Flap Technique for Periodontial Bone Implants

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

• Difficulty:
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)
• Facial
– Sulcular incision around each tooth without involving the interdental papilla.

• Lingual
– 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 didn’t develop • Normal pyramidal-shaped interdental papilla • Regular flap technique  a small crater • Can also used in the anterior area.

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