Oral Surgery Flaps Desgning

This slides are regarding the flaps' principles and flap's designing.

1. MedentaOral & Dental Care
Flaps Designs
Hedayatullah Ehsan (DMD)
[email protected]
[phone]

2. What is flap?
Tissue lifted from it’s position in body (donor site)
Moved to another site (recipient)
+ it’s blood supply
(Pedicle Flap)
Reflected to expose bone for
surgery
The purpose of flaps:
*Defect reconstruction
*Surgical exposure (access)

3. Blade #Dentistry
10 used for Skin
11 I&D (incision and drainage like abscess)
12 inaccessible area (tuberosity)
15 mucoperiosteal surgery (most common)

4. Bard-barker 3#(10,11,12,15)
Bard-barker 4#(18 to 23): no
for dentistry
Bard-barker=Blade holder

5. Principles:
* Asepsis & Antisepsis:
Asepsis:istheavoidanceofpathogenicmicroorganisms.Inpractical
terms,‘aseptictechnique’isonewhichaimstoexcludeall
microorganisms.Surgicaltechniqueisasepticintheuseofsterile
instruments,clothing,andthe‘notouch”technique.
Antisepsis:isanagentortheapplicationofanagentwhichinhibitsthe
growthofmicroorganismswhileincontactwiththem.Scrubbingupand
preparationofoperativesitesareexamplesofantisepsis.
Disinfection:istheinhibitionordestructionofpathogens,whereas
sterilizationisthedestructionorremovalofallformsoflife.Disinfection
usingglutaraldehydeorhypochloriteissecondchoice,forusewhere
truesterilizationisnotfeasible.

6. Principles:
Finger grip: is used for longer
incision (Skin)
Pencil or Pen grasp: 35 -45 degree
accuracy & contact surface: advantages
It is used for shortincisions.
* Scalping Holding:
Power grip: also used for longer
incision but we never start in incision
by this technique bczof it is powerful.
So, we use it for dissecting in another
incisions. We use it in a general surgery
–dissecting under mucoperiosteal

7. *Placement of Incisions (proper placement):
1-Stay on healthy bone and away from defect at least 6mm, preserve papilla.
Principles:
2-Don’t make it on tension areas or prominences like Canine prominence. If we don’t
follow this rule it will cause flap dehiscence(Opening the surgical wound).

8. *Base of Flap ˃ Heightof Flap ( X ˃ Y):
Principles:
* Cut in sharp perpendicularcut: Try to cut vertically not oblique bczit
decreases the healing (flap necrosis)
Perpendicular:
Perpendicularlines are lines
that intersect at a 90 degrees
angle.

9. Principles:
*Aim is to avoid the Complications:
1: Flap Tearing
2: Flap Necrosis
3: Flap Opening

10. Flaps:
Perfect Surgeon must have the heart of the lion and
the hands of a lady, not the claws of a lion and the
heart of a sheep

11. Flaps:
Type of Flap
• Full thickness
–Mucosal tissue + Periosteum
–Preserve periosteum
–Most popular flap in dentistry
• Partial thickness (split thickness)
–Periosteum is left attached to bone
–Able to apically reposition flap
• Increase amount of attached gingiva
–Special OMS/Perioprocedures

12. Types of MucoperiostealFlaps:
Flaps:
1: Gingival or Envelop Flap
2: Two sided or Triangular Flap (Intrasulcular Flap)
3: Three sided or Trapezoidal Flap (Rectangular Flap)
4: Semilunar Flaps
5: Submarginal Flaps
6: Pedicles Flaps

13. Gingival Flap or EnvelopFlap:
Flaps:
–Flap of choice for most procedures
–Full thickness flaps
• sulcular incision withoutvertical releasing incision
–At least one tooth distal to two teeth mesial
• Extend the “coverage” as clinically necessary
• Add on one or two vertical release incision(s)
Indications:
–Cervical resorptive defects
–Cervical area perforations
–Periodontal procedures

14. Two sided or Triangular Flap (IntrasulcularFlap):
Flaps:
Envelope flap with 1 Vertical Release incision
–Next most useful flap for exodontia
–Provide even greater access
• Proximity to apex
• Deeply impacted tooth
Indications:
–Periapical Surgery Posterior areas
–surgical removal of root tips, impacted teeth, small cysts, and
apicectomies

15. Trapezoidalor RectangularFlap (Three sided Flap):
Principles:
Envelope Flap with 2 Vertical Release Incisions ( rectangular flap)
–2 vertical releasing incisions added to a basic envelop flap
–Basic flap with releasing incision design
• 1 distal and 1 mesial from surgical site
Indications:
–Multiple teeth
–Large lesions
–Long roots
–when an extensive surgical field exposure is required
especially when two-sided flap is inadequate

16. SemilunarFlap (CurvedFlap):
Flaps:
–Full thickness
–Not involving gingival sulcus
–Placed partly in attached gingiva and extend into mucosal tissue
–Indications
• Periapical endodontic surgery
• Retrieval of small root tips
• Esthetic crowns
–The lowest point of the incision must be at least 0.5 cm from the
gingival margin
–At least 2mm apical to the base of the gingival sulcus
• Periodontal probing should precede incision

17. SubmarginalFlap:
Flaps:
Indications:
–Prosthetic crowns

18. Y Shaped Flap:
Flaps:
-An incisionis made along the Medline of palate,
as well as two anterolateral incisions, which are
anterior to the canines.
-This type of flap is indicatedin surgical
procedures involving the removal of small
exostoses (torus palatinus).

19. PedicleFlaps:
Flaps:
Pedicle Flaps are suitable for closure of oroantral
communication.
Three Main Types of Pedicle Flaps:
1: Buccal2: Palatal3: Bridge Flaps
Pedicle Bridge Flap is used for closure of oroantral
communication.
Pedicle Buccal & Palatal Flaps are suitable for closure of
oroantral communication.

20. PedicleFlaps:
Flaps:
–Long, narrow flap for complete tissue coverage over
osseous cavity
–Periodontology
• Correctgingival recession
–Closureof oro-antral fistula
–High potential for necrosisand ejection
• Technique sensitiveto maintain adequate blood flow in
the flap

21. Thanks/هننم
دشاب حرطم لاوس!
Ehsan_wardak