Flap Technique forPeriodontial Bone ImplantsH. H. Takei, T. J. Han, F. A. Carranz, Jr., E. B. Kenney and V. Lekovict
Introduction• Difficulty: 1. Immediate, partial or complete exfoliation of the implant materials 2. Plaque retention, persistent soft tissue inflammation and/or delayed sequestration of implant materials. Papilla preservation techniques Papilla preservation techniques
Incision (Fig. 1)• Facial – Sulcular incision around each tooth without involving the interdental papilla.• Lingual – Sulcular incision along each tooth with a semilunar incision across each interdental papilla. – From the line-angles, papillary incision line is > 5 mm from the gingival margin.
Description• Presurgical Preparation – The gingiva, especially the interdental papilla, must be free of inflammation and firm. – Oral hygiene
Description• Surgical Technique – Probing the extent of the bone defect – Incision: > 3 mm apical to the margin of the interproximal bony defect – Defect involves lingual side semilunar incision on the facial side – Tip of the scalpel blade in contact with the root – Blood supply, maximum amount of tissue interdentally
Description• Reflection of Flap (Fig. 2) – Curette/interproximal knife – Make sure the interdental tissue is completely free and mobile – Carefully pushed with a blunt instrument – Full-thickness flap is reflected with a periodontal elevator on both facial and lingual side – Small back-action chisels scrape the margins of the flap remove pocket epi. and granulation tissue – Fine tissue scissors trim the excess granulation tissue (Fig. 3)
Description• Reflection of Flap – Thickness of the interdental papilla must be > 2 mm blood supply and provide the graft material – Anterior area, horizontal bone loss, minimal trimming to prevent gingival recession
Description• Placement of Implant Material and Closure of Flap – Retention of the material – Cross mattress suture (Fig. 4): very loose prior to the placement of graft prevents dislodgement of the graft during the suturing optimal flap closure without stitches touching the graft. Tightened – Soft, surgical dressing reduced thbrishinge likelihood of post-op flap displacement by mastication, tongue action or. – Antibiotics
Description• Postoperative Care – Dressing is replaced 7 days later – Cleaned with NS and new dressing for another week. – 2 weeks later, cleaned with H2O2 – Oral hygiene instruction – The pocket should not be probed until 3 months later
Discussion• Interdental soft tissue craters didn’t develop• Normal pyramidal-shaped interdental papilla• Regular flap technique a small crater• Can also used in the anterior area.