Periodontal flaps can be classified based on bone exposure, flap placement, and papilla management. A full thickness flap reflects all soft tissue including periosteum to expose bone, while a partial thickness flap reflects only epithelium and connective tissue, leaving bone covered. Flaps can be placed in their original position (non-displaced) or moved to a new position (displaced). Conventional flaps split the papilla while papilla preservation flaps incorporate the entire papilla into one flap. Proper flap design and suturing are important to achieve desired outcomes and promote healing.
Gingivectomy and gingivoplasty are the periodontal surgical procedures. It was first introduced by Pierre fauchard. It is used in pocket elimination by gingival resection whereas gingivoplasty refers to recontouring of gingiva in the absence of pockets.
Gingivectomy and gingivoplasty are the periodontal surgical procedures. It was first introduced by Pierre fauchard. It is used in pocket elimination by gingival resection whereas gingivoplasty refers to recontouring of gingiva in the absence of pockets.
mucogingival surgery or plastic surgery of muco-gingival tissue is a surgical procedure targeted to correct and eliminate anatomic, developmental and traumatic alterations of gingiva.
Periodontitis is a complex infection initiated by bacteria –tissue destruction.
Host: the organism from which a parasite obtains its nourishment/ an individual who receives a graft
Modulation: the alteration of function or status of something in response to a stimulus or an altered physical or chemical environment
Various Plaque Hypothesis are proposed to prove how plaque becomes pathogenic and cause periodontitis. Helpful in understanding pathogenesis of periodontitis especially how Gingivitis change to Periodontitis. All the details have been added and made in easy language to understand.
Useful for BDS and MDS students
ROS is a substractive method of having positive bone architecture. it includes osteotomy and ostectomy procedures. osteotomy is to remove non supporting bone and ostectomy is to remove supporting bone for having positive bony architecture. there is definitive osseous surgery and compromise osseous surgery. transgingival probing is a method of determining osseous topography. various hand and rotary instruments are use for this procedure.
Definition of periodontal pocket, classification, Histopathology of periodontal pocket, microflora involved, pathogenesis, periodontal pocket as a healing lesion, microtopography of root surface, treatment of periodontal pocket
mucogingival surgery or plastic surgery of muco-gingival tissue is a surgical procedure targeted to correct and eliminate anatomic, developmental and traumatic alterations of gingiva.
Periodontitis is a complex infection initiated by bacteria –tissue destruction.
Host: the organism from which a parasite obtains its nourishment/ an individual who receives a graft
Modulation: the alteration of function or status of something in response to a stimulus or an altered physical or chemical environment
Various Plaque Hypothesis are proposed to prove how plaque becomes pathogenic and cause periodontitis. Helpful in understanding pathogenesis of periodontitis especially how Gingivitis change to Periodontitis. All the details have been added and made in easy language to understand.
Useful for BDS and MDS students
ROS is a substractive method of having positive bone architecture. it includes osteotomy and ostectomy procedures. osteotomy is to remove non supporting bone and ostectomy is to remove supporting bone for having positive bony architecture. there is definitive osseous surgery and compromise osseous surgery. transgingival probing is a method of determining osseous topography. various hand and rotary instruments are use for this procedure.
Definition of periodontal pocket, classification, Histopathology of periodontal pocket, microflora involved, pathogenesis, periodontal pocket as a healing lesion, microtopography of root surface, treatment of periodontal pocket
JOURNAL CLUB ON CORONALLY ADVANCED FLAP vs THE POUCH TECHNIQUE COMBINED WITH ...Shilpa Shiv
CORONALLY ADVANCED FLAP vs THE POUCH TECHNIQUE COMBINED WITH A CONNECTIVE TISSUE GRAFT TO TREAT MILLER'S CLASS I GINGIVAL RECESSION, JCP 2014;41(4):387-395.
Minimally Invasive Surgery & Acellular Dermal Matrix to Correct Gingival Rece...Edward Gottesman
Successful root coverage for single or multiple teeth can be achieved with a minimally invasive tunneling technique and acellular derail matrix (Alloderm®).
Presentation given by Dr. Edward Gottesman, periodontist in New York, New York at the American Academy of Periondontology Meeting in San Francisco in September, 2014.
Visit http://perionyc.com for more information.
Gingivectomy means excision of the gingiva.
Gingivoplasty is a reshaping of the gingiva to create physiologic gingival contours with the sole purpose of recontouring the gingiva in the absence of pockets.
REFERENCES TAKEN FROM CARRANZA'S TEXTBOOK OF CLINICAL PERIODONTOLOGY AND LINDHE'S TEXTBOOK OF CLINICAL PERIODONTOLOGY AND IMPLANT DENTISTRY. CONTAINS ENOUGH AND MORE DETAILS OF THIS TOPIC FOR BDS STUDENTS.HOPE THIS PRESENTATION WILL HELP U GAIN SOME KNOWLEDGE ABOUT PERIODONTAL PLASTIC AND ESTHETIC DENTISTRY.
In periodontology, classifications are widely used to categorize defects due to periodontitis according to their etiology, diagnosis, treatment and prognosis.
Several classifications have been proposed in the literature in order to facilitate the diagnosis of gingival recessions.
this presentation covers all the aspects and techniques of flap surgery with relevant diagrams and is made from from authentic text books and articles.
A periodontal flap is a section of gingiva and/mucosa that is surgically separated from the underlying tissue to provide visibility and the access to the bone and the root surface. The flap also allows the gingiva to be displaced to a different location in patients with mucogingival involvement.
In this PowerPoint presentation, the periodontal flap is described under the headings: indication, contraindications, classification of flaps, flap design, horizontal and vertical incisions and various flap technique such as modified widman flap, undisplaced flap, palatal flap, apically displaced flap, papilla preservation flap and distal molar surgery for maxillary and mandibular molars. It also contains healing after flap surgery.
Surgical endodontics(Apicectomy) by Dr. Amit Suryawanshi .Oral & Maxillofac...All Good Things
Description:
Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best & your replies are welcomed!
Surgical endodontics (Apicectomy) by Dr. Amit T. Suryawanshi, Oral Surgeon, ...All Good Things
Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best.
Flap Design, one from important topics in Oral Surgery Syllabus, student must be know:
Definition Incision and flap.
Principles of flap design.
Enumerate types of flap with advantages, disadvantages, indications...
Complications.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
The Periodontal flap
1. T H E P E R I O D O N T A L F L A P
By-
Aananyaa Jhaldiyal
BDS IV year (2009-10)
Roll no. 01
2. A periodontal flap is a section of gingiva &/or mucosa
surgically separated from the underlying tissues to provide
visibility of and access to the bone and root surface.
A flap also allows the gingiva to be displaced to a different
location in patients with mucogingival involvement.
3. Periodontal flaps can be classified as follows –
a) Based on bone exposure after flap reflection
- mucoperiosteal or full thickness flap
- partial thickness or mucosal flap
b) Based on placement of flap after surgery
- displaced flap
- non displaced flap
c) Based on management of papilla
- conventional flap
- papilla preservation flap
4. 1) Full thickness or mucoperiosteal flap-
All the soft tissue, including the periosteum, is reflected to
expose the bone.
Indication- need to view the alveolar bone
2) Partial thickness or mucosal flap-
It includes only the epithelium and a layer of underlying
connective tissue.
The bone remains covered by a layer of connective tissue,
including the periosteum.
Also known as split thickness flap.
Indication- when flap is to be positioned apically, laterally
or coronally; or when the operator does not want to expose
the bone.
A) Based on bone exposure after flap reflection
5. Fig :A) internal bevel incision to reflect full thickness
flap. B) internal bevel incision to reflect a partial
thickness flap.
6. 1) Non – displaced flap
The flap is returned and sutured in its original position.
2) Displaced flap
The flap is placed apically, coronally, or laterally to its original
position.
1) Conventional flap
In this the interdental papilla is split beneath the contact
point of the two approximating teeth to allow reflection of
buccal and lingual flaps.
B ) B a s e d o n f l a p p l a c e m e n t a f t e r s u r g e r y
C ) B a s e d o n m a n a g e m e n t o f p a p i l l a
7. The incision is usually scalloped to maintain gingival
morphology and retain as much papilla as possible.
Indications-
1) When the interdental spaces are too narrow, thereby
precluding the possibility of preserving the papilla.
2) When the flap is to be displaced.
Examples- modified Widman flap, the undisplaced flap,
the apically displaced flap, & the flap for reconstructive
procedures.
2) Papilla preservation flap
In this the entire papilla is incorporated into one of the
flaps by means of crevicular interdental incisions to sever
8. the connective tissue attachment and a horizontal incision
at the base of the papilla, leaving it connected to one of the
flaps.
Indications-
1) When there are open interdental spaces
2) When esthetics is of concern
3) When bone regeneration techniques are attempted.
9. Dictated by the surgical judgment of the operator.
Depend on the objectives of the procedure.
Factors to be considered in designing the flap are-
1) Degree of access to the underlying bone and root
surfaces
2) Final position of the flap
3) Preservation of good blood supply to the flap
Two basic flap designs are used -
1. Conventional flap
2. Papilla preservation flap
10. The incisions for the facial, and the lingual or palatal flap
reach the tip of the interdental papilla or its vicinity,
thereby splitting the papilla into facial half and a lingual
or palatal half.
Fig: flap design for
conventional flap
technique.
1 ) C o n v e n t i o n a l f l a p
11. papilla is preserved ( not split).
The entire surgical procedure should be planned in detail
before the procedure is initiated as detailed planning
allows for a better clinical result.
2 ) P a p i l l a p r e s e r v a t i o n f l a p
12. There are basically two types of periodontal flap
incisions-
Horizontal
incisions
Vertical incisions
1) Internal
bevel
incision
2) Crevicular
incision
3) Interdental
incision
1) Oblique
releasing
incision
13. Horizontal incisions are directed along the margin of the
gingiva in a mesial or a distal direction.
Types of horizontal incisions recommended are-
It is the incision from which the flap is reflected to expose
the underlying bone and root.
1 ) I n t e r n a l b e v e l i n c i s i o n
14. Objectives of internal bevel incision are -
1. It removes the pocket lining
2. Conserves the relatively uninvolved outer surface of the
gingiva, which when apically positioned, becomes
attached gingiva.
3. Produces a sharp, thin flap margin for adaptation to the
bone tooth junction.
This incision is also termed as the first incision because it
is the initial incision in the reflection of a periodontal flap.
Also termed as reverse bevel incision because its bevel is in
reverse direction from that of the gingivectomy incision.
15. Blade used for making this incision - #15C or #15
surgical blade.
Fig: Position of the knife in performing internal bevel incision.
The internal bevel incision starts from a designated area
on the gingiva and is directed to an area at or near the
crest of the bone.
16. It is made from the base of the pocket to the crest of the
bone.
The incision together with the initial reverse bevel incision
forms a V- shaped wedge ending at or near the crest of
bone.
This wedge of tissue contains most of the inflamed &
granulomatous areas that constitute the lateral wall of the
pocket as well as the junctional epithelium & the
connective tissue fibers that still persist between the bottom
of the pocket & the crest of the bone.
2 ) C r e v i c u l a r i n c i s i o n
17. Fig : Position of knife in performing crevicular incision.
18. A periosteal elevator is inserted into the initial internal
bevel incision, & the flap is separated from the bone .
The most apical end of the internal bevel incision is
exposed and visible. With this access, the surgeon is able
to make the interdental incision.
This incision is made to separate the collar of the gingiva
that is left around the tooth.
Knife used for this incision- Orban knife.
3 ) I n t e r d e n t a l i n c i s i o n
19. The incision is made not only around the facial & the
lingual radicular area but also interdentally, connecting
the facial and the lingual segments to the free the gingiva
completely around the tooth.
Fig : Three incisions necessary for flap surgery. A) internal
bevel incision B) crevicular incision C) interdental
incision.
20. Vertical or oblique releasing incisions can be used on one
or both ends of the horizontal incision, depending on the
purpose & design of the flap.
Vertical incisions at both the ends are necessary if the flap
is to be apically displaced.
Vertical incision must extend beyond the mucogingival
line, reaching the alveolar mucosa, to allow for the release
of the flap to be displaced.
21. Vertical incisions are avoided in the lingual or palatal
areas.
Facial vertical incisions should not be made in the centre
of an interdental papilla or over the radicular surface of a
tooth.
Fig : The incision
should be made at the
line angles.
22. Incisions should be made at the line angles of a tooth
either to include the papilla in the flap or to avoid it
completely.
Vertical incisions should also be designed to avoid short
flaps with long, apically directed incisions because this
could jeopardize the blood supply of the flap.
23. S.no Type of flap Reflection
accomplished by
Instrument
used
1) Full thickness
flap or
mucoperiosteal
flap
Blunt dissection Periosteal
elevator
which
separates the
mucoperioste
um from the
bone.
2) Partial thickness
flap or mucosal
flap
Sharp dissection Surgical
scalpel (#15)
24. Fig : Elevation of flap with
periosteal elevator to obtain full
thickness flap.
Fig: Elevation of flap with BP
knife to obtain a split thickness
flap.
25. The purpose of suturing is to maintain the flap in the
desired position until healing has progressed to the point
where sutures are no longer needed.
Suture materials for periodontal flap are –
1) Non absorbable •Silk: braided
•Nylon: monofilament
(ethilon)
•EPTfe: monofilament
(Gore- tex)
•Polyester: braided
(Ethibond)
27. The resorbable sutures have gained popularity because
they enhance patient comfort & eliminate suture removal
appointments.
The non resorbable silk braided suture was the most
commonly used in the past due to its ease of use & low
cost.
The expanded polytetrafluoroethylene synthetic
monofilament is an excellent nonresorbable suture widely
used today.
The most commonly used resorbable sutures are the
natural plain gut or the chromic gut. Both are mono-
28. filaments and are processed from purified collagen of
either sheep or cattle intestine.
The chromic gut is a plain gut suture processed with
chromic salts to make it resistant to enzymatic resorption,
thereby increasing the resorption time.
1) The needle should enter the tissues at right angles and no
less than 2 to 3 mm from the incision.
2) The needle is then carried through the tissue, following
the needle's curvature.
T e c h n i q u e o r p r i n c i p l e s o f s u t u r i n g
29. 3) The knot should not be placed over the incision.
4) The periodontal flap is closed either with independent
sutures or with continuous, independent sling sutures.
5) Sutures of any type in the interdental papillae should be
placed at a point located below the imaginary line that
forms the base of the triangle of the interdental papilla as
shown in the figure below.
30. 6) The location of sutures for closure of a palatal flap depends
on the extent of flap elevation that has been performed.
The flap is divided in four quadrants as shown in the figure
below. If the elevation of the flap is slight or moderate, the
sutures can be placed in the quadrant closest to the teeth. If
the flap elevation is substantial, the sutures should be
placed in the central quadrants of the palate.
31. 7) The clinician may or may not use periodontal dressings.
When the flaps are not apically displaced, it is not
necessary to use dressings other than for patient comfort.
L i g a t i o n
1) Interdental
ligation
Direct Loop Suture
permits a better
closure of the interdental
papilla .
should be performed
when bone grafts are
used or when close
apposition of the
scalloped incision is
required.
figure-eight
suture
there is thread
between the two flaps.
used when the flaps
are not in close
apposition because of
apical flap position or
non-scalloped
incisions.
32. 2) Sling ligation The sling ligation can be used for a flap
on one surface of a tooth that involves two
interdental spaces.
T y p e s O f S u t u r e s
1) Horizontal mattress
suture
often used for the
interproximal areas of diastema
or for wide interdental spaces
to adapt the interproximal
papilla properly against the
bone.
can be incorporated with the
continuous, independent sling
sutures.
33. 2) Continuous,
independent sling
suture
is used when there is both a facial
and a lingual flap involving many
teeth.
This type of suture does not pull on
the lingual flap when this flap is
sutured.
is especially appropriate for the
maxillary arch because the palatal
gingiva is attached and fibrous
3) Anchor suture This suture closes the facial and
lingual flaps and adapts them tightly
against the tooth.
34. 4) Closed-Anchor
Suture
Another technique to close a flap
located in an edentulous area
mesial or distal to a tooth.
Consists of tying a direct suture
that closes the proximal flap,
carrying one of the threads around
the tooth to anchor the tissue
against the tooth, and then tying
the two threads.
5) Periosteal suture used to hold the apically
displaced partial-thickness flaps on
the periosteum.
It is of two types-
1. holding suture
2. closing suture
35. FIG: Periosteal sutures for an apically displaced flap. Holding
sutures, shown at the bottom, are done first, followed by the
closing sutures, shown at the coronal edge of the flap.
1. The Holding Suture - is a horizontal mattress suture placed
at the base of the displaced flap to secure it into the new
position.
2. The Closing Suture- are used to secure the flap edges to the
periosteum.
36. 1) Immediately
after
suturing ( up
to 24 hours)
A connection between the flap and the
tooth or bone surface is established which
contains fibrin reticulum with many PMN
leukocytes, erythrocytes, debris of injured
cells, & capillaries at the edge of the
wound.
2) 1-3 days
after flap
surgery.
The space between the flap & the tooth or
bone is thinner & epithetlial cells migrate
over the border of the flap, usually
contacting the tooth at this time.
37. 3) One week
after surgery.
An epithelial attachment to the root has been
established by means of hemidesmosomes & a
basal lamina.
Blood clot is replaced by granulation tissue
derived from the gingival connective tissue,
the bone marrow, & the PDL.
4) Two weeks
after surgery.
Collagen fibers begin to appear parallel to the
tooth surface.
Union of the flap to the tooth is still weak
because of presence of immature collagen
collagen fibers.
5) One month
after surgery.
A fully epithelialized gingival crevice with a
well defined epithelial attachment is present.
There is beginning of functional arrangement
of supra crestal fibers.