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Seminar Elective Year 6
Flap
Flap
Adequate size
Anatomical consideration
Margins on sound bone
Relieving incisions
Broad base
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Adequate size
Gain access to underlying hard tissue
Small flap causes difficulty for the surgeon and
tension on the flap, resulting in excessive tiss
ue trauma
A general rule for the size of a flap is to start
one tooth behind the tooth to be operated and
continue to one tooth in front.
Anatomical consideration
(Mandible)
Mental nerve
Anatomical consideration
(Mandible)
Lingual nerve
Anatomical consideration
(Maxilla)
Anatomical consideration
(Maxilla)
Nasopalatine nerve
The resultant bleeding can be easily controlled
with pressure and the nerve can regenerate.
Relieving incisions
This decision will depend on the amount of
reflection required to gain adequate access to s
urgical field
The incision should be made obliquely, so the
base of the flap is broader than the free edge
The incision should also not divide interdental
papillae
It is also important not to cross bony
prominences, if done flap will be under tension,
which could lead to dehiscence
Surgical removal
lower 3rd molar
Surgical procedures
The same theatre, operator, surgical instruments,
rotary ,material and irrigation devices.
Sedation: IV 0.03 mg/kg of midazolam
8 mg of dexamethasone and 1 g co-amoxicalv IV
Local anesthesia : 2% lidocaine with 1:100,000
adrenaline by local infiltration and inferior alveolar
nerve block.
Envelope flap, Triangular flap
The tooth was removed, the socket was inspected,
dental follicular tissue was curetted.
The socket was irrigated with normal saline.
Surgical procedures
The flap was repositioned and sutured with 4-0
silk.
Postoperative instruction and medication: a nonsteroidal analgesic 5 days and mouth wash.
Facial swelling
Pain
Periodontal
examination of
2nd molar
Result
Pain
No
significant
difference
Swelli
ng
Trism
us
Triangular flap
More swelling in
day 2 and 7
No significant
difference after
day 14
Triangular flap
More limit mouth
opening after 7
days
Triangular flap
More swelling in
day 2
No significant
difference
Result
Plaque
accumulat
e
No
significa
nt
differen
ce
Periodonta
l bleeding
No
signific
ant
differen
ce
Probing
depth at
distal of
2nd molar
Alveolar
osteitis
Envelop
e flap
Increase
pocket
depth in
day 7,
14 and
in final
Envelop
e flap
Higher
incidenc
e but not
statistica
lly
significa
nt
Discussion
Envelope flap
Advantages :
Envelope flap
Disadvantages :
Triangular flap
Advantages :
Triangular flap
Anterior releasing component induce
inflammation in muscle of mastication
, muscle irritation and buccal tissue
edema
Greater facial swelling and trismus
Discussion
No significant correlation between duration and
postoperative swelling
Greater pain score with longer operation time