Flap surgery in periodontitis treatment

Flap surgery is a dental surgical procedure used in the treatment of advanced periodontal disease. The flap is the fragment of mucosa or periosteum that is pulled away from the alveolar bone. In this way, a periodontist has good access and visibility to the affected area, the periodontal pockets can be cleaned and possibly defects or deformities of the alveolar bone can be corrected, and at the end of the surgical procedure the flap is reapplied and sutured. In this way, the wound is protected and a physiognomic and esthetic aspect of the gingiva is obtained after healing.

 

How many types is the lamboul?

 

In relation to the alveolar bone: 

• Partially reflected Lambou
• Lambou fully reflected 

Depending on the layers that form it:

• Mucoperiostal lick
• Mucozal lick 

By the position in which the flap is placed at the end of the operation:

• Lambou coronar
• Lateral Lambou
• Apical lambou 

By extent:

• Lambou limited in L, on 1-3 teeth 
• Lambou extended over a group of teeth or an entire arch

 

When is flap surgery recommended?

 

Patients suffering from periodontal disease can choose flap surgery, depending on the periodontal status and the indications of the periodontal specialist. It is essential that, before establishing the treatment plan, a consultation is performed, so that the #LifeDentist can correctly assess the degree of periodontal damage.

Flap surgery can be performed in the following cases:

• Periodontal disease with the existence of periodontal pockets with an average depth of 4 to 8 mm (medium and large periodontal pockets), which cannot be cleaned by non-surgical periodontal procedures 
• Marginal periodontal abscess (on lateral and sometimes front teeth)
• Recurrence following subgingival curettage 
• Vertical bone resorption 
• Root removal in the case of a multirooted tooth 
• Crown lengthening 
• Complementary to tissue regeneration operations 
• Bone additions made to periodontal pockets 

There are also cases in which flap surgery is contraindicated, including: 

• Bone atrophy and/or friable mucosa without evidence of inflammation and without periodontal pockets 
• Bone resorption and advanced gingival retraction (to near the apex - risk of tooth loss)
• Highly mobile teeth 
• Horizontal resorption (bone atrophy caused by aging)
• The mucosa is thin, poorly vascularized, atrophied

 

What is the flap operation?

 

When the periodontist recommends a surgical intervention such as flap surgery, the doctor-patient communication plays an essential role in correctly informing the patient.

Flap surgery can be performed using several techniques: 

1. Surgery with a fully reflected mucoperiosteal flap 
2. Operation with partially reflected mucoperiosteal flap 
3. Apical repositioned flap surgery
4. Coronary repositioned flap surgery 
5. Mucosal flap surgery 

 

Operation with mucoperiosteal flap fully reflected

It consists of exposing the bone through an incision in the soft tissue and periosteum. The access to the bone helps with recontouring and subsequent regeneration. The specialist will make an incision in the gingival sulcus, a few millimeters from the gingival margin, continuing towards the cres crest of the bone up to the root tip.

 

Operation with partially reflected mucoperiosteal flap

It is more difficult, because several incisions are necessary. The advantage of this technique is the reduction of trauma to the tissues and the more esthetic appearance obtained postoperatively. Initially, an incision is made at 0.5 mm from the gingival crest, buccally, and at 1.5-2 mm on the oral side. The second incision is vertical, in the gingival fossa, and the third incision is horizontal and removes the tissues between the two initial incisions.

 

Mucosal flap surgery

Involves an incision at the edge of the free gum that continues to the root of the tooth, which continues beyond the alveolar ridge.

 

Apical repositioned flap surgery

It is indicated in the presence of periodontal pockets and for coronal debonding. This technique can be performed for a maximum of 4 to 6 teeth in a single session.

 

Coronary flap surgery

It is performed to ensure a perfect closure of the wound and stabilization of the clot. The operation is indicated for lesions between the roots of the mandibular molars and between the vestibular roots of the maxillary molars. It involves the fixation of an orthodontic bracket from which the suture will be suspended at the end of the surgery.

 

What are the advantages and disadvantages of flap surgery?

 

The advantages of flap surgery for the treatment of periodontitis are:

• Cleaning the infection from the affected bone 
• Correction of bone defects by the addition of materials with regenerative properties 
• Removes periodontal pockets more easily 
• Creating an area free of damaged and infected tissue
• Easy access to periodontal pockets 
• Easy access to root level 

The disadvantages of flap surgery are: 

• Increased risk of necrosis (improper incisions may be made, affecting blood circulation and proper irrigation of the flap) 
• Receding gums that occur after gum healing
• Loss of alveolar bone substrate  

Also, flap surgery requires a local anesthesiafollowed by incision and removal of gum tissue from the teeth and bone. Following a flap-type surgery, bone grafts can be applied and various tissue regeneration procedures can be performed. At the end of the surgery, the gingiva will be repositioned and the suture will be made with non-absorbable sutures. The entire procedure lasts from one to three hours.

 

What are the risks of flap surgery?

 

Flap surgeries are part of the surgical treatment of periodontitis, being invasive maneuvers that involve a long duration of treatment procedures, a difficult recovery and the risk of complications is very high. 

The risks of labiaplasty are:

• Risk of infection
• Severe gum recession after surgery
• Gum swelling and bleeding in the first days after surgery 
• The appearance of hypersensitivity in teeth that have had surgery
• The appearance of increased tooth mobility 
• Tooth loss 

In order to eliminate the risk of complications following flap flap surgery, it is it is essential that the patient follow the periodontist's recommendations exactly in order to minimize side effects.

 

Patients who come to our clinics are advised to give up the harmful factors that have led to periodontal disease from the very beginning (smoking, unbalanced diet) and to maintain oral hygiene at home and at the specialist's office, by having scaling and brushing! 

No more than 6 months should elapse between routine check-ups in order to assess the oral status and perform a complete professional hygiene package.

Schedule NOW and benefit from periodontal treatment with the help of Life Dental Spa specialists!