Basic Rules of Incision in Periodontal Flap Preparation

Shin,  Seung-Il

J Korean Dent Assoc > Volume 50(8); 2012 > Article

The Journal of The Korean Dental Association 2012;50(8):474-481.
Published online August 31, 2012.

임상가를 위한 특집 3 - 치주판막 절개의 기본원리

신승일

경희대학교 치의학전문대학원 치주과학교실

Basic Rules of Incision in Periodontal Flap Preparation

Seung-Il Shin

Department of Periodontology, School of Dentistry, Kyung Hee University

Abstract

The periodontal flap surgery is the most widely utilized surgical procedure to reduce the pocket depth and to access the subgingival root surfaces for scaling and root planing. The diagnosis of the periodontal lesion and the objective of the surgery will dictate the type of flap procedure which will be utilized to obtain the best result. The incisions, type of flap and the selection of suturing design must be planned and executed to fit the problem. Periodontal flaps are designed to preserve gingival integrity and to gain access to root surfaces for residual calculus removal and to thoroughly remove granulation tissue so bone defects can be visualized and treated. Gentle and efficient procedures result in optimum healing and minimal postoperative pain. When flaps need to be repositioned apically or less often, coronally, then the flaps must sit passively at the appropriate level before suturing. To ensure this, buccal and lingual flaps need to be elevated beyond the mucogingival junction so the elasticity of the mucosa allows for flap mobility. Sometimes it may be necessary to extend the flap elevation apically with a split incision approach to minimize the effect of the less elastic periosteum. Vertical incisions can aid in flap positioning by allow ing the clinician to suture the flap at a different level to the adjacent untreated gingiva. In osseous periodontal surgery, flaps are apically positioned to minimize postoperative pocket depth. In regenerative periodontal surgery including implant surgery, soft tissue cove rage of bony defects, graft materials, membranes, and bio logic agents is important so sulcular incisions and light suturing techniques are crucial.

Key Words: periodontal flap;incision;full thickness;partial thickness;primary passive closure;