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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| Buccal incisions are made so that a full-thickness flap can be reflected. A #12-B blade is used for the buccal incision. | |
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| A sulcular incision is made beginning at the posterior tooth and proceeds forward with the blade cutting with an up-and-down motion. The incision is for a full-thickness mucal-periostial flap and so the tip of the blade is contacting the alveolar bone margin. In contrast to the palatal flap, where the blade was outside the alveolar bone margin. Interproximal tissue is maintained by allowing the #12-B blade to pass deep into the interdental space. The incision is terminated just a short distance anterior to the line angle on the distal of the cuspid tooth. | |
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| A Gracey curette is the next instrument to be used to reflect the flap. This curette, of small dimension, is used to initiate the full-thickness flap. The tip of this instrument is passed through the buccal incision so that it contacts the bone and the periosteum elevation is begun. | |
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| The interdental papillae are carefully reflected using a minimum of trauma. | |
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| The Goldman Fox periosteal elevator allows for atraumatic flap elevation. This periosteal elevator, of narrow cross-section, is then applied to reflect the buccal-mucoperiosteal flap. This instrument passes under the periosteum and moves laterally to reflect the flap. | |
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| The flap should be freed-up so that reflection of the periosteum is a minimum of 5mm apical to the mucal-gingival junction. This will allow the elasticity of the oral-mucosal part of the flap to give the flap mobility. | |
| Degranulation is initiated with large scalers. The Ball scaler is a double-ended instrument which gives excellent interproximal access. The buccal interproximal tissues are removed in large pieces so that minimal time is taken to clean up the area and to expose the bone margin. | | |
| The palatal surface is treated in the same manner. | | |
| An ultrasonic scaler is now used to remove smaller pieces of granulation tissue along the bone margins. The tip of this instrument is applied directly to the bone and clumps of tissue are removed. The instrument moves throughout the entire surgical area and will allow direct visual access of all the root surfaces. Granulation tissue removal also exposes the depths of the bony defects. The same is done on the palatal surfaces. | | |
| Gracey curettes are used to refine the removal of the granulation tissue. All small tissue tags are removed and a clear view of the bone defects and the root surfaces is obtained so that a decision can be made on the extent of the osseous surgery that is needed. | | |
PERIODONTICS INFORMATION CENTER