Canis ISSN: 2398-2942

Periodontal flap procedure

Contributor(s): Rachel Perry

Introduction

  • Periodontal surgery aims to remove inciting causes of periodontitis Periodontitis and preserve or regenerate the periodontium.
  • A periodontal flap may be used in all cases where surgical treatment of periodontal disease is indicated.
  • A periodontal flap is a section of gingiva and/or mucosa surgically separated from underlying tissue and retaining vascular attachment. It allows visibility of and access to bone and root surface.
  • Creation of a periodontal flap allows access for subgingival scaling and root planing and may also allow elimination of the pocket while re-establishing a gingival contour facilitating homecare.
  • Treatment planning should be carefully considered before embarking on a periodontal flap procedure.
  • The client's wishes, expectations and capability of performing homecare must be initially assessed.
  • Any periodontal surgery must be in the animal's best interest, andnotperformed to satisfy a client.

Uses

  • Access to and treatment of deep periodontal pockets >4mm (which will be inefficiently cleaned in a closed fashion).
  • Furcational involvement, or where recontouring bony lesions is required.
  • Pocket reduction/elimination.
  • Lateral sliding flaps may be used to repair gingival clefts (localized gingival recession), covering the exposed root and re-establishing correct gingival width.

Advantages

  • Enhanced access.
  • Enhanced visualization and therefore more effective subgingival debridement in an open fashion.
  • Replacement of flap in original position or apically/coronally re-positioned.
  • Preservation of oral epithelium and existing gingiva.
  • Access for osteoplasty and ostectomy procedures Alveolectomy and alveoloplasty.
  • Pocket reduction/elimation is possible.

Disadvantages

  • Requires general anesthesia.
  • Takes longer than extraction therefore increased costs.
  • Must be combined with exceptional home care by client.
  • Follow up mandatory.
  • Technically challenging.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • The long-term success of treatment is directly related to the quality of daily plaque removal provided at home, and commitment to professional prophylaxis on a regular basis.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Beckman B (2003) Mandibular incisor apically repositioned flap in the dog. J Vet Dent 20 (4), 245-249 PubMed.

Other sources of information

  • Newman M G, Takeu H H, Klokkevold P R, Carranza F R (2012)Carranza's Clinical Periodontology.St Louis: Elsevier Saunders.
  • Holmstrom S E, Frost Fitch P, Eisner E R (2004)Veterinary Dental techniques for the Small Animal Practitioner.Philadeplphia: Saunders.
  • Wiggs R B, Lobprise H B (1997)Veterinary Dentistry Principles and Practice.Philadelphia: Lippincott-Raven.


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