The cell surface components or adhesive molecules of bacteria that interact with a variety of host componentsand responsible for recognizing and binding to specific host cell receptors A. Cadherins B. Adhesins C. Cohesins D. Fimbriae Answer: B 2. Periodontal maintenance (Supportive periodontal therapy), Orthodontic-periodontal interrelationship, Piezosurgery in periodontics and oral implantology. 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. 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. The vertical incision should be made in such a way that interdental papilla is completely preserved. 2. In addition, the interdental incision is performed after the flap is elevated to remove the interdental tissue. It can be used in combination with other procedures such as osseous resection, regenerative procedures, hemisection procedure and procedures involving wedge excision. Periodontal flap surgeries are also done for the establishment of . If the tissue is too thick, the flap margin should be thinned with the initial incision. Following is the description of marginal and para-marginal internal bevel incisions. A technique using a mixture of bone dust and blood is called as a. bone blend technique b. bone swaging technique Ramfjord and Nissle 8 in 1974, modified the original Widman flap procedure . Position of the knife to perform the crevicular (second) incision. 1. These meniscus tears are displaced into the tibia or femoral recesses and can be often difficult to diagnose intraoperatively. the.undisplaced flap and the gingivectomy. 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 key point to be remembered here is, more the thickness of the gingiva more scalloped is the incision. After these three incisions are made correctly, a triangular wedge of the tissue is obtained containing the inflamed connective. The objectives for the other two flap proceduresthe undisplaced flap and the apically displaced flapinclude root surface access and the reduction or elimination of the pocket depth. A. A vertical incision may be given unilaterally (at one end of the flap) or bilaterally (on both ends of the flap). Contents available in the book .. A new technique for arthroscopic meniscectomy using a traction suture, , 2015-02, ()KCI . The incision is carried around the entire tooth. The flap also allows the gingiva to be displaced to a different location in patients with mucogingival involvement. - Charter's method - Bass method - Still man method - Both a and b correct . Contents available in the book . b. 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. In 1973, App 25 reported a similar technique and termed it as Intact Papilla Flap which retained the interdental gingiva in the buccal flap. See video of the surgery at: Modified flap operation. Genon and Bender in 1984 27 also reported a similar technique indicated for esthetic purpose. The base of the flap should be wider than the flap margin so that the blood supply to the flap is not jeopardized. As described in History of surgical periodontal pocket therapy and osseous resective surgeries the palatal approach for . Hemorrhage occurring after 7-14 days is secondary to trauma or surgery. One of the most common complication after periodontal flap surgery is post-operative bleeding. ( intently, the undisplaced flap is perhaps the most commonly performed type ol periodontal surgery. Platelets rich fibrin (PRF) preparation and application in the . 2. 2014 Apr;41:S98-107. 2. Endodontic Topics. This incision is made on the buccal aspect of the tooth till the desired level, sparing the interdental gingiva. The coronally directed incision is designated as external bevel incision whereas the apically directed incisions are the internal bevel and sulcular incision. Tooth with marked mobility and severe attachment loss. Contents available in the book . Furthermore, the access to the bone defects facilitates the execution of various regenerative procedures. Contents available in the book .. Step 2: The mucogingival junction is assessed to determine the amount of keratinized tissue. The pockets are then measured and bleeding points are produced with the help of a periodontal probe on the outer surface of the gingiva, indicating the bottom of the pocket. The flap was repositioned and sutured and . A periosteal elevator is inserted into the initial internal bevel incision, and the flap is separated from the bone. 74. The incision is usually scalloped to maintain gingival morphology and to retain as much papilla as possible. 2011 Sep;25(1):4-15. Itisnecessary toemphasise thefollowing points: I)Reaming ofthemedullary cavity wasnever employed. As already stated, depending on the thickness of the gingiva, any of the following approaches can be used. Periodontal pockets in areas where esthetics is critical. During this whole procedure, the placement of the primary incision is very important because if improperly given it may become short, leaving exposed bone or may become longer requiring further trimming which is difficult. Following are the steps followed during this procedure. During the initial phase of healing, inflammatory cells are attracted by platelet and complement derived mediators and aggregate around the blood clot. The area to be operated is then isolated with the help of gauge. An intrasulcular incision is given all around the teeth to be involved in the surgical procedure. Horizontal incisions are directed along the margin of the gingiva in a mesial or distal direction. 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. The necessary degree of access to the underlying bone and root surfaces and the final position of the flap must be considered when designing the flap. 12 or no. After the removal of the secondary flap, scaling and root planing is done and the flap is adapted to its position. The modified Widman flap is indicated in cases of perio-dontitis with pocket depths of 5-7 mm. 1- initial internal bevel incision 2- crevicular incisions 3- initial elevation of the flap 4- vertical incisions extending beyond the mucogingival junction 5- SRP performed 6- flap is apically positioned 7- place periodontal dressing to ensure the flap remains apically displaced It is indicated where complete access to the bone is required, for example, in the case of osseous resective surgeries. Persistent inflammation in areas with moderate to deep pockets. Papillae are then sutured with interrupted or horizontal mattress sutures. In case where the soft tissue is quite thick, this incision. 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 . Undisplaced flaps are one of the most common periodontal surgeries for correcting anatomical factors that predispose patients to predisposing periodontal disease, and makes it possible to improve aesthetics by eliminating obstacle of wearing a denture. After healing, the resultant architecture of the area should enhance the ease and effectiveness of self-performed oral hygiene measures by the patient. Contents available in the book .. The main advantages of this procedure are the preservation of maximum healthy tissue and minimum post-operative discomfort to the patient. Ahmad Syaify, Sp.Perio (K) Spesialis Konsultan Bedah Perio & Estetik. Contents available in the book .. The local anesthetic agent is delivered to achieve profound anesthesia. Alveolar crest reduction following full and partial thickness flaps. Contents available in the book . To preserve the present attached gingiva or even to establish an adequate strip of it, where it is narrow or absent. Periodontal flaps involve the use of horizontal (mesialdistal) and vertical (occlusalapical) incisions. a. Non-displaced flap. 1. May cause esthetic problems due to root exposure. 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. Rough handling of the tissue and long duration of the surgery commonly result in post-operative swelling. The periosteum left on the bone may also be used for suturing the flap when it is displaced apically. Step 7:Continuous, independent sling sutures are placed in both the facial and palatal areas (Figure 59-3, I and J) and covered with a periodontal surgical pack. The internal bevel incision should be scalloped into the interdental area to preserve the interdental papilla (see Figure 59-2). 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. Contents available in the book . 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). The flap also allows the gingiva to be displaced to a different location in patients with mucogingival involvement. Pockets around the teeth in which a complete removal of root irritants is not clinically possible without gaining complete access to the root surfaces. It is discarded after the crevicular (second) and interdental (third) incisions are performed (Figure 57-5). That portion of the gingiva left around the tooth contains the epithelium of the pocket lining and the adjacent granulomatous tissue. The secondary flap removed, can be used as an autogenous connective tissue graft. 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? 4. The first step . 6. 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. Internal bevel and is 0.5-1.0mm from gingival margin Modified Widman Flap The location of the primary incision is based on the thickness of the gingiva, width of attached gingiva, the contour of the gingival margins, surgical objectives, and esthetic considerations. 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. May cause attachment loss due to surgery. This preview shows page 166 - 168 out of 197 pages.. View full document. Contents available in the book .. 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. The apically displaced flap is . Table 1: showing thickness of gingiva in maxillary tooth region . The challenging nature of scaphoid fracture and nonunion surgery make it an obvious target. that still persist between the bottom of the pocket and the crest of the bone. The partial-thickness flap is indicated when the flap is to be positioned apically or when the operator does not want to expose bone. As soon the granulation tissue is removed, the clear bone margins and root surfaces are visible. In areas with shallow periodontal pocket depth. Flaps in which the interdental papilla is split beneath the contact of two approximating teeth, allowing the reflection of buccal and lingual flaps, are described as the conventional flaps. Coronally displaced flap Connective tissue autograft Free gingival graft Laterally positioned flap Apically displaced flap 5. 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. Periodontal flap surgery with conventional incision commonly results in gingival recession and loss of interdental papillae after treatment. Contents available in the book . 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. Before we go into the details of the periodontal flap surgeries, let us discuss the incisions used in surgical periodontal therapy. 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 . After removing the wedge of the tissue the margins of the flap are undermined with the help of scalpel blades, In this technique, two incisions are made with the help of no. Position of the knife to perform the internal bevel incision. Square, parallel, or H design. After the primary incision, tissue can now be retracted with the help of rat-tail pliers. Following is the description of step by step procedure followed while doing a modified Widman flap surgery. The modified Widman flap. 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: After the gingivectomy incision, primary and the secondary incisions are placed in the same way as described in the partial-thickness flap procedure. Contents available in the book .. After it is removed there is minimum bleeding from the flaps as well as the exposed bone. Signs and symptoms may include continuous flow, oozing or expectoration of blood or copious pink saliva. The information presented in this website has been collected from various leading journals, books and websites. These vertical incisions are now joined with a horizontal incision as shown in the following figure. Sutures are removed after one week and the area is irrigated with normal saline. In the present discussion, we shall study in detail, the current concepts and advances in various periodontal flap surgeries. Long-term outcome of undisplaced fatigue fractures of the femoral neck in young male adults; The aim of this review is to determine the use of 3D printed technologies in the treatment of scaphoid fractures. 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. Unsuitable for treatment of deep periodontal pockets. Contents available in the book .. 4. The first incision or the internal bevel incision is then made from the bleeding points directed at an apical level to the alveolar crest. Conflicting data surround the advisability of uncovering the bone when this is not actually needed. It conserves the relatively uninvolved outer surface of the gingiva. According to management of papilla: Posterior spinal fusion for adolescent idiopathic scoliosis using a convex pedicle screw technique; . 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. Diagram showing the location of two different areas where the internal bevel incision is made in an undisplaced flap. The modified Widman flap facilitates instrumentation for root therapy. 15 scalpel blade, parallel to each other beginning at the distal end of the edentulous area, continued to the tooth. Connective tissue grafting harvesting techniques as well as free gingival graft. 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. a. This drawback of conventional flap techniques led to the development of this flap technique which intended to spare the papilla instead of splitting it. The patient is recalled after one week for suture removal. The partial-thickness flap includes only the epithelium and a layer of the underlying connective tissue. Contents available in the book .. This is mainly because of the reason that all the lateral blood supply to . No incision is made through the interdental papillae. 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. Burkhardt R, Lang NP. 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. 12 or no. in adults. Contents available in the book .. This increase in the width of the attached gingiva is based on the apical shift of the mucogingival junction, which may include the apical displacement of the muscle attachments. Because the pocket wall is not displaced apically, the initial incision should eliminate the pocket wall. Normal interincisal opening is approximately 35-45mm, with mild . Intrabony pockets on distal areas of last molars. This will allow the clinician to retain the maximum amount of gingival tissue, including the papilla, which is essential for graft or membrane coverage. The use of continuous suturing in suture materials tearing through the flap edges and both plastic surgery (1) and periodontal surgery subsequent retraction of the flaps to less desirable has many advantages. 1. Step 2:The gingiva is reflected with a periosteal elevator (Figure 59-3, D). 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. It differs from the modified Widman flap in that the soft-tissue pocket wall is removed with the initial incision; thus, it may be considered an internal bevel gingivectomy. The undisplaced flap and the gingivectomy are the two techniques that surgically remove the pocket wall. The area is then irrigated with an antimicrobial solution. In this technique no. Enter the email address you signed up with and we'll email you a reset link. If a full-thickness flap has been elevated, the sutures are placed along the mesial and the distal vertical incision lines to. The operated area will be cleaner without dressing and will heal faster. Assign a 'primary' menu craigslist hattiesburg ms community ; cottonwood financial administrative services, llc Clubbing Tar Staining Signs of other disease Hands warm and well perfused Salbutamol and CO2 retention flap Radial rate and rhythm respiratory rate Pattern of breathing ASK FOR BP FACE Eye . Pronounced gingival overgrowth, which is handled more efficiently by means of gingivectomy / gingivoplasty. 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. The blade is introduced into the sulcus or pocket and is inserted as far as possible into the interdental space around the tooth, keeping it close to the crown. Areas where greater probing depth reduction is required. The incisions made should be reverse bevel to achieve thinning of tissue so that an adequate final approximation of the flaps can be achieved. Its final position is not determined by the placement of the first incision. This is a modification of the partial thickness palatal flap procedure in which gingivectomy is done prior to the placement of primary and the secondary incision. Locations of the internal bevel incisions for the different types of flaps. 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. Short anatomic crowns in the anterior region. After the flap has been elevated, a wedge of tissue remains on the teeth and is attached by the base of the papillae. Contents available in the book .. 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. The beak-shaped no. It is contraindicated in areas where the width of attached gingiva would be reduced to < 3 mm. Contents available in the book .. 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 most abundant cells during the initial healing phase are the neutrophils. Conflicting data surround the advisability of uncovering the bone when this is not actually needed. 1972 Mar;43(3):141-4. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window). The periodontal dressing is not required if the flap has been adapted adequately to cover the interdental area. This incision is placed through the gingival sulcus. This incision is indicated in the following situations. Root planing is done followed by osseous surgery if needed. Contents available in the book .. With this access, the surgeon is able to make the third incision, which is also known as the interdental incision, to separate the collar of gingiva that is left around the tooth. Most commonly done suturing is the interrupted suturing. The secondary. The beak-shaped no. Flaps are used for pocket therapy to accomplish the following: 1. Therefore, these flaps accomplish the double objective of eliminating the pocket and increasing the width of the attached gingiva. Step 1:The initial incision is an internal bevel incision to the alveolar crest starting 0.5mm to 1mm away from the gingival margin (Figure 59-3, C). 2006 Aug;77(8):1452-7. The first documented report of papilla preservation procedure was by Kromer 24 in 1956, which was designed to retain osseous implants. The area is re-inspected for any remaining granulation tissue, tissue tags or deposits on the root surfaces. 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. 12 or no. in 1985 28 introduced a detailed description of the surgical approach reported earlier by Genon and named the technique as Papilla Preservation Flap. The granulomatous tissue is then removed and the deposits on the root surfaces are removed by scaling. Vertical relaxing incisions are usually not needed. Henry H. Takei, Fermin A. Carranza and Jonathan H. Do. More is the thickness of the gingiva, farther is the incision placed to include more tissue which needs to be removed. Conventional flaps include: The modified Widman flap, The undisplaced flap, The apically displaced flap, The flap for regenerative procedures. These techniques are described in detail in. Displaced flap: This is especially important in maxillary and mandibular anterior areas which have a prime esthetic concern. The most likely etiologic factor is local anesthetic, secondary to an inferior alveolar nerve block that penetrates the medial pterygoid muscle. Contraindications of periodontal flap surgery. Unrealistic patient expectations or desires. The term gingival ablation indicates? To preserve the present attached gingiva or even to establish an adequate strip of it, where it is narrow or absent. To perform this technique without creating a mucogingival problem, the clinician should determine that enough attached gingiva will remain after removal of the pocket wall. After this, the second or the sulcular incision is made from the bottom of the pocket till the crest of the alveolar bone. Our courses are designed to. Contents available in the book .. It is most commonly caused due to infection and sloughing of blood vessels. The modified Widman flap facilitates instrumentation for root therapy. A periodontal flap is a section of gingiva and/or mucosa surgically separated from the underlying tissue to provide visibility and access to the bone and root surfaces, Periodontal flap surgeries are also done for the establishment of. ), Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on 59: The Flap Technique for Pocket Therapy, Several techniques can be used for the treatment of periodontal pockets. Ramfjord SP, Nissle RR. An intact papilla should be either excluded or included in the flap. Periodontal pockets in severe periodontal disease. Following is the description of these flaps. b. Papilla preservation flap. Contents available in the book .. After the patient has been thoroughly evaluated and pre-pared with non-surgical periodontal therapy, quadrant or area to be operated is selected. This incision has also been termed the first incision, because it is the initial incision for the reflection of a periodontal flap; it has also been called the reverse bevel incision, because its bevel is in reverse direction from that of the gingivectomy incision. When the flap is placed apically, coronally or laterally to its original position. 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 Flap reflection till alveolar mucosa to mobilize the flap causes more post-operative pain and discomfort. After pushing the papillae buccally, both the flap and the papilla are reflected off the bone with a periosteal elevator. The buccal and palatal/lingual flaps are reflected with the help of a periosteal elevator. The first step, Trismus is the inability to open the mouth. 2. It enhances the potential for effective periodontal maintenance and preservation of attachment levels. During the initial phase of healing, inflammatory cells are attracted by platelet and complement derived mediators and aggregate around the blood clot. These incisions are made in a horizontal direction and may be coronally or apically directed. 1. Semiconductor chip assemblies, methods of making same and components for sameSemiconductor chip assemblies, methods of making same and components for same .. .. . Thus, an incision should not be made too close to the tooth, because it will not eliminate the pocket wall, and it may result in the re-creation of the soft-tissue pocket.
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