Periodontal disease chapter
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Simple Flap Procedures

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Simple flap procedures include the Simple Apically Repositioned Flap and the Modified Widman (Reverse Bevel) Flap.

Objective

To gain access to the deeper periodontal structures using a flap reflected from the root and alveolar surfaces.

Indications

  • Active pockets over 4mm deep which are not responding to initial treatment
  • Pockets beyond the muco-gingival line with bone loss
  • Pockets with marginal deformity.

Contraindications

Gingival enlargement by hyperplasia.

 

Method 1: Modified Widman

   
  1. Use a reverse bevel incision at approximately 10 degrees to the long axis of the tooth. Incise around the tooth (teeth) approximately 1mm from the gingival margin. Scallop between teeth to preserve the interdental papilla.
  Modified Widman 1
     
  1. Make releasing incisions at the line angle (imaginary line of roots) of the adjacent healthy teeth.
  Modified Widman 2
     
  1. Reflect full gingival flap with periosteal elevator. A collar of tissue, which includes the sulcus epithelium, should remain attached to the tooth at this time.
  Modified Widman 3
     
  1. Remove remaining collar of tissue with a curette.
  Modified Widman 4
     
  1. Systematically plane the root and correct osseous defects.
  Modified Widman 5
     
  1. Close labial or palatal flaps with interrupted sutures.
  Modified Widman 6
 

Method 2: Apically Repositioned Flap

   
  1. Proceed as above, or via a sulcus incision, without leaving a collar of gingiva attached to the tooth.
   
     
  1. Make releasing incisions at the line angle (imaginary line of roots) of the adjacent healthy teeth.
 
     
  1. Reflect full gingival flap with periosteal elevator beyond the mucogingival junction (MGJ).

   
     
  1. Root plane and curette exposed surface. Any diseased bone is recontoured with a diamond bur in a high speed handpiece or with a Weidelstead chisel.

 
     
  1. Replace the flap further down the long axis of the root to eliminate pocket depth. This is known as apical repositioning. Note that the MGJ line will not be continuous with the adjacent teeth. The redundant tissue can be left to fibrose naturally. A barrier material can be employed to eliminate pockets within the bone before the flap is replaced.

 
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