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Flap Technique for Periodontial Bone Implants

H. H. Takei, T. J. Han, F. A. Carranz, Jr., E. B. Kenney and V. Lekovict

1. Immediate, partial or complete exfoliation of the implant materials 2. Plaque retention, persistent soft tissue inflammation and/or delayed sequestration of implant materials.

Papilla preservation techniques

Incision (Fig. 1)
Sulcular incision around each tooth without involving the interdental papilla.

Sulcular incision along each tooth with a semilunar incision across each interdental papilla. From the line-angles, papillary incision line is > 5 mm from the gingival margin.

Presurgical Preparation
The gingiva, especially the interdental papilla, must be free of inflammation and firm. Oral hygiene

Surgical Technique
Probing the extent of the bone defect Incision: > 3 mm apical to the margin of the interproximal bony defect Defect involves lingual side semilunar incision on the facial side Tip of the scalpel blade in contact with the root Blood supply, maximum amount of tissue interdentally

Reflection of Flap (Fig. 2)
Curette/interproximal knife Make sure the interdental tissue is completely free and mobile Carefully pushed with a blunt instrument Full-thickness flap is reflected with a periodontal elevator on both facial and lingual side Small back-action chisels scrape the margins of the flap remove pocket epi. and granulation tissue Fine tissue scissors trim the excess

Reflection of Flap
Thickness of the interdental papilla must be > 2 mm blood supply and provide the graft material Anterior area, horizontal bone loss, minimal trimming to prevent gingival recession

Placement of Implant Material and Closure of Flap
Retention of the material Cross mattress suture (Fig. 4): very loose prior to the placement of graft prevents dislodgement of the graft during the suturing optimal flap closure without stitches touching the graft. Tightened Soft, surgical dressing reduced thbrishinge likelihood of post-op flap displacement by mastication, tongue action or.

Postoperative Care
Dressing is replaced 7 days later Cleaned with NS and new dressing for another week. 2 weeks later, cleaned with H2O2 Oral hygiene instruction The pocket should not be probed until 3 months later

Interdental soft tissue craters didnt develop Normal pyramidal-shaped interdental papilla Regular flap technique a small crater Can also used in the anterior area.