Periodontal Flap Designs for Access and Osseous Surgery
In the sequence of treatment of the periodontal patient, surgical intervention may become necessary after completion of the nonsurgical phase. Periodontal surgical techniques aim to gain access to root surfaces for debridement and root planing and/or to r
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Periodontal Flap Designs for Access and Osseous Surgery Antonio Moretti and Karin Schey
3.1
Introduction
Upon completion of initial periodontal therapy, when inflammation of the gingiva has been reduced and the patient has shown improved compliance with oral hygiene, surgical intervention might be necessary. Periodontal surgery may become important to facilitate the access to the root surfaces for proper debridement as well as access to the alveolar bone to reestablish a more desirable bony architecture. Historically, the rationale for performing periodontal surgeries, according to Barrington [1], is as follows: 1. Eliminate pockets by removing soft tissue, recontouring it, or by using a combination of the two procedures. 2. Eliminate pockets by removing osseous tissue, recontouring it, or by using a combination of the two procedures. 3. Remove diseased periodontal tissue in order to create conditions favorable for new attachment or readaptation of the soft and/or osseous tissue to the tooth. 4. Correct mucogingival deficiencies and deformities. 5. Establish acceptable gingival contours to aide in effective hygiene. 6. Improve the esthetic appearance of soft tissue in areas of tissue enlargement. 7. Create a favorable environment for necessary restorative dentistry. 8. Establish drainage for gingival or periodontal abscess to turn an acute periodontal problem into a more treatable state. To date, the rationale for surgery includes access for scaling and root planing and access for restorative procedures, soft tissue biopsy, and periodontal regeneration A. Moretti (*) · K. Schey Department of Periodontology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA e-mail: [email protected]; [email protected] © Springer Nature Switzerland AG 2020 S. Nares (ed.), Advances in Periodontal Surgery, https://doi.org/10.1007/978-3-030-12310-9_3
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A. Moretti and K. Schey Periodontal Resective Surgery
Periodontal Minimally Resective Surgery
Periodontal Non-Resective Surgery
Open Flap Debridement (OFD)
Soft Tissue
Hard Tissue
Hard and Soft Tissue
Widman Flap
Gingivectomy
Osseous
Crown Lengthening
Modified Widman Flap (MWF)
Laser Assisted MWF
Excisional New Attachment Procedure (ENAP)
Laser Assisted New Attachment Procedure (LANAP)
Gingivoplasty Distal Wedge
Root Shaping
Apically Positioned Flap Single Flap Approach Papilla Preservation Flap
Fig. 3.1 Categories of periodontal surgery
procedures. The goal for this chapter is to exclusively discuss the periodontal flap designs for access and osseous surgery. The objectives described here have been established for several decades, but the techniques have evolved to reflect new knowledge and preferences. Broadly speaking, periodontal surgery can be divided into resective and non- resective techniques as depicted in Fig. 3.1.
3.1.1 Periodontal Resective Surgery Soft Tissue Periodontal resective surgery can be categorized into soft tissue or hard tissue procedures. Soft tissue focused surgeries include gingivectomy, gingivoplasty,
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