At the end of this lecture, you will be asked if you would like to take this course for continuing education units.
California Continuing Education Credits: 4 units
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| Four separate palatal incisions are made using disposable scalpel blades and an interproximal knife. The first palatal incision is made with a #15 scalpel. Beginning at the distal of the molar, a scalloped, reverse bevel incision is continued anteriorally. | | |
| The blade is angled so that this incision is made parallel to the outer surface of the palatal tissue. This will insure that the palatal flap will have a thin cross-section, and so, will adapt well around the teeth. | | |
| The scalloped shape is accentuated so that the incision on the midpalatal surface of each tooth is more apical than the incisions in the interproximal region. | | |
| This scalloping allows the apically positioned palatal flap to cover the interproximal tissues because the alveolus becomes wider as we proceed apically. | | |
| The incision is continued forward to include the premolars with accentuation of the scalloping of the palatal gingival margin. | | |
| A second vertical incision is placed on the mesial of the first premolar and is angled anteriorally to maximize the blood supply to the flap. | | |
| The scalpel is now used to reflect the flap beginning with the vertical incision, and a split-thickness flap is obtained with the blade cutting outside the alveolar bone. | | |
| Then a periostial elevator reflects the tissue while the split-thickness flap is continued with a #15 blade. | | |
| Complete reflection of this split-thickness flap is accomplished. The flap continues to have the thin cross-section that was begun with the initial palatal incision. Palatal tissue is reflected so that at least 3mm of periosteum covering the bone can be visualized. | | |
| A #12-B scalpel is then used to make the third, or sulcular, incision on the palate. This blade is used with an up-and-down motion that allows for precise cutting. The tip of the blade passes apically to the bony crest, and so frees up the cuff of the gingival tissue. | | |
| Cuts are made across each papilla, in order to separate the palatal papilla from the buccal papilla. | | |
| An Orban interproximal knife is used for the fourth incision. The blade is angled to allow a horizontal cutting action and this interproximal knife is used to make the final palatal incision perpendicular to the tooth and at the same time incises the tissue at the alveolar bony crest. It is moved along the entire palatal surface with the tip passing through the interproximal tissue. | | |
| The Kirkland chisel has one end that is a back-action chisel. The other end is a straight chisel. The cuff of gingival tissue is now removed with the back-action hoe beginning at the posterior portion of the surgical area. This allows for exposure of the bone margin. | | |
| The same instrument is used to remove the thin tissue covering of the periosteum so that at least 3mm of the bone margin can be seen and will be accessible for any necessary osseous surgery. | | |
| A Prichard periosteal elevator is useful to hold back the palatal flap. Large pieces of tissue are removed with a minimum of tissue trauma because the interproximal knife has made a clean cut of the gingival margin. | | |
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