5. Access Flaps

Question 1

What is removed in a modified widman flap

Answer 1

sulcular epithelium
pocket epithelium
JE

Question 2

New CT forms in what direction

Answer 2

apical to coronal

Question 3

Purpose of membranes

Answer 3

prevent the oral epithelium from contacting the clot that facilitates perio regeneration and CT attachment

Question 4

ENAP and LANAP mean

Answer 4

Excisional new attachment procedure

Laser assisted new attachment procedure

Question 5

LANAP removes _ and leaves _

Answer 5

Removes diseased pocket epithelium

Leaves CT

Question 6

Patients have (more/less) recession and root sensitivity with LANAP

Answer 6

less

Question 7

New cementum, PDL, and attachment to the root is formed by what for LANAP

Answer 7

stem cells

Question 8

Is LA needed with LANAP

Answer 8

yes

Question 9

Laser for LANAP should be held _ in relation to the root surface

Answer 9

parallel

Question 10

How is the pocket epithelium removed with LANAP

Answer 10

photothermolysis

Question 11

How many passes are done with the laser in LANAP

Answer 11

2

Question 12

ADA statements on lasers

Answer 12

• More data on lasers is needed to know what extent LANAP is safe and effective
• Lasers have only inconsistently shown the ability to reduce microorganisms within a perio pocket
• Lasers for the purpose of improved wound healing is contraversial and not well supported by studies

Question 13

Can lasers harm patients

Answer 13

yes and no- if the inappropriate wavelength is used the laser can damage the perio tissues

Question 14

What is the superior wavelength for lasers

Answer 14

hasn’t yet be determined

Question 15

What are the two classifications of perio flaps

Answer 15

• Full thickness

- Partial (split) thickness

Question 16

Describe a full thickness flap

Answer 16

• Bone completely exposed
• Periosteum included in the flap
• Blunt disection
• Used for osseous surgery, osseous grafting, and guided tissue regenertion
• associated with more bone resorption

Question 17

Describe partial (split) thickness flap

Answer 17

• Bone still covered by periosteum and CT
• Sharp disection
• Use in areas of thin bone dehiscence, and fenestration

Question 18

Most common location in the mouth for split thickness flap

Answer 18

Where the roots are prominent in the arch (thinner bone)

• Cuspids
• Maxillary 1st molars (MB root)

Question 19

Periodontal flaps in addition to being classified based on their thickness are also classified based on

Answer 19

-Their position post operatively

replaced and positioned

Question 20

Describe the difference between replaced and positioned flaps

Answer 20

Replaced

• Put back where it originally was
• AKA undisplaced and repositioned

Positioned

• AKA displaced or moved
• Apically positioned
• Laterally positioned
• Coronally positioned

Question 21

What is the most common flap in perio surgery

Answer 21

-Apically positioned flap

Question 22

Apically positioned flap are

Answer 22

• Get rid of perio pockets
• Exposed root surfaces
• Width of keratinized tissue is maintained

Question 23

Coronally positioned flap

Answer 23

-Cover root surfaces

Question 24

Laterally positioned flaps

Answer 24

-Also to cover root surfaces (mucogingival defects)

Question 25

Coronally positioned flaps are most commonly done with (full/split) thickness flaps

Answer 25

split

Question 26

Laterally positioned flaps are most commonly done with (full/split) thickness flaps ... except when

Answer 26

split...thin biotype

Question 27

Describe papilla preservation

Answer 27

- No incision through the papilla - B and a L flap - Flap is typically brought to the lingual

Question 28

Papilla preservation is especially useful when

Answer 28

- Holding in graft material | - Esthetic areas (prevents black triangles)

Question 29

Closed procedures are ususally done in what phase of perio therapy

Answer 29

initial phase (SRP)

Question 30

Downsides of closed procedures are

Answer 30

-Rely on tactile sense (poorer results in deeper pockets)

Question 31

Benefits of open procedures

Answer 31

- Visualize and access - Root surface (subgingival calculus and root defect-- i.e cracks) - Alveolar bone (morphology of the osseous defect-- i.e number of walls) - Furcations

Question 32

Compare a gingivectomy with a flap

Answer 32

Gingivectomy - Heals with secondary intention - "fast" procedure - No reattachment - Some post-op bleeding - No visibility of alveolar bone - Removes a good deal of keratinized tissue Falps - Heals by primary intention - "Slower" procedure - Possible reattachment - Minimal post op bleeding - Good visibility of bone - Preserves more keratinized gingiva

Question 33

Internal bevel incision location is dependent on

Answer 33

the depth of the pocket and the thickness of the tissue

Question 34

Describe a modified Widman flap

Answer 34

- Paramarginal internal bevel incision - Percise incisions - Partial flap reflection (not past the MGJ - Goal is not pocket eliminaiton rather pocket "healing"

Question 35

Indications for modified Widman

Answer 35

- All types of periodontitis - Especially pocket depths of 5-7 mm - May be used with other procedures (wedge excisions and reflected flaps)

Question 36

Modified Widman is a (replaced/positioned) flap

Answer 36

replaced

Question 37

Healing of a modified widman is by (primary/secondary) intention

Answer 37

primary

Question 38

Advantages of the Modified Widman

Answer 38

- Root debridment with direct vision - Tissue friendly (minimal bleeding and recession) - Heals by primary intention - Minimal loss of crestal bone - Minimal post-op discomfort

Question 39

Another name for modified widman is

Answer 39

open flap curretage

Question 40

Steps for an open flap curretage procedure

Answer 40

``` First incision -Paramarginal -Scalloping -Parallel to long axis of the tooth -~ 1 mm from the gingival margin -Extended interproximally as far as possible Flap reflection (only within the keratinizaed gingiva) Second incision- sulcular Third incision- horizontal (interproximal) Remove the collar of soft tissue -Root debridmenet -Flap repositioning and suturing ```

Question 41

Why is the modified widman extended interproximally as far as possible

Answer 41

to achieve primary closure --> healing by primary intention --> papilla preservation

Question 42

Incision of a modified widman will contain

Answer 42

sulcular eptihelium and may contain JE

Question 43

Modified widman is a (full/partial) thickness flap

Answer 43

full

Question 44

Why back in the day dis some people treat the root surfaces with a diamond

Answer 44

remove necrotic cementum make a biologically compatible surface for attachement

Question 45

What technique is best for interproximal suturing and why

Answer 45

loops because you get primary closure and you don't get suture material between the flaps