Perio flaps

Perio Flap Designs

1. Flap
Design
Homan Zandi
2004

2. Free
Gingiva
Attached
Gingiva
Mucogingival
Junction
Alveolar Mucosa
Hom
a
n Zandi
Enamel
Connective
T
issue
JE
CEJ

3. Objective
•
T
he
flap
should
offer adequate
a
ccess
and
have an adequate
blood
supply
•
T
he
flap
must be of
adequate
s
ize
and
fully
reflected
•
T
he
edges
must lie
on
the
s
ound bone

4. Mucoperiosteal
Flap
•
M
ucosa
•
C
onnective
t
issue
•P
e
r
io
s
t
e
u
m
Hom
a
n Zandi

5. Considerations
•
T
he
number
of
teeth
involved
in the
s
urgery
•
T
he
length
and shape
of
the
r
oots
involved
•
T
he
dimensions
of
the
lesion
•
T
he
amount
of
attached
gingiva
•
T
he
existence
and depth
o
f
periodontal
pockets
•
T
he
locations of
muscle
a
ttachments
and
frenums
•
T
he
height
o
r depth
o
f
t
he
vestibule
•
T
he
location of
anatomic
structures, such
as
the
neurovascular
bundles and the
m
axillary
sinus

6. Techniques
•
G
ingival flap
•
I
ntrasulcular
flap
(marginal)
–
T
riangular
–
R
ectangular
•
S
emilunar
flap
•
S
ubmarginal
flap
–
O
chsentein-Luebke
f
lap

7. Hom
a
n Zandi

8. Gingival Flap
•
I
ndications –
C
ervical
r
esorptive
defects
–
C
ervical
a
rea
perforations
–
P
eriodontal
procedures
Hom
a
n Zandi

9. Intrasulcular
Flap
(Triangular)
•
I
ndications –
P
eriapical
S
ugery
Postrerior
areas
Hom
a
n Zandi

10. Intrasulcular
Flap
(Rectangular)
•
I
ndications –
M
ultiple teeth
–
L
arge lesions
–
Long
roots
Hom
a
n Zandi

11. Semilunar
F
lap
•
I
ndications –
E
sthetic
c
rowns
Hom
a
n Zandi

12. Submarginal
Flap
Ochsenbein-Luebke
Flap
•
I
ndications –
P
rosthetic
c
rowns
Hom
a
n Zandi

13. Incision
•
T
issue
s
hould
be handled
gently
•
S
harp
dissection
should
be used
•
C
areful
hemostasis
s
hould
be attained
•
T
ension
should
be avoided

14. Hom
a
n Zandi
# 11 Scalpel
#
15C Scalpel

15. Hom
a
n Zandi
# 12 Scalpel

16. Most endodontic surgery
p
roblems can
be avoided
by using
the
f
ollowing
incision
rules
1. Firm
continuous
incision

17. 2) An incision
should
not cross an underlying
bony
defect
Hom
a
n Zandi

18. 2) An incision
should
not cross an underlying
bony
defect
Hom
a
n Zandi

19. 2) An incision
should
not cross an underlying
bony
defect
Hom
a
n Zandi

20. 2) An incision
should
not cross an underlying
bony
defect
Hom
a
n Zandi

21. 3) The
v
ertical
incision
s
hould
be in the
c
oncavities
between
bone eminences
Hom
a
n Zandi

22. Hom
a
n Zandi

23. 4) The
v
ertical
incision
s
hould
not extend
into
the
muccobuccal
fold
Hom
a
n Zandi

24. 4) The
v
ertical
incision
s
hould
not extend
into
the
muccobuccal
fold
Hom
a
n Zandi

25. 5) The
t
ermination
of
the
v
ertical
incision
a
t the
g
ingival
crest
m
ust be at the
m
esial
o
r distal
line angle of
the
tooth
Hom
a
n Zandi

26. 6) The
base of
the
f
lap
m
ust be at least
equal
t
o the
w
idth
of
its
f
ree
end
Hom
a
n Zandi

27. Hom
a
n Zandi

28. Hom
a
n Zandi

29. Hom
a
n Zandi

30. Hom
a
n Zandi

31. Most endodontic surgery
p
roblems can
be
avoided
by using
t
he
following
incision
rules
1)
Firm
continuous
incision
2)
An incision
should
n
ot cross an underlying
b
ony
defect
3)
The
v
ertical
incision
s
hould
be in the
c
oncavities
between
bone eminences
4)
The
v
ertical
incision
s
hould
not extend
into
the
muccobuccal
fold
5)
The
t
ermination
of
the
v
ertical
incision
a
t the
gingival crest
m
ust be at the
m
esial
o
r distal
line
angle of
the
t
ooth
6)
The
b
ase of
the
f
lap
m
ust be at least
equal
t
o the
width
o
f
its
free
end