SlideShare una empresa de Scribd logo
1 de 47
Descargar para leer sin conexión
‫صدق هللا العظيم‬
OBJECTIVES OF THE SURGICAL PHASE

1- Improvement of the prognosis of teeth
    and their replacements.
2- Improvement of esthetics.

 The surgical phase consists of techniques
performed for pocket therapy and for the
correction of related morphologic problems,
namely mucogingival defects.
Surgical techniques allow :
1- Increase accessibility to the root
   surface, making it possible to remove
   all irritants.
2- Reduce or eliminate pocket depth.
3- Reshape soft and hard tissues to attain
    a harmonious topography.
Indications for periodontal surgery
1- Areas with irregular bony contours, deep
   craters, and other defects usually require a
   surgical approach.
2- Pockets on teeth in which a complete removal
    of root irritants is not considered clinically
    possible may call for surgery.
3- In cases of furcation involvement of Grade II or
     III, a surgical approach ensures the removal
     of irritants; any necessary root resection or
     hemisection       also    requires   surgical
     intervention.
4- Intrabony pockets on distal areas of last
     molars,  frequently   complicated    by
     mucogingival problems, are usually
     unresponsive to nonsurgical methods.
5- Persistent inflammation in areas with
   moderate to deep pockets may require a
   surgical approach.
Classification of Flaps:
1- Bone exposure after flap reflection.
2- Placement of the flap after surgery.
3- Management of the papilla.

Based on bone exposure after reflection:
** Full thickness (mucoperiosteal) is indicated
  when   resective     osseous      surgery   is
  contemplated.
** Partial thickness (split thickness flap) is
  indicated when the flap is to be positioned
  apically or when the operator does not
  desire to expose bone.
Diagram of the internal bevel incision (first incision) to reflect a full
              thickness and the split thickness flap.
Based on flap placement after surgery, flaps
   are classified):
** Nondisplaced flaps, when theflap is returned
  and sutured in its original position; or 2)
  displaced flas that are placed apically, coronally,
  or laterally.
Based on management of the papilla:
** Flaps can be conventional or papilla
  preservation flaps.
The conventional flap is used:
(1) The interdental spaces are too narrow.
(2) When the flap is to be displaced.
Conventional flaps include the modified
widman and the flap, the undisplaced flap,
the apically displaced flap, and the flap for
regenerative procedure procedures.

Design of the Flap:
   The design of the flap is dictated by the
surgical judgement of the operator and
may depend on the objectives of the
operation.
Horizontal Incisions:
1- The internal bevel incision.
2- Crevicular incision.
3- Interdental incision.
Vertical incisions:
Vertical or oblique releasing incisions can
be used on one or both ends of the
horizontal incision, depending on the
design and purpose of the flap.
Elevation of the Flap:
1- Full thickness flap.
  The reflection is accomplished by blunt
dissection.
2- Partial thickness flap.
   The reflection is accomplished by sharp
dissection.
A, Diagram of the internal bevel incision (first incision) to reflect a tull thickness
(mucoperiosteal) flap. Note that the incision ends on the bone to allow for the reflection of the
entire flap. B, Diagram of the internal bevel incision to reflect a partial thickness flap. Note that
the incision ends on the root surface to preserve the periosteum on the bone.
Sutures for Periodontal Flaps
TYPES
  OF
NEEDLES
Ligation:
Interdental Ligation:
1- The director loop suture.
2- Figure-eight suture.
Sling Ligation:




    A single, interrupted sling suture is used to adapt
                 the flap arount the tooth.
Continuous Independent Sling Suture.




    The continuous, independent sling suture is used to adapt the buccal and lingual flaps
without tying the buccal flap to the lingual flap. The teeth are used to suspend each flap against
the bone. It is important to anchor the suture on the two teeth at the beginning and end of the
flap so that the suture will not pull the buccal flap to the lingual flap.
Anchor Suture




Distal wedge suture. This suture is also used to close
flaps that are mesial or distal to a lone-standing tooth.
Periosteal Suture




This type of suture is used to hold in place apically
         displaced partial thickness flaps.
FLAPS FOR POCKET                 FLAPS FOR
    THERAPY                    REGENERATIVE
                                  SURGERY


1- The modified widman      1- The papilla
    flap.                       preservation flap.
2- The undisplaced flap     2- Conventional flap for
    the palatal flap.           regenerative
3- The apically displaced       surgery.
    flap.
FLAPS FOR POCKET THERAPY

Flaps are used for pocket therapy to
  accomplish the following:
1- Increase accessibility to root deposits.
2- Eliminate or reduce pocket depth by
   resection of the pocket wall.
3- Expose the area to perform regenerative
   methods.
The modified widman flap.

1- Facilitates instrumentation.
2- Removal of the pocket lining.
3- Not eliminate or reduce pocket depth.
The undisplaced (Unrepositioned) flaps.
1- Improving accessibility for instrumentation.
2- Removes the pocket wall.
3- Reducing or eliminating the pocket.




                             Diagram showing the location of
                         different areas where the internal bevel
                         incision is made in an undisplaced flap.
The apically displaced flap:
1- Improving accessibility.
2- Removes the pocket wall.
3- It increases the width of the attached gingiva by transforming the
      previously unattached keratinized pocket wall into attached tissue.
FLAPS FOR REGENERATIVE SURGERY



1- The papilla preservation flap.
2- Conventional flap for regenerative surgery.
  The flap using only crevicular or pocket incisions, to retain the
  maximum amount of gingival tissue, including the papilla, for
  graft or membrane coverage.
Surgery 2
Surgery 2
Surgery 2
Surgery 2
Surgery 2
Surgery 2
Surgery 2

Más contenido relacionado

La actualidad más candente

Periodontal plastic and esthetic surgery
Periodontal plastic and esthetic surgeryPeriodontal plastic and esthetic surgery
Periodontal plastic and esthetic surgeryjosna thankachan
 
TOOTH SUPPORTED OVERDENTURE
TOOTH SUPPORTED OVERDENTURETOOTH SUPPORTED OVERDENTURE
TOOTH SUPPORTED OVERDENTUREshari kurup
 
Complications of lower anterior implants| Complications of Dental Implants by...
Complications of lower anterior implants| Complications of Dental Implants by...Complications of lower anterior implants| Complications of Dental Implants by...
Complications of lower anterior implants| Complications of Dental Implants by...Dr. Rajat Sachdeva
 
dental implant impression technique
dental implant impression technique dental implant impression technique
dental implant impression technique Sara Zaky
 
Standard surgical procedure for implant placement
Standard surgical procedure for implant placement Standard surgical procedure for implant placement
Standard surgical procedure for implant placement Diana Abo el Ola
 
Curettage, gingivectomy & gingivoplasty
Curettage, gingivectomy & gingivoplastyCurettage, gingivectomy & gingivoplasty
Curettage, gingivectomy & gingivoplastysameerahmed233
 
Restorative interrelationships(carranza 2012)
Restorative interrelationships(carranza 2012) Restorative interrelationships(carranza 2012)
Restorative interrelationships(carranza 2012) Meysam Aryam
 
Periodontal surgery
Periodontal surgeryPeriodontal surgery
Periodontal surgeryEnas Elgendy
 
Balanced occlusion aditi ghai
Balanced occlusion aditi ghaiBalanced occlusion aditi ghai
Balanced occlusion aditi ghaiAditi Ghai
 
Modified Papilla Preservation Technique
Modified Papilla Preservation TechniqueModified Papilla Preservation Technique
Modified Papilla Preservation TechniqueWendy Jeng
 
Gingival tissue management
Gingival tissue managementGingival tissue management
Gingival tissue managementAnkit Patel
 
Ridge Split Techniques.pptx
Ridge Split Techniques.pptxRidge Split Techniques.pptx
Ridge Split Techniques.pptxRinisha Sinha
 
Lip Repositioning flap.pptx
Lip Repositioning flap.pptxLip Repositioning flap.pptx
Lip Repositioning flap.pptxAlexJames725570
 

La actualidad más candente (20)

The Periodontal flap
The Periodontal flapThe Periodontal flap
The Periodontal flap
 
Immediate implants
Immediate implants Immediate implants
Immediate implants
 
General Principles of Surgical Techniques for Periodontal Regeneration
General Principles of Surgical Techniques for Periodontal RegenerationGeneral Principles of Surgical Techniques for Periodontal Regeneration
General Principles of Surgical Techniques for Periodontal Regeneration
 
Periodontal plastic and esthetic surgery
Periodontal plastic and esthetic surgeryPeriodontal plastic and esthetic surgery
Periodontal plastic and esthetic surgery
 
036. mucogingival surgery
036. mucogingival surgery036. mucogingival surgery
036. mucogingival surgery
 
Periodontal plastic surgery
Periodontal plastic surgeryPeriodontal plastic surgery
Periodontal plastic surgery
 
TOOTH SUPPORTED OVERDENTURE
TOOTH SUPPORTED OVERDENTURETOOTH SUPPORTED OVERDENTURE
TOOTH SUPPORTED OVERDENTURE
 
Complications of lower anterior implants| Complications of Dental Implants by...
Complications of lower anterior implants| Complications of Dental Implants by...Complications of lower anterior implants| Complications of Dental Implants by...
Complications of lower anterior implants| Complications of Dental Implants by...
 
dental implant impression technique
dental implant impression technique dental implant impression technique
dental implant impression technique
 
Standard surgical procedure for implant placement
Standard surgical procedure for implant placement Standard surgical procedure for implant placement
Standard surgical procedure for implant placement
 
Ridge augmentation
Ridge augmentationRidge augmentation
Ridge augmentation
 
Gingivectomy
GingivectomyGingivectomy
Gingivectomy
 
Curettage, gingivectomy & gingivoplasty
Curettage, gingivectomy & gingivoplastyCurettage, gingivectomy & gingivoplasty
Curettage, gingivectomy & gingivoplasty
 
Restorative interrelationships(carranza 2012)
Restorative interrelationships(carranza 2012) Restorative interrelationships(carranza 2012)
Restorative interrelationships(carranza 2012)
 
Periodontal surgery
Periodontal surgeryPeriodontal surgery
Periodontal surgery
 
Balanced occlusion aditi ghai
Balanced occlusion aditi ghaiBalanced occlusion aditi ghai
Balanced occlusion aditi ghai
 
Modified Papilla Preservation Technique
Modified Papilla Preservation TechniqueModified Papilla Preservation Technique
Modified Papilla Preservation Technique
 
Gingival tissue management
Gingival tissue managementGingival tissue management
Gingival tissue management
 
Ridge Split Techniques.pptx
Ridge Split Techniques.pptxRidge Split Techniques.pptx
Ridge Split Techniques.pptx
 
Lip Repositioning flap.pptx
Lip Repositioning flap.pptxLip Repositioning flap.pptx
Lip Repositioning flap.pptx
 

Similar a Surgery 2

periodontal_flap_one_2-10-2013.ppt
periodontal_flap_one_2-10-2013.pptperiodontal_flap_one_2-10-2013.ppt
periodontal_flap_one_2-10-2013.pptHoeliom
 
perioflapssss-150308033218-conversion-gate01.pdf
perioflapssss-150308033218-conversion-gate01.pdfperioflapssss-150308033218-conversion-gate01.pdf
perioflapssss-150308033218-conversion-gate01.pdfVineeta Gupta
 
Flap Design for Minor Oral Surgery
Flap Design for Minor  Oral SurgeryFlap Design for Minor  Oral Surgery
Flap Design for Minor Oral Surgeryssuseraf61fb
 
Periodontal flap (Carranza 57)
Periodontal flap (Carranza 57)Periodontal flap (Carranza 57)
Periodontal flap (Carranza 57)Dara Ghaznavi
 
Periodontal Flap.pptx
Periodontal Flap.pptxPeriodontal Flap.pptx
Periodontal Flap.pptxChhayaDev
 
Endodontic surgery
Endodontic surgeryEndodontic surgery
Endodontic surgeryakhil shetty
 
Periodontal flap design for access on osseous surgery
Periodontal flap design for access on osseous surgeryPeriodontal flap design for access on osseous surgery
Periodontal flap design for access on osseous surgeryDisha Rai
 
Preprosthetic surgery.pdf
Preprosthetic surgery.pdfPreprosthetic surgery.pdf
Preprosthetic surgery.pdfdrsiva77
 
periodontal flap
periodontal flapperiodontal flap
periodontal flaps farrokhi
 
Root coverage procedures periodontics.pptx
Root coverage procedures periodontics.pptxRoot coverage procedures periodontics.pptx
Root coverage procedures periodontics.pptxwanidayim1
 
Acquired maxillary defects copy removeable
Acquired maxillary defects copy removeableAcquired maxillary defects copy removeable
Acquired maxillary defects copy removeableHishamBakar
 

Similar a Surgery 2 (20)

periodontal_flap_one_2-10-2013.ppt
periodontal_flap_one_2-10-2013.pptperiodontal_flap_one_2-10-2013.ppt
periodontal_flap_one_2-10-2013.ppt
 
Flap techniques for pocket therapy
Flap techniques for pocket therapy  Flap techniques for pocket therapy
Flap techniques for pocket therapy
 
perioflapssss-150308033218-conversion-gate01.pdf
perioflapssss-150308033218-conversion-gate01.pdfperioflapssss-150308033218-conversion-gate01.pdf
perioflapssss-150308033218-conversion-gate01.pdf
 
periodontal flap techniques
periodontal flap techniquesperiodontal flap techniques
periodontal flap techniques
 
flap surgery.pptx
flap surgery.pptxflap surgery.pptx
flap surgery.pptx
 
The periodontal flap
The periodontal flapThe periodontal flap
The periodontal flap
 
Flap Design for Minor Oral Surgery
Flap Design for Minor  Oral SurgeryFlap Design for Minor  Oral Surgery
Flap Design for Minor Oral Surgery
 
Periodontal flaps
Periodontal flapsPeriodontal flaps
Periodontal flaps
 
Periodontal flap (Carranza 57)
Periodontal flap (Carranza 57)Periodontal flap (Carranza 57)
Periodontal flap (Carranza 57)
 
Periodontal Flap.pptx
Periodontal Flap.pptxPeriodontal Flap.pptx
Periodontal Flap.pptx
 
Endodontic surgery
Endodontic surgeryEndodontic surgery
Endodontic surgery
 
Periodontal flap design for access on osseous surgery
Periodontal flap design for access on osseous surgeryPeriodontal flap design for access on osseous surgery
Periodontal flap design for access on osseous surgery
 
Preprosthetic surgery.pdf
Preprosthetic surgery.pdfPreprosthetic surgery.pdf
Preprosthetic surgery.pdf
 
periodontal flap
periodontal flapperiodontal flap
periodontal flap
 
Root coverage procedures periodontics.pptx
Root coverage procedures periodontics.pptxRoot coverage procedures periodontics.pptx
Root coverage procedures periodontics.pptx
 
Surgical exodontia
Surgical exodontiaSurgical exodontia
Surgical exodontia
 
Periodontal flap
Periodontal flapPeriodontal flap
Periodontal flap
 
Transalveolar Extraction
Transalveolar ExtractionTransalveolar Extraction
Transalveolar Extraction
 
Vishal
VishalVishal
Vishal
 
Acquired maxillary defects copy removeable
Acquired maxillary defects copy removeableAcquired maxillary defects copy removeable
Acquired maxillary defects copy removeable
 

Surgery 2

  • 2.
  • 3. OBJECTIVES OF THE SURGICAL PHASE 1- Improvement of the prognosis of teeth and their replacements. 2- Improvement of esthetics. The surgical phase consists of techniques performed for pocket therapy and for the correction of related morphologic problems, namely mucogingival defects.
  • 4. Surgical techniques allow : 1- Increase accessibility to the root surface, making it possible to remove all irritants. 2- Reduce or eliminate pocket depth. 3- Reshape soft and hard tissues to attain a harmonious topography.
  • 5.
  • 6. Indications for periodontal surgery 1- Areas with irregular bony contours, deep craters, and other defects usually require a surgical approach. 2- Pockets on teeth in which a complete removal of root irritants is not considered clinically possible may call for surgery. 3- In cases of furcation involvement of Grade II or III, a surgical approach ensures the removal of irritants; any necessary root resection or hemisection also requires surgical intervention.
  • 7. 4- Intrabony pockets on distal areas of last molars, frequently complicated by mucogingival problems, are usually unresponsive to nonsurgical methods. 5- Persistent inflammation in areas with moderate to deep pockets may require a surgical approach.
  • 8. Classification of Flaps: 1- Bone exposure after flap reflection. 2- Placement of the flap after surgery. 3- Management of the papilla. Based on bone exposure after reflection: ** Full thickness (mucoperiosteal) is indicated when resective osseous surgery is contemplated. ** Partial thickness (split thickness flap) is indicated when the flap is to be positioned apically or when the operator does not desire to expose bone.
  • 9. Diagram of the internal bevel incision (first incision) to reflect a full thickness and the split thickness flap.
  • 10. Based on flap placement after surgery, flaps are classified): ** Nondisplaced flaps, when theflap is returned and sutured in its original position; or 2) displaced flas that are placed apically, coronally, or laterally. Based on management of the papilla: ** Flaps can be conventional or papilla preservation flaps. The conventional flap is used: (1) The interdental spaces are too narrow. (2) When the flap is to be displaced.
  • 11. Conventional flaps include the modified widman and the flap, the undisplaced flap, the apically displaced flap, and the flap for regenerative procedure procedures. Design of the Flap: The design of the flap is dictated by the surgical judgement of the operator and may depend on the objectives of the operation.
  • 12.
  • 13. Horizontal Incisions: 1- The internal bevel incision. 2- Crevicular incision. 3- Interdental incision.
  • 14. Vertical incisions: Vertical or oblique releasing incisions can be used on one or both ends of the horizontal incision, depending on the design and purpose of the flap.
  • 15.
  • 16.
  • 17. Elevation of the Flap: 1- Full thickness flap. The reflection is accomplished by blunt dissection. 2- Partial thickness flap. The reflection is accomplished by sharp dissection.
  • 18. A, Diagram of the internal bevel incision (first incision) to reflect a tull thickness (mucoperiosteal) flap. Note that the incision ends on the bone to allow for the reflection of the entire flap. B, Diagram of the internal bevel incision to reflect a partial thickness flap. Note that the incision ends on the root surface to preserve the periosteum on the bone.
  • 21. Ligation: Interdental Ligation: 1- The director loop suture. 2- Figure-eight suture.
  • 22. Sling Ligation: A single, interrupted sling suture is used to adapt the flap arount the tooth.
  • 23. Continuous Independent Sling Suture. The continuous, independent sling suture is used to adapt the buccal and lingual flaps without tying the buccal flap to the lingual flap. The teeth are used to suspend each flap against the bone. It is important to anchor the suture on the two teeth at the beginning and end of the flap so that the suture will not pull the buccal flap to the lingual flap.
  • 24. Anchor Suture Distal wedge suture. This suture is also used to close flaps that are mesial or distal to a lone-standing tooth.
  • 25. Periosteal Suture This type of suture is used to hold in place apically displaced partial thickness flaps.
  • 26.
  • 27. FLAPS FOR POCKET FLAPS FOR THERAPY REGENERATIVE SURGERY 1- The modified widman 1- The papilla flap. preservation flap. 2- The undisplaced flap 2- Conventional flap for the palatal flap. regenerative 3- The apically displaced surgery. flap.
  • 28. FLAPS FOR POCKET THERAPY Flaps are used for pocket therapy to accomplish the following: 1- Increase accessibility to root deposits. 2- Eliminate or reduce pocket depth by resection of the pocket wall. 3- Expose the area to perform regenerative methods.
  • 29. The modified widman flap. 1- Facilitates instrumentation. 2- Removal of the pocket lining. 3- Not eliminate or reduce pocket depth.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34.
  • 35. The undisplaced (Unrepositioned) flaps. 1- Improving accessibility for instrumentation. 2- Removes the pocket wall. 3- Reducing or eliminating the pocket. Diagram showing the location of different areas where the internal bevel incision is made in an undisplaced flap.
  • 36. The apically displaced flap: 1- Improving accessibility. 2- Removes the pocket wall. 3- It increases the width of the attached gingiva by transforming the previously unattached keratinized pocket wall into attached tissue.
  • 37.
  • 38.
  • 39.
  • 40. FLAPS FOR REGENERATIVE SURGERY 1- The papilla preservation flap. 2- Conventional flap for regenerative surgery. The flap using only crevicular or pocket incisions, to retain the maximum amount of gingival tissue, including the papilla, for graft or membrane coverage.