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DRJEBIN,MDS.,D.ICOI
DEF:
Aperiodontalflapisasectionofgingivaand/ormucosasurgicallyseparatedfromthe underlyingtissuestoprovidevisibilityandaccesstotheboneandrootsurface.
INDICATIONS: Irregularbonycontours Deepcraters Pocketsonteethinwhichacompleteremovalofrootirritantsisnotclinicallypossible GradeIIorIIIfurcationinvolvement Rootresection/hemisection Intrabonypocketsondistalareasoflastmolars Persistentinflammationinareaswithmoderatetodeeppockets. CONTRAINDICATIONS: Uncontrolledmedicalconditionssuchas unstableangina uncontrolleddiabetes uncontrolledhypertension myocardialinfarction/strokewithin6months Poorplaquecontrol Highcariesrate Unrealisticpatientexpectationsordesires
CLASSIFICATIONOFFLAPS
Classifiedbasedon: Boneexposureafterflapreflection Fullthickness(mucoperiosteal) Partialthickness(mucosal) Placementoftheflapaftersurgery Nondisplacedflaps Displacedflaps Managementofthepapilla Conventionalflaps Papillapreservationflaps
BASEDONFLAPPLACEMENTAFTERSURGERY
Nondisplacedflaps: Whentheflapisreturnedandsuturedinitsoriginalposition.
Displacedflaps: Whentheflapisplacedapically,coronallyorlaterallytotheiroriginalposition
DESIGNOFTHEFLAP
Splitthepapilla(conventionalflap)or Preserveit(papillapreservationflap).
BASEDONMANAGEMENTOFTHEPAPILLA CONVENTIONALFLAP
The interdental papilla is split beneath the contact point of the two approximating teeth to allow reflection of buccal and lingual flaps.
PAPILLAPRESERVATIONFLAP
The papilla preservation flap incorporates the entire papilla in one of the flaps
Envelope Flap
Pedicle Flap
Triangular Flap
INCISIONS
Horizontalincisions. Verticalincisions.
HORIZONTALINCISIONS Horizontalincisionsaredirectedalongthemarginofthegingivainamesialoradistal direction. Twotypesofhorizontalincisionshavebeenrecommended: A)Theinternalbevelincision,whichstartsatadistancefromthegingivalmarginandis aimedatthebonecrest,and B)Thecrevicularincision,whichstartsatthebottomofthepocketandisdirectedtothe bonemargin. C)Inaddition,theinterdentalincision isperformedaftertheflapiselevated.
INTERNALBEVELINCISION