dental

1. KIRKLAND FLAP
• In 1931, Kirkland described a Surgical procedure to be used in the
treatment of “periodontal pus pockets”.
• Basically an access flap used to allow proper root debridement

2. INDICATIONS :
• Used in the anterior regions of the dentition for esthetic reasons, since the root
surfaces are not markedly exposed.
• Bone regeneration in intrabony defects.
• When the interdental areas are too narrow to permit preservation of flap

3. ADVANTAGE:
• Facilitate the debridement of the root surfaces as well as the removal of the
pocket epithelium and the inflamed connective tissue.
• Eliminate the deepened pockets.
• Cause a minimal amount of trauma to the remaining periodontal tissues and
a minimum of discomfort to the patient.

4. Technique:
• Intracrevicular incision (Pocket incisions) are made on both the labial and the lingual
aspects of the interdental area.
• The incisions are extended in a mesial and a distal direction.

5. The gingiva is retracted labially and lingually to expose the diseased root
surfaces which are carefully debrided.

6. Following the elimination of the pocket epithelium and granulation tissue from
the inner surface of the flaps, these are replaced at their original position and
secured with interproximal sutures

7. MODIFIED WIDMAN FLAP
Ramfjord and Nissle (1974) described the modified Widman flap technique

8. INDICATIONS:
• Effective with pocket depths of 5-7mm on both buccal and lingual sides.
CONTRAINDICATIONS:
• Lack of or very thin and narrow attached gingiva can render the technique
difficult, because a narrow band of attached gingiva does not permit the initial
scalloped incision (internal gingivectomy)

9. ADVANTAGE
• Possibility of obtaining a close adaptation of the soft tissues to the root surfaces
• Minimum of trauma to which the alveolar bone and the soft connective tissues are
exposed
• Less exposure of the root surfaces, which from an esthetic point of view is an
advantage in the treatment of anterior segments of the dentition.

10. TECHNIQUE:
Step 1: The first incision parallel to the long-axis of the tooth is a scalloped internal
bevel incision to the alveolar crest starting 0.5 to 1 mm away from the gingival
margin. The papillae are dissected and thinned to have a thickness similar to that of
the remaining flaps.

11. Step 2: Full-thickness flaps are reflected 2 to 3 mm away from the
alveolar crest

12. Step 3: The second, crevicular incision is made in the gingival crevice to
detach the attachment apparatus from the root.

13. Step 4: The interdental tissue and the gingival collar are detached from the bone
with a third incision

14. Step 5: The gingival collar and granulation tissue are removed with curettes.
The root surfaces are scaled and planed. Residual periodontal fibers attached
to the tooth surface should not be disturbed

15. Step 6: Adapt the facial and lingual interdental tissue in such a way that no
interdental bone remains exposed at the time of suturing.
The flaps may be thinned to allow for close adaptation of the gingiva around
the entire circumference of the tooth.

16. Step 7: The flaps are sutured together with individual interdental
sutures and covered with a surgical dressing.