Dr.

Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Surgical Procedures
Gingivectomy
Periodontal Periodontal Flaps
Osseous Contouring
Surgery

Bone Grafts
Laterally Sliding Flap
Free gingival Graft

Periodontal Flaps
Increase access to root Horizontal Incision
Reduce pocket depth VS
Expose area for regeneration Vertical Incision
Crown lengthening

Incision Design
Internal bevel
scalloped

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 Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Internal Bevel Scalloped

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 Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Vertical Incision

Correct
Incorrect

Vertical Releasing Incision Bard Parker with

1. #15 Blade
2. #11 Blade
3. #12 Blade
4. #12B Blade

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 Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Full Thickness Flap

VS
Partial Thickness Flap

Full-Thickness Flap Partial Thickness Flap

Full-Thickness (Mucoperiosteal Flap) Partial Thickness Flap

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 Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Full-Thickness Flap

6 months Post FTF - Bone Loss on Premolar

Conventional Flap Technique Sulcular Incision

Repositioned Flap
VS
Apically Positioned
Flap

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 Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Apically Positioned Flap

Flap
Indications

Probing Beyond Mucogingival Junction Surgical Crown Lengthening

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 Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Biologic Width
Restorative margin cannot
be placed closer than 2 mm
to crestal bone or will
disrupt attachment structure

Biologic Width
Expose 3-4 mm of tooth
coronal to bone during
surgery to accommodate 2
mm biologic width

Surgical Crown Lengthening

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 Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Primary Incision (Internal Bevel)

Primary Incision Primary Incision

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 Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Primary Incision - Flap Reflected Secondary Incision

Buck or Orban Knives Remove Interproximal Tissue

Full Thickness Flap Reflected Full Thickness Flap Reflected

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 Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Suturing Suturing

Interrupted Sutures Interrupted Sutures

Coe Pack Placed

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 Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Post-Surgical Hemorrhage
Dressing Removal Times
Pressure
General Guidelines
Remove pack, sutures, clot
Minimum - 3 to 4 days
Identify source/stop
Maximum - 7 to 10 days
bleeding

Chlorhexidine Rinses 4 Weeks Postoperative

Recession, no attached gingiva

Free Gingival
Grafting

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 Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Incision Partial Thickness Flap

Remove Keratinized Epithelium Suture Alveolar Mucosa

Tin Foil Template on Donor Site Donor Site Incision - Palate

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 Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Suture to Reflect Graft Free Gingival Graft

Place Graft on Recipient Site Place Coe Pack over Recipient Site

Donor Surgical Site Coe Pack over Donor Site

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 Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

10 Days Post Surgery Six Weeks Post Surgery

A Flexible Analgesic Strategy

If aspirin-like drugs are indicated
Mild Pain 200 to 400 mg ibuprofen or 650 mg aspirin

Pain Moderate Pain 600 to 800 mg ibuprofen

Inadequate pain relief

Management
Inadequate pain relief

400 mg ibuprofen plus non-narcotic/narcotic

combination analgesic equivalent to 60 mg
codeine
Inadequate pain relief

600 to 800 mg ibuprofen plus non-narcotic

Severe Pain combination analgesic equivalent to 10
oxycocodone

A Flexible Analgesic Strategy

If aspirin-like drugs are contraindicated
Mild Pain 650 to 1000 mg acetaminophen

Mod Pain
Inadequate pain relief

600 to 1000 mg acetaminophen and narcotic

Distal Wedge
Procedures
equivalent to 60 mg codeine or hydrocodone
Inadequate pain relief

Severe Pain 1000 mg acetaminophen and narcotic equivalent

to 10 mg oxycocodone

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 Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Types of Types of
Incision Incision
Design for Design for
Distal Distal
Wedge Wedges
Surgical Surgical
Procedures Procedures

Distal - 2nd Molar - 7 mm Pocket

Distal Wedge - Diverging Incisions Full-Thickness Flap Reflected

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 Dr. Larry Wolff
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Flap Approximation Flap Sutured

7 Days Post Surgery

Distal
Pocket
Elimination

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