UCLA SCHOOL OF DENTISTRY

TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS

Periodontal Flap Surgery

E. Barrie Kenney, B.D.Sc., D.D.S., M.S., F.R.A.C.D.S. Professor and Chairman Division of Associated Clinical Specialties

OSTEOPLASTY
and

OSTECTOMY

Osseous surgery has changed the bone margin, so that the mid-facial bone level is apical to the interproximal bone level. This is called Positive Architecture.

NEGATIVE BONE ARCHITECTURE exists when facial bone levels are coronal to interproximal bone levels.

Positive Bone Architecture provides a bone contour which will result in the gingival contours following the same pattern, and this gives the most stable and healthy post-surgical result with shallow pockets and absence of inflammation. Negative Bone Architecture results in soft tissue contours that are positive with underlying bone contours that are negative. This is unstable and often results in postsurgical pocket formation and gingival inflammation.

In the Palatal Approach to osseous surgery, there is more emphasis on bone reduction (ostectomy) on the palate than on the buccal. This reduces the risk of removing excess healthy bone in the buccal furcation and results in soft tissue healing that gives palatal access to the mesial and distal furcations for interproximal plaque removal by the patient.

Flap Incisions for Edentulous Interproximal Regions

MESIAL AND DISTAL WEDGE TECHNIQUES

Pockets exists on the mesial and distal of the upper molar. The mesial edentulous region will have a mesial wedge technique with parallel incisions over the ridge to expose the bone defects and root surfaces.

The distal wedge technique is similar to that on the mesial, with vertical incisions at its most distal portion.

Distal wedge incisions to expose bone defects and root surfaces.

Osseous surgery and root planing are followed by suturing flaps, so that soft tissue is in close proximity to the distal bone, with post-surgical reduction of pocket depth.

Another technique for distal pockets is a trap-door approach, where 2 parallel incisions run distally to allow elevation of a trap door or distal flap of tissue.
This is useful when bone graft materials are to be placed in distal intrabony defects.

In cases with hyperplastic gingival tissues, a gingivectomy is the first incision, then labial and lingual flaps are elevated to gain access for root planing and osseous surgery. The flaps are then sutured in an apical position in close proximity to the bone margins.

SUTURING TECHNIQUES FOR FLAP SURGERY

SUTURING TECHNIQUES FOR FLAP SURGERY----MATTRESS SUTURES

MATTRESS SUTURE