INTRODUCTION

• The ultimate goal of periodontal treatment aims at preserving the teeth in health.

• To achieve this outcome various nonsurgical and surgical treatment modalities have been
performed.

• Periodontal treatment traditionally comprises of initial non-surgical treatment.

• Non-surgical therapy remains the core component of periodontal therapy but also presents
with many limitations related to restricted access.
•
 Periodontal flap is a section of gingiva and / or mucosa surgically separated from the
underlying tissues to provide visibility of and access to the bone and root surface. The flap
also allows the gingiva to be displaced to a different location in patients with mucogingival
involvement.

• According to Peter F. Fedi. “A flap is defined as that portion of the gingiva, alveolar mucosa,
and/or periosteum that retains its blood supply when it is elevated or dissected from the
alveolar bone”.

• According to Ramfjord “A flap is a piece of tissue partly severed from its place of origin for use
in surgical grafting and repair of body defects”.

• According to Grant “A flap is a segment of gingiva and adjoining alveolar mucosa raised from
the underlying tissues by surgical means”.
 PRE-SURGICAL PREPARATIONS

LOCAL ANAESTHESIA

INCISION AND FLAP REFLECTION

DEBRIDEMENT

SUTURING AND PERIODONTAL

PACK PLACEMENT
•
Pierre Fauchard described instruments for resective procedure in 1742

• In 1884, Robicsek described a procedure very similar to what was later termed the
“gingivectomy” by Pickerill in 1912

• G. V. Black, Ward and Crane & Kaplan - advocated the need to remove infected bone as part
of the gingivectomy procedure
• In 1911,
Neumann described a technique as “the radical treatment of alveolar pyorrhea.”

• Widman modified technique and presented to the Scandinavian Dental Association in 1916

• Cieszynski introduced the reverse bevel incision

• In 1931, Kirkland introduced modified flap operation

• In 1935, Kronfeld showed bone is neither necrotic nor infected

• 1954 Nabers described a procedure called “repositioning of the attached gingiva.”

• In 1957, Ariaudo & Tyrrell introduce use of 2 releasing incision

• In 1962, Friedman coined term apically repositioned flap

• In 1958, Oschenbein introduced modified partial thickness palatal flap

• In 1965, Prichard popularized the technique

• In 1974, Ramford and nissle – modified Widman flap

• Takei et al., - papilla preservation flap techneique

• Cortellini et al., modified the technique

• In 1966, Robinson – distal wedge procedure

• In 1976, R A Yukna – excisional new attachment procedure.

• RATIONALE

• To enable visual instrumentation of root surfaces

• To re-establish the healthy, clinical status of periodontium with long term maintenance

• To restore the periodontal apparatus when attachment loss has occurred

OBJECTIVES

• Pocket elimination or reduction.

• Preservation of adequate zone of attached gingiva.

• To permit access to underlying bone and root surface.

• To provide acceptable soft tissue contours.

• Modification of osseous defects.

INDICATIONS

 Impaired access for scaling and root planing.

 Impaired access for self-performed plaque control.

 Pocket depth reduction.

 Persistent inflammation in areas with moderate to deep pockets

 Correction of gross gingival aberrations

 Grade II / Grade III furcation involvement.

 Resective osseous surgery

 Correction of mucogingival problems.

 Root coverage procedures.

 Regenerative procedures- soft tissue grafting or bone regeneration

 Root resection/Hemisection

 Crown lengthening

 Ridge augmentation.

 Socket preservation

 Tori reduction

 Tuberosity reduction.

 Papilla reconstruction

 Faciliation of restorative procedures.

 Pre-prosthetic surgery

 Treatment of periodontal abscess

CONTRAINDICATIONS

× Uncontrolled systemic conditions

× Smoking- may not be considered as an absolute conta-indication.

× Poor plaque control

× Poor patient compliance

× High caries rate

× Unrealistic patient expectations.