation tissue, as well as tissue tags, are then removed. Contents available in the book .. After pushing the papillae buccally, both the flap and the papilla are reflected off the bone with a periosteal elevator. The horizontal or interdental incision is then made using a small knife (Orban 1 or 2), severing the supracrestal gingival fibers. 3. The techniques that are used to achieve reconstructive and regenerative objectives are the papilla preservation flap8 and the conventional flap, which involve only crevicular or pocket incisions. 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 (adsbygoogle = window.adsbygoogle || []).push({}); The external bevel incision is typically used in gingivectomy procedures. 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 (. The first, second and third incisions are placed in the same way as in case of modified Widman flap and the wedge of the infected tissue is removed. Undisplaced femoral neck fractures in children have a high risk of secondary displacement. Contents available in the book .. Contents available in the book .. Contents available in the book .. The bleeding is frequently associated with pain. 5. Scaling, root planing and osseous recontouring (if required) are carried out. 2. It is caused by trauma or spasm to the muscles of mastication. Henry H. Takei, Fermin A. Carranza and Kitetsu Shin. In case, where osseous recontouring is done the flap margins may be re-scalloped and trimmed to adapt to the root bone junction. Contents available in the book .. To evaluate clinical and radiological outcomes after surgical treatment of scaphoid nonunion in adolescents with a vascularized thumb metacarpal periosteal pedicled flap (VTMPF). To preserve the present attached gingiva or even to establish an adequate strip of it, where it is narrow or absent. APICALLY REPOSITIONED FLAP/ PERIODONTAL FLAP SURGICAL TECHNIQUE/ DR. ANKITA KOTECHA 17,228 views Jul 30, 2020 This video is about APICALLY REPOSITIONED FLAP .more Dislike Share dental studies. - Charter's method - Bass method - Still man method - Both a and b correct . 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. 1972 Mar;43(3):141-4. After the administration of local anesthesia, bone sounding is performed to identify the exact thickness of the gingiva. Sutures are placed to secure the flaps in their position. 12D blade is usually used for this incision. Position of the knife to perform the crevicular (second) incision. The modified Widman flap facilitates instrumentation for root therapy. Apically displaced flap, and The thicker the tissue is, the more apical the ending point of the incision (see Figure 59-4). Contents available in the book .. Journal of periodontology. Step 5:Tissue tags and granulation tissue are removed with a curette. The main causes for the bleeding include intrinsic trauma to the operated site, even after repeated instructions patients tend to play with the area of surgery with their tongue and dislodge the blood clot, tongue may also cause suction of blood by creating small negative pressures that cause secondary bleeding, presence of foreign bodies, infection, salivary enzymes may lyse the blood clot before it gets organized and slippage of suture. The bleeding may range from a minor leakage or oozing, to extensive or frank bleeding at the surgical site. In areas with thin gingiva and alveolar process. Contents available in the book .. 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. The buccal and the lingual/palatal flaps are then elevated to expose the diseased root surfaces and the marginal bone. The modified Widman flap. If the dressing has to be placed, a dry foil is first placed over the flap before covering it with the dressing so that the displacement of the pack under the flap is prevented. 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 vertical incision must extend beyond the mucogingival line, reaching the alveolar mucosa, to allow for the release of the flap to be displaced. 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. the.undisplaced flap and the gingivectomy. Contents available in the book .. The flap is sutured with interrupted or continuous sling sutures. (The use of this technique in palatal areas is considered in the discussion that follows this list. The continuous sling suture has an advantage that it uses tooth as an anchor and thus, facilitates to hold the flap edges at the root-bone junction. 4. In case of periodontitis with active pockets 5-6 mm deep or greater, that do not respond satisfactorily to the initial therapy. The flap is then elevated with the help of a small periosteal elevator. The incision is started from the greatest scallop of the gingiva around the tooth, which is usually present little distal to the mid-axis of the tooth in case of maxillary incisors and canines. Triangular 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). The challenging nature of scaphoid fracture and nonunion surgery make it an obvious target. The flap is placed at the toothbone junction by apically displacing the flap. After these three incisions are made correctly, a triangular wedge of the tissue is obtained containing the inflamed connective. 6. It enhances the potential for effective periodontal maintenance and preservation of attachment levels. Possibility of exposure of furcations and roots, which complicates postoperative supragingival plaque control. Contents available in the book . The conventional flap is used (1) when the interdental spaces are too narrow, thereby precluding the possibility of preserving the papilla, and (2) when the flap is to be displaced. Osseous surgical procedures with very deep osseous defects and irregular bone loss, facially and lingually/ palatally. The internal bevel incision may be a marginal incision (from the top of gingival margin) or para-marginal incision (at a distance from the gingival margin). For flap placement after surgery, flaps are classified as either (1) nondisplaced flaps, when the flap is returned and sutured in its original position, or (2) displaced flaps, which are placed apically, coronally, or laterally to their original position. In this technique, two incisions are made with the help of no. The granulation tissue is removed from the area and scaling and root planing is done. 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. The deposits on the root surfaces are removed and root planing is done. preservation flap ) papila interdental tidak terpotong karena tercakup ke salah satu flep (gambar 2C). Contents available in the book . If a full-thickness flap has been elevated, the sutures are placed along the mesial and the distal vertical incision lines to. Periodontal maintenance (Supportive periodontal therapy), Orthodontic-periodontal interrelationship, Piezosurgery in periodontics and oral implantology. Before we go into the details of the periodontal flap surgeries, let us discuss the incisions used in surgical periodontal therapy. Technique-The technique that weusehas been reported previously (Zucman and Maurer 1965). Contents available in the book .. 2. The flap also allows the gingiva to be displaced to a different location in patients with mucogingival involvement. 12 or no. The key point to be remembered here is, more the thickness of the gingiva more scalloped is the incision. After it is removed there is minimum bleeding from the flaps as well as the exposed bone. Internal bevel and is 0.5-1.0mm from gingival margin Modified Widman Flap The area is re-inspected for any remaining granulation tissue, tissue tags or deposits on the root surfaces. Conventional flaps include the modified Widman flap, the undisplaced flap, the apically displaced flap, and the flap for reconstructive procedures. In case of generalized chronic periodontitis with localized gingival overgrow th,undisplaced flap with internal bevel incision has given better results esthetically and structurally .Thus with th is approach there is improvement in periodontal health along with good esthetics. Following is the description of marginal and para-marginal internal bevel incisions. The undisplaced flap and gingivectomy are the two techniques that surgically removed the pocket wall. This is also known as Ledge-and-wedge technique. To improve esthetics as well as treat periodontal disease the method of choice remains is undisplaced flap surgery [12, 13]. Step 2:The initial or internal bevel incision is made (Figure 59-4) after scalloping the bleeding marks on the gingiva (Figure 59-5). Periodontal flap surgery with conventional incision commonly results in gingival recession and loss of interdental papillae after treatment. 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. The flap technique best suited for grafting purposes is the papilla preservation flap because it provides complete coverage of the interdental area after suturing. 7. Periodontal flaps can be classified on the basis of the following: For bone exposure after reflection, the flaps are classified as either full-thickness (mucoperiosteal) or partial-thickness (mucosal) flaps (Figure 57-1). The first documented report of papilla preservation procedure was by Kromer 24 in 1956, which was designed to retain osseous implants. Areas with sufficient band of attached gingiva. Depending on the purpose, it can be a full . The patients were assigned randomly to one of the techniques, and results were analyzed yearly for up to 7 years after therapy. THE UNDISPLACED FLAP TECHNIQUE Step 1: Measure pockets by periodontal probe,and a bleeding point is produced on the outer surface of the gingiva by pocket marker. Step 2: The initial, or internal bevel, incision is made. Apically displaced flaps have the important advantage of preserving the outer portion of the pocket wall and transforming it into attached gingiva. The operated area will be cleaner without dressing and will heal faster. May cause hypersensitivity. This approach was described by Staffileno (1969) 23. Continuous, independent sling sutures are placed in both the facial and palatal areas (. As discussed in, Periodontal treatment of medically compromised patients, antibiotic prophylaxis is must in patients with medical conditions such as rheumatic heart disease. Within the first few days, monocytes and macrophages start populating the area 37. In this flap procedure, no ostectomy is performed; however, minor osetoplasty may be done to modify the undesired bony architecture. These landmarks establish the presence and width of the attached gingiva, which is the basis for the decision. The starting point on the gingiva is determined by whether the flap is apically displaced or not displaced (Figure 57-7). The Orban knife is usually used for this incision. The thickness of the gingiva. Clin Appl Thromb Hemost. The classic treatment till today in developing countries is removal of excess gingival growth by scalpel but one should remember about the periodontal treatment which should be done before commencing the surgical part of . 1. Gain access for osseous resective surgery, if necessary, 4. Contents available in the book . The meniscus comma sign has been described for displaced flap tears of the meniscus. Different suture techniques Course Duration : 8,9,10,15,16,17 Mar Early registration fees before15/2: 5500 L.E . 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. Therefore, these flaps accomplish the double objective of eliminating the pocket and increasing the width of the attached gingiva. After the patient has been thoroughly evaluated and pre-pared with non-surgical periodontal therapy, quadrant or area to be operated is selected. The distance of the primary incision from the gingival margin depends on the thickness of the gingiva. The basic clinical steps followed during this flap procedure are as follows. The interdental papilla is then freed from the underlying bone and is completely mobilized. The internal bevel incision is also known as reverse bevel incision because its bevel is in the reverse direction from that of the gingivectomy incision. 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. In addition, thinning of the flap should be performed with the initial incision, because it is easier to accomplish at this time than it is later with a loose, reflected flap that is difficult to manage. 5. Areas where post-operative maintenance can be most effectively done by doing this procedure. Periodontal Flap Surgery Wendy Jeng 117.4k views 035. periodontal flap Dr.Jaffar Raza BDS 7.5k views 17.occlusal schemes anatomic and semiamatomic occlusion www.ffofr.org - Foundation for Oral Facial Rehabilitiation 1.1k views Suturing techniques involved in dental surgery Hasanain Alani The triangular wedge of the tissue made by the above three incisions is then removed with the help of curettes. For the correction of bone morphology (osteoplasty, osseous resection). The periodontal flap surgeries have been practiced for more than one hundred years now, since their introduction in the early 1900s. 6. Periodontal pockets in severe periodontal disease. One incision is now placed perpendicular to these parallel incisions at their distal end. Flaps are used for pocket therapy to accomplish the following: 1. This technique offers the possibility of establishing an intimate postoperative adaptation of healthy collagenous connective tissue to tooth surfaces,2,3,5,6 and it provides access for adequate instrumentation of the root surfaces and immediate closure of the area. Journal of periodontology. When the flap is placed apically, coronally or laterally to its original position. Endodontic Topics. Flap design for a conventional or traditional flap technique. Contents available in the book . The blade should be kept on the vertical height of the alveolus so that palatal artery is not injured. 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. It is discarded after the crevicular (second) and interdental (third) incisions are performed (Figure 57-5). After administration of local anesthesia, bone sounding is done to assess the thickness of gingiva and underlying osseous topography. Incisions used in papilla preservation flap using primary and secondary incisions. The periodontal dressing is not required if the flap has been adapted adequately to cover the interdental area. Contents available in the book .. See Page 1 It differs from the modified Widman llap in that the soft tissue pocket wall is removed with the initial incision; thus it may be considered an internal bevel glngivectomy. This complete exposure of and access to the underlying bone is indicated when resective osseous surgery is contemplated. It enhances the potential for effective periodontal maintenance and preservation of attachment levels. They are also useful for treating moderate to deep periodontal pockets in the posterior regions. Contents available in the book .. After administrating local anesthesia, profound anesthesia is achieved in the area to be operated. The apically displaced flap provides accessibility and eliminates the pocket, but it does the latter by apically positioning the soft-tissue wall of the pocket.2 Therefore, it preserves or increases the width of the attached gingiva by transforming the previously unattached keratinized pocket wall into attached tissue. 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. 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). As the flap is to be placed in an apical position, vertical incisions are made extending beyond the mucogingival junction. Although some details may be modified during the actual performance of the procedure, detailed planning allows for a better clinical result.