Periodontal Flaps

Periodontal Flaps

Answer. Following are the incisions in the periodontal flap surgery:

• Horizontal incisions
  • Internal bevel incision
  • Cervical or sulcular incision
  • Interdental incision
• Vertical incision
• Thinning incision
• Cut back incision
• Periosteal incision

Horizontal Incisions

• Horizontal incisions are directed along the margin of the gingiva in a mesial or a distal direction.
• Two types of horizontal incisions have been recommended: the internal bevel incision, which starts at a distance from gingival margin and is aimed at the bone crest and the crevicular incision, which starts at the bottom of the pocket and is directed to the bone margin.

Internal Bevel Incision

• The internal bevel incision is basic to most of the periodontal flap procedures.
• Internal Bevel Incision is also known as first incision as it is the initial incision in reflection of periodontal flap.
• Internal Bevel Incision is also known as reverse bevel incision as its bevel is in the reverse direction as compared to external bevel incision.
• Internal Bevel Incision is the incision from which the flap is reflected to expose the underlying bone and root.
• Objectives of internal bevel incision
  • Internal Bevel Incision removes the pocket lining.
  • Internal Bevel Incision conserves the relatively uninvolved outer surface of the gingiva, which, if apically positioned, becomes attached gingiva.
  • Internal Bevel Incision produces a sharp, thin flap margin for adaptation to the bone-tooth junction.
• The #11 or #15 surgical scalpel is used most often to make internal bevel incision.
• Internal bevel incision starts from a designated area on the gingiva and is directed to an area at or near the crest of the bone.
• The starting point on gingiva is determined by whether the flap is apically displaced or not displaced.

Crevicular Incision

• Internal Bevel Incision is also known as the second incision and is made from the base of the pocket to the crest of the bone.
• This incision is carried around the entire tooth with the help of 12 no. surgical blade.
• Purpose of this incision is to facilitate the removal of inflammatory granulation tissue surrounding the cervical area left after reflecting the primary flap.

Interdental Incision

• It is also known as third incision.
• After crevicular incision a periosteal elevator is used to separate the flap from bone. With this access, the periodontal surgeon can able to make the third or interdental incision, to separate the collar of the gingiva which is left around the tooth.
• Orban knife is usually utilized for this incision.
• Incision is given at facial and lingual radicular area and also interdentally connecting facial and lingual segments to free gingiva completely around the tooth.

Vertical Incisions

• Vertical or oblique releasing incisions can be used on one or both ends of the horizontal incision, depending on the design and purpose of the flap.
• Vertical incisions at both ends are necessary if the flap is to be apically displaced.
• Vertical incisions must extend beyond the mucogingival line, reaching the alveolar mucosa, to allow for the release of the flap to be displaced.
• In general, vertical incisions in the lingual and palatal areas are avoided.
• Incisions should be made at the line angles of a tooth either to include the papilla in the flap or to avoid it completely.
• The vertical incision should also be designed so as to avoid short flaps (mesiodistal) with long, apically directed horizontal incisions because these could jeopardize the blood supply to the flap.

Thinning Incision

• Thinning Incision extends from gingiva towards the base of flap in palatal flap and distal wedge procedures.
• Thinning Incision is given with the help of 11 No. or 15 No. surgical blade.

Cut Back Incision

• Cut Back Incision is made at apical aspect of releasing incision and is directed towards the base of flap in laterally positioned flap.
• Cut Back Incision is given with the help of 11 No. or 15 No. surgical blade.

Periosteal Releasing Incision

• Periosteal Releasing Incision is made at the base of flap serving the underlying periosteum.
• Periosteal Releasing Incision is given with the help of 15 No. or 15C No. surgical blade.