Flap Design for Minor Oral Surgery
Flap
Flap
Stages of Operation
• Aseptic Technique
• Retraction
• Incision
• Reflection
• Bone removal
– access
– point of elevation
– removal of obstruction
• Tooth section
Principles of Flap Design
1. outlined by a surgical incision
2. carries its own blood supply
3. allows surgical access to underlying tissues
4. can be replaced in the original position
5. can be maintained with sutures and is expected to
heal
Used in oral surgical, periodontic, and endodontic
procedures to gain access
.
Rules of Flap
1)Firm continuous incision
2)An incision should not cross an under lying bony defect
3)The vertical incision should be in the concavities between bone
eminences
4)The vertical incision should not extend into the muccobuccal fold
5)The termination of the vertical incision at the gingival crest must
be at the mesial or distal line angle of the tooth
6)The base of the flap must be at least equal to the width of its
free end
Complications
A. Flap necrosis
B. Flap Dehiscence
C. Flap Tearing
D. Injury to Local Structures
A. Flap necrosis
1.
Base > Free margin
•
to preserve an adequate blood supply
•
unless a major artery is present in the base
2.
Width of Base > Length of Flap*2
•
less critical in oral cavity, but length < width
•
a long, straight incision with adequate flap reflection heals more
rapidly than a short, torn incision.
3.
An axial blood supply in the base
4.
Hold the flap with a retractor resting on intact bone to prevent
tension.
B. Flap Dehiscence
1. T
he incisions must be made over intact bone
2.
If the pathologic condition has eroded the buccocortical plate,
the incision must be at least 6 or 8 mm away from it.
3.
The incision is 6 to 8 mm away from the bony defect created by
surgery.
4.
Gently handle the flap's edges
5.
Do not place the flap under tension
6.
Do not cross bony prominences, ex: canine eminence
•
Envelope flaps
–
an incision around the necks of several teeth.
–
extends
2 teeth anterior and 1 tooth posterior
.
If not provide sufficient access…
•
Vertical (oblique) releasing incisions:
–
extends
1 tooth anterior and 1 tooth posterior
.
–
started at the line angle of a tooth.
–
carried obliquely apically into the unattached gingiva.
–
If cross the papilla localized periodontal problems
C. Flap Tearing
•
Mandible
: lingual n. & mental n.
D. Injury to Local Structures
•
Maxilla
: greater palatine a. & nasopalatine n./a.
Summary
Types of Mucoperiosteal Flaps
1. Envelope/sulcular incision
2. Envelope with one releasing incision (three-corner flap)
3. Envelope with two releasing incisions (four-corner flap)
4. Semilunar incision
5. Y-incision
6. Pedicle flap
Full-thickness
mucoperiosteal
flap
11 15 12
2 teeth anterior
1 tooth posterior
1. Envelope/Sulcular flap
Edentulous:
at the crest of the ridge
removal of a mandibular torus
1 tooth anterior
1 tooth posterior
2. Three-corner flap
Greater access in an apical direction,
especially in the posterior aspect of the
mouth
Triangular
1 tooth anterior
1 tooth posterior
3. Four-corner flap
rarely indicated
Rectangular
4. Semilunar incision
to approach the root apex
avoids trauma to the papillae and gingival margin
useful for periapical surgery of a limited extent.
should not cross major prominences, ex: canine eminence
5. Y-incision
removal of a maxillary
palatal torus
6. Pedicle flap
mobilizes from one area and then rotates
to fill a soft tissue defect in another area.
closure of oroantral communications
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