Dr Hiroj Bagde

1. INCISIONS AND TISSUE
MANAGEMENT IN
PERIODONTAL SURGERY---
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2. INTRODUCTION
❖ Incision:
A cut or surgical wound made by a knife,
electrosurgical scalpel, laser, or other such instrument.
--- GPT
Severing of tissue by means of a knife, scalpel
--- Peterson
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3. ESSENTIAL PRECONDITIONS FOR
SELECTION
❖ Osseous topography
❖ Blood supply
❖ Protection to anatomic structures
❖ Primary wound closure
❖ Unseen findings ?
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4. WHY PROPER INCISIONS?
❖ Impaired wound healing
❖ Injured nerves and anatomic structures
❖ Esthetic impairment
❖ Anatomical limits
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5. INCISIONS FOR PERIODONTAL
SURGERY
❖ Horizontal incisions
Internal / Apically directed
External / Coronally directed
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6. 6

7. HORIZONTAL INCISIONS
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8. Internal bevel
incision
External bevel
incision
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9. SULCULAR INCISION
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10. INDICATIONS
❖ Access flap surgery
❖ Access flap surgery for GTR
❖ Narrow keratinized gingiva < 3 mm
❖ Esthetically relevant areas
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11. PARAPAPILLARY INCISION
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12. INDICATIONS
❖ Maintain interdental gingiva
❖ Treatment confined to oral/buccal surfaces
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13. PAPILLA PRESERVING
INCISION
❖ Takei et al
Papilla preservation flap incision
❖ Cortellini et al
Modified papilla preservation flap incision
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15. MARGINAL INCISION
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16. ❖ Difficult to perform
❖ No guidance at tooth surface
❖ Slippage
❖ Gingival biotype ( thick)
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17. PARAMARGINAL INCISION
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18. INDICATIONS
❖ >5 mm pocket depth
❖ Esthetics not relevant
❖ Crown lengthening
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19. SPECIAL FORM—CRESCENT
INCISION
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20. WEDGE PROCEDURE
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21. APICAL POSITIONING
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22. 22

23. VERTICAL INCISIONS
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24. 24

25. INCISIONS IN IMPLANTS
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26. 26

27. TISSUE MANAGEMENT
❖ Inflammation free
❖ Oral hygiene proper
❖ Sufficient deep anesthesia
❖ Sharp instruments
❖ Proper instrumentation
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28. ❖ Sutures
❖ Periodontal pack
❖ Microsurgery
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29. CONCLUSION
❖ Proper incisions and proper management of the tissues will
lead to a good healing to occur by repair of the tissues
Hence proper instrumentation and proper
use wherever necessary will help for the periodontal
procedures to be precise and will help to obtain good results.
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