Incisions and Flaps

8/2/2019 Incisions and Flaps

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INCISIONS

ANDFLAPS


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INCISIONS AND FLAPS

Definition

Flap is a small incision made in mucosa and

periosteum under local anaesthesia to gainaccess to the area for raising the mucoperiosteum

to perform dentoalveolar surgeries.


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Rules of flap design.

Avoid severing large vessels and nerves.

Place margins far away from surgical areas to

ensure wound margins over sound bone. This

also gives room for any adjustments and

avoids collapse of flap into the bony defect.

Design the flap for adequate visibility without

over exposure of bone.


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Base of flap should be the widest portion

There should be no sharp angles on the flap.

Sharp corners tend to slough due to poor

circulation .

Vertical or oblique incisions should not bemade over root eminence. It is best to incise

in trough between adjacent teeth.


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Maintain integrity of interdental papilla . The

papilla at incision line is allowed to remain

whereas other papilla should be included inflap.

Use sharp instruments. Always include the

point of the blade during incision as it allowsthe bone contour & any irregularities to be

followed easily.


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Be gentle with the flap. The retractor should

be broad and designed to contact bone so the

flap rests on it passively.

Do not incise close to gingival sulcus when

using a horizontal or semilunar incision. 2-3mm

of attatched gingiva should be left around eachtooth .

To avoid tearing the mucoperiosteum , incision

should be made in one pass bone deep & with

firm & continuous stroke.


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Incise in the attatched gingiva for semilunar

flap.

Elevate the flap away from the line of visionto provide adequate exposure to the surgical

area.


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Types of flaps in intraoral

incisions1. ENVELOPE FLAP

2. TWO-SIDED TRIANGULAR FLAP

3. THREE-SIDED TRAPEZOIDAL FLAP

4. SEMILUNAR/ELLIPTICAL/CURVED FLAP

5. OCHSENBEIN-LUBKE FLAP

6. PEDICAL FLAP


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ENVELOPE FLAP This is made by extended horizontal incision in

the gingival sulcus along the cervical lines of

the teeth.

INDICATIONS- Surgical procedures including

cervical lines labially (buccally) and palatally

(lingually), apicoectomy (palatal root), removal

of impacted teeth and cysts.


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ADVANTAGES-Avoidance of vertical incision &

easy reapproximation to original position.

DISADVANTAGES-Difficult reflection (mainly

palatally), great tension with the risk of ends

tearing, limited visualization in apicoectomy,

limited access, possibility of injury to palatal

nerves and vessels, defect of attached gingiva.


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TWO-SIDED TRIANGULAR FLAP This is made by an L-shaped incision on the

side of an envelope flap preferably divergent

towards vestibular sulcus extending to

interdental papilla of gingiva.

INDICATIONS-Surgical removal of root tips,

cysts & apicoectomies.


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ADVANTAGES-Ensures adequate blood supply,

good visualization, good stability and

reapproximation, easily modified by additional

vertical incision or lengthening horizontal

incision.

DISADVANTAGES-Limited access to long roots,

tension is created when flap is held with a

retractor, may cause defects in attatched gingiva.


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THREE-SIDED TRAPEZOIDAL FLAP It is made by giving an second vertical incision

to the horizontal incision for better access.

The oblique incision always extends to

interdental papilla. This ensures integrity of

the gingiva.

INDICATIONS-Extensive surgical procedures

requiring adequate access.


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ADVANTAGES-Provides excellent access,

produces no tension on the tissues, allows

easy reapproximation of the flap to its original

position and hastens healing.

DISADVANTAGES-Produces defect in attatched

gingiva (recession of gingiva).


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In case of missing teeth and edentulous

arches, horizontal incision is made over the

alveolar crest whereas vertical incision is

carried out in the same way.


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SEMILUNAR FLAP This flap is made by a curved incision

beginning from the vestibular fold & has abow-shaped course. The lowest point should

be atleast 0.5mm from the gingival margin.

INDICATIONS-Surgeries requiring periapicalexposure, apicoectomies, removal of cysts &

root tips.


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ADVANTAGES-Small incision & easy reflection,

no recession of gingiva, no intervention at

periodontium, easier oral hygiene.

DISADVANTAGES-Possibility of incision beingperformed right over bone lesion, scarring in

anterior regions, difficulty in reapproximation

and suturing, limited access & visualization,

tendency to tear.


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OCHSENBEIN-LUBKE FLAP It is a combination of both vertical &

semilunar incisions. The flap is scalloped tofollow gingival architecture.

INDICATIONS- For those cases where there is afear that elevation of attatched gingiva will

lead to shrinkage & exposure of margins of

restoration.


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ADVANTAGES-Sparing of marginal gingiva,

easy lip retraction & most adequate visibility,

non-exposure & minimal loss of crestal bone,

ease of reapproximation of flap & suturing,

good esthetic results.

DISADVANTAGES-Difficulty in reapproximation

of attatched gingiva.


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PEDICLE FLAP This type of flap is based on & along a

particular blood vessel like Greater palantineartery in the palate.

INDICATIONS-Mainly used for closure of

oroantral communications, reconstruction for

malignant defects.


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Three types of pedicle flaps used for closure of

oroantral communication are-

1. Buccal flap

2. Palatal flap3. Pedicle bridge flap


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THANKYOU

Incisions and Flaps

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