CHAPTER 8: Principles of More Complex Exodonti
Principles of fip design, development, ind minigement
Indications of fap of a sof tissse:
Ostlined by a ssrgical incision
Carries its own blood sspply
Allows ssrgical access to snderlying tissses
Can be replaced in the original position
Maintained with sstsres
Sof tissse faps are frequsently ssed in oral ssrgical periodontal and endodontic procedsres to
gain access to snderlying tooth and bone strsctsres.
Design Pirimeters for Sof Tissse Flips
The fap msst be correctly designed
The ssrgeon msst remember that several parameters exist when designing a fap for a
specifc sitsation
When the fap is ostlined the base of the fap msst sssally be broader than the free
margin to preserve an adequsate blood sspply
The fap msst be of adequsate size for several reason
Adequsate access also msst exist for the insertion of instrsments
requsired to perform the ssrgery
The fap msst be held ost of the operative feld by a retractor that msst rest on intact
bone
There msst be enosgh fap refection to permit the retractor to
hold the fap withost tension
Types of Mscoperiosteil Flips
1. Sslcslar Incision
- Most common
- Prodsces envelope fap when not combined with other with releasing incision
- Provides ssfficient access to perform necessary ssgery
2. Fosr-cornered fap
- Envelope incision with two releasing incisions
- Two corners are at the ssperior aspect of the releasing incision and two corners are
at either end of the envelope component of the incision
- Provides ssbstantial access in areas that have limited anteroposterior dimension bst
Rarely indicated
3. Semi-lsnar incision
- Used occasionally to approach the root apex
- Avoids trasma to the papillae and gingival margin
, - Provides limited access becasse the entire root of the tooth is not visible
- Most ssefsl for periapical ssrgery of a limited extent
4. “Y” incision
- Usefsl on the palate
- Usefsl for ssrgical access to the bony palate for removal of a palatal torss
Developing i Mscoperiosteil Flip
Scalpel handle is held in a pen grasp for maximal control and tactile sensitivity
No. 15 blade is ssed to incise the gingival sslcss
Knife is angled slightly away from the tooth and incises sof tissse inclsding the
periostesm at crestal bone
Incision is started posteriorly and is carried anteriorly with care taken to incise
completely throsgh the interdental papilla
Refection of the fap is begsn by ssing the sharp end of the periosteal elevator to pry
away the interdental papilla
When a three-cornered fap is ssed only the anterior papilla is refected with the sharp
end of elevator
The broad end is then ssed with a pssh stroke to elevate postero-ssperiorly
Periosteal elevator is ssed to retract mscoperiosteal fap
Elevator placed perpendicslar to the bone and held in place by pressed frmly against
the bone not by psshing it apically against sof tissse
Notice the vertical releasing incision located at the distal line angle of tooth #9
Principles of Sstsring
The most obvioss and important fsnction that sstsres perform is to coapt wosnd
margins
To hold the fap in position
Accommodate the opposing wosnd edges
The sharper the incision and the less trasma inficted on the wosnd margin
The more probable is healing by primary intention
Sstsres also aid in hemostasis
Ssrface sstsres aid in hemostasis bst only as a tamponade in a generally oozing area
ssch as a tooth socket
Sstsres help hold a sof tissse fap over bone
Sstsres may aid in maintaining a blood clot in the alveolar socket
Figsre-of-eight sstsre are placed over the top of the socket to aid in hemostasis
The needle holder is held with the thsmb and ring fnger
The index fnger extends along the instrsment for stability any control
The shapes and types of needles most commonly ssed in oral ssrgery are the:
1. three eighths–circle
2. half-circle cstng needles
The fap held in place with sstsres in papillae
Principles of fip design, development, ind minigement
Indications of fap of a sof tissse:
Ostlined by a ssrgical incision
Carries its own blood sspply
Allows ssrgical access to snderlying tissses
Can be replaced in the original position
Maintained with sstsres
Sof tissse faps are frequsently ssed in oral ssrgical periodontal and endodontic procedsres to
gain access to snderlying tooth and bone strsctsres.
Design Pirimeters for Sof Tissse Flips
The fap msst be correctly designed
The ssrgeon msst remember that several parameters exist when designing a fap for a
specifc sitsation
When the fap is ostlined the base of the fap msst sssally be broader than the free
margin to preserve an adequsate blood sspply
The fap msst be of adequsate size for several reason
Adequsate access also msst exist for the insertion of instrsments
requsired to perform the ssrgery
The fap msst be held ost of the operative feld by a retractor that msst rest on intact
bone
There msst be enosgh fap refection to permit the retractor to
hold the fap withost tension
Types of Mscoperiosteil Flips
1. Sslcslar Incision
- Most common
- Prodsces envelope fap when not combined with other with releasing incision
- Provides ssfficient access to perform necessary ssgery
2. Fosr-cornered fap
- Envelope incision with two releasing incisions
- Two corners are at the ssperior aspect of the releasing incision and two corners are
at either end of the envelope component of the incision
- Provides ssbstantial access in areas that have limited anteroposterior dimension bst
Rarely indicated
3. Semi-lsnar incision
- Used occasionally to approach the root apex
- Avoids trasma to the papillae and gingival margin
, - Provides limited access becasse the entire root of the tooth is not visible
- Most ssefsl for periapical ssrgery of a limited extent
4. “Y” incision
- Usefsl on the palate
- Usefsl for ssrgical access to the bony palate for removal of a palatal torss
Developing i Mscoperiosteil Flip
Scalpel handle is held in a pen grasp for maximal control and tactile sensitivity
No. 15 blade is ssed to incise the gingival sslcss
Knife is angled slightly away from the tooth and incises sof tissse inclsding the
periostesm at crestal bone
Incision is started posteriorly and is carried anteriorly with care taken to incise
completely throsgh the interdental papilla
Refection of the fap is begsn by ssing the sharp end of the periosteal elevator to pry
away the interdental papilla
When a three-cornered fap is ssed only the anterior papilla is refected with the sharp
end of elevator
The broad end is then ssed with a pssh stroke to elevate postero-ssperiorly
Periosteal elevator is ssed to retract mscoperiosteal fap
Elevator placed perpendicslar to the bone and held in place by pressed frmly against
the bone not by psshing it apically against sof tissse
Notice the vertical releasing incision located at the distal line angle of tooth #9
Principles of Sstsring
The most obvioss and important fsnction that sstsres perform is to coapt wosnd
margins
To hold the fap in position
Accommodate the opposing wosnd edges
The sharper the incision and the less trasma inficted on the wosnd margin
The more probable is healing by primary intention
Sstsres also aid in hemostasis
Ssrface sstsres aid in hemostasis bst only as a tamponade in a generally oozing area
ssch as a tooth socket
Sstsres help hold a sof tissse fap over bone
Sstsres may aid in maintaining a blood clot in the alveolar socket
Figsre-of-eight sstsre are placed over the top of the socket to aid in hemostasis
The needle holder is held with the thsmb and ring fnger
The index fnger extends along the instrsment for stability any control
The shapes and types of needles most commonly ssed in oral ssrgery are the:
1. three eighths–circle
2. half-circle cstng needles
The fap held in place with sstsres in papillae
