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1. Creation of mucoperiosteal flap. 2. Removal of bone / Tooth division. 3. Delivery of tooth / root portion.

4. Wound debridement or wound toilet.

5. Wound closure / Packing. 6. After care.


Incision and flap reflection

Different designs Envelope & 3 corner. Anterior limb, posterior limb and middle portion. Objectives are good exposure to operative field, broad based with good blood supply and close on sound bone rather on bony defect.

Commonly used Flap Designs

Bone removal
Balanced but not un necessary. Occ:, buccal & distal aspect. Down to cervical line of imp tooth but varies according to angulations, depth and morphology of roots. Bone should not removed from lingual aspect as danger to lingual nerve.

Tooth sectioning
Depends on;
Direction of delivery of imp. tooth. Angulations, depth and root pattern (divergent roots). Mesio angular, vertical, horizontal or disto angular.

Wound toilet and closure

Debriment. Bone trimming / filing irrigation. Hemostasis bleeding points & brisk ooze. Flap approximated back and closed on sound bone.

Post operative morbidity

Swelling. Pain. Limitation of mouth opening. Complications:
Secondary bleeding. Dry socket. Nerve damage.