2. INTRODUCTION
• Comprises of
- elevationof softtissueflap,
-removalofthebone,and
-sectioningoftherootofthetooth.
• Often called the open or surgical method.
21. The technical goals to be achieved
1. Toimprove the access
2. Toachieve mechanical advantage
3. To reduce resistance
4. To correct an inadequate path of withdrawal
22. 1. Improved access:
This is done by raising a mucoperiosteal flap
and adequate bone removal.
2. Improved mechanical advantage:
This is achieved by bone removal and
preparation of purchase point.
23. 3. Reduce resistance:
This is achieved by removal of bone support and
sectioning of teeth (Odontectomy).
4. Correct path of removal:
This is achieved by removal of bone and sectioning
of teeth.
25. Principles Of Flap Design
The general indications for flap reflection include the
following:
• To allow for complete access and visualization of the surgical
field.
• Toallow for bone removal and tooth sectioning.
• To prevent unnecessary trauma to soft tissue and bony
structures.
26. The term local flap indicates a section of soft tissue that
1. Is outlined by a surgical incision,
2. Carries its own blood supply,
3. Allows surgical access to underlying tissues,
4. Can be replaced in the original position, and
5. Can be maintained with sutures and is expected to
heal.
27. Types of flap
A.
- Full thickness mucoperiosteal flap
- Partial thickness flap
B.
- Envelope flap
- Two sided triangular flap
- Three sided rhomboid flap
- Semilunar flap
C.
- Labial or Buccal flap
- Palatal or Lingual flap
28. Types of Incisions
Horizontal
• Internal bevel incision - starts at distal area from
the margin and is aimed at bony crest. This is
also known as first incision.
• Crevicular incision - starts at the bottom of the
pocket and is directed to the bony margin. This is
known as second incision.
29. Vertical
a.k.a. releasing incisions, on one or both the sides of
the flap.
• Double vertical incisions on both sides of the flap
will result in trapezoidal flap. The incisions should
extend beyond mucogingival line reaching the
alveolar mucosa to allow the release of a flap for
reflection.
• Vertical incisions should be placed at obtuse angle
to the horizontal incision and should leave
interdental papillae intact.
30. A trapezoidal or four-cornered flap. The base of the
flap (double-ended blue arrow) should be wider than
the coronal aspect of the flap
31. The Incision
When making an incision, the #15 blade should be
carried down to the bone in a full-thickness fashion.
32. Semilunar (curved, elliptical)
This type of incision is used, when it is desirable to
maintain the attached gingiva intact around the teeth
and for endodontic surgery.
36. Envelope flap
Ideally, this type of flap should be extended one tooth
posterior and two teeth anterior to the one being extracted
in order to provide adequate reflection with minimal
tension on the flap.
37.
38.
39.
40.
41.
42.
43.
44. Flap design consideration
AVOID
Incision over boney prominences
Incision through papilla
Incision over facial aspect or mid-
crown
Incision not over sound bone
Vertical incision in the region of
mental foramen
Lingual releasing in the posterior
mandible
Vertical releasing incision in the
posterior palate
RESULTS, IF NOT AVOIDED
Tension, dehiscence and delayed healing
Dehiscence, periodontal defect
Dehiscence, periodontal defect
Collapse and delayed healing
Injury to the mental nerve
Injury to the lingual nerve
Injury to the greater palatine
neurovascular bundle
49. The Placement of Purchase Point
Should be placed close to
the level of the bone.
Should be deep enough to
allow for placement of a Crane
pick.
Enough tooth structure (3 mm)
should be left coronal to the
purchase point to prevent tooth
fracture during elevation.
50. TECHNIQUE FOR SURGICAL EXTRACTION
OF A MULTIROOTED TOOTH
A multirooted tooth can be divided with a bur to convert
it into multiple single-rooted teeth to facilitate its
removal.
51.
52. The tooth is sectioned with a fissure bur on a surgical drill. The
sectioning should extend into the furcation area and about three
quarters of the way through the tooth in a bucco-lingual direction,
avoiding the lingual plate. Note the cut extending into the furcation
area (red arrow).
53.
54.
55. The area is irrigated, especially under the flap,
and then sutured.
72. Indications for Leaving a Root Tip
1. Small root tip less than 4 mm in size.
2. No evidence of periapical pathology or infection
associated with root tip.
3. Inability to visualize root tip
4. Removal of root tip will cause destruction to adjacent
structures
5. Proximity to the inferior alveolar nerve
6. Proximity to the maxillary sinus
7. Ill-feeling patient
8. Uncontrolled hemorrhage
73. Flap Closure
• When the surgical procedure is completed and the
surgical site has been irrigated, the flap can be sutured.
• Suturing the flap holds it in position andreapproximates
the wound margins.
74. Common Mistakes during Surgical
Extractions
• Attempting a simple forcep extraction,
• Poor flap design,
• Inadequate reflection of a flap,
• Use of uncontrolled force,
• Inadequate seating and adaptation of the forceps,
• Attempting the removal of root tips without adequate access
and visualization,
• Inadequate irrigation of the surgical site prior to reapproximation of
the flap,
• Poor reapproximation of the flap.
75.
76. Dr Singhai’s - Dental, Maxillofacial and
Implant Surgery Clinic
Opposite MPEB Office Gate no. 2, Private Bus Stand
Road, Krishnagunj Ward, Sagar (M.P.) - 470002
Contact No.- 9926650936, 7750951013
