The procedural selection in a periodontal surgery should rely on simplicity, predictability, efficiency, Mucogingival considerations, osseous topography, anatomic and physical limitations, age and systemic factors.
The incisions should be clear, smooth, and well-defined to minimize the healing time. Such incisions prevent occurrence of uneven ragged flap edges.
To maintain the functional zone of the attached keratinized gingiva, flaps should be designed for maximum use and retention of keratinized gingival tissue, as it prevents the need of secondary procedures.
In the design of flaps, it needs to be ensured that there is adequate access and visibility.The design should also prevent bone exposure as it can lead to formation of dehiscence or fenestration.
For prevention of excessive bleeding, hematoma formation, displacement, bone exposure, or infection, adequate flap stabilization should be ensured.
is a technique for increasing crown height of teeth by flap surgery with or without bone surgery. There are two main types:
Aesthetic crown lengthening which is performed when a “gummy” smile is an issue for the patient
Functional crown lengthening is used to make an unrestorable tooth restorable. For example, a tooth with caries that extends below the gums may undergo crown lengthening so that the caries is no longer below the gums and a crown may be placed.
Contraindications
Untreated or unstable gum disease and gingival phenotype
Considerations
Strategic value of tooth
Crown/root ratio that will remain following surgery
Aesthetics will be affected such as longer clinical crowns and loss of interdental papillae leading to “black triangles”
is indicated by thick, prominent muscle attachments known as fraena or a frenum with close attachment to the gum margin. Thick frenum attachment or close attachment to gum margin can contribute to increased plaque accumulation, persistent inflammation, muscular pull on gum and affect gum contour. Usual sites for frenectomy are buccal regions of upper and lower incisors, upper canines and premolars. Fenectomy is rarely required for lingual sites.
Stretching the lip and gripping the frenum with forceps
Cutting through base of frenum on both sides of forceps
Incision on alveolar side near to bone leaving the periosteum intact.
Removal of the frenal tissue and suturing the edges of the wound closely with restorbable sutures
Placing Swabs over the wound
The patient is instructed to rinse twice daily with chlorohexidine mouthwash.
Mucogingival flap surgery
Mucogingival surgery is a procedure where the gums are separate from teeth and temporarily folded back to allow the dentist to directly view and reach root surface of the tooth and bone. It is used for crown lengthening surgery. It also, if required, can be used for guided tissue regeneration.
Mucogingival flaps thickness
Full thickness flap involves incision down to bone. Using blunt dissection, the flap is raised from bone. Full thickness flap is a simple procedure which provides access to root surface and bone. The procedure leaves minimal post-operative discomfort. It provides limited mobility of flap and is unsuitable for grafting. Split thickness flap involves sharp cutting of tissues and leaving the underlying periosteum intact. The procedure prevents exposure dehiscence and allows good blood supply for grafting. It does not provide access to underlying bone or root surface and results in greater post-operative discomfort.
