Periodontal Flap Surgery for Maxillary Posterior Segments

Dr. E. Barrie Kenney & Dr. Voja Lekovic

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

	A continuous sling suture with palatal mattress sutures will be used. A 15cm Crile-Wood needle holder holds the needle. Flaps are sutured with a 3-0 silk suture attached to a X-1 end cutting needle.
	A mattress suture is begun on the palatal and the palatal flap is sutured with a continuous sling suture.
	The needle is passed around the tooth one time before the next mattress suture is placed. This anchoring of the suture insures the palatal flap is held in an apical position. The suture is passed through the last palatal papilla and then continued to the buccal.
	The buccal flap suturing begins from the distal portion forward with a simple sling suture with anchors placed around the tooth to hold the buccal tissue at its correct position. Care is taken to position the flap close to the bone margin and to get the best possible flap adaption interproximally. The needle penetrates each papilla in keratinized tissue at least 3-4mm away from the flap margin.
	Each interproximal tissue is positioned and the continuous suture moves forward.
	The two flaps are tied with a knot in the anterior portion of the surgery.
	Pressure is applied to the flaps with saline moistened gauze for 2-3 minutes to insure close flap adaption and to promote hemostasis.
	The surgical dressing is mixed and placed in sterile saline. When the dressing is set enough not to stick to the gloves, a roll is applied to the palatal, and then another roll is applied to the buccal. The dressing is pushed interproximally.
	Cotton pliers are used to lock the dressing in the embrasures. This will join the buccal and palatal rolls. The area is checked to make sure there is no excess dressing in the vestibule and on the occlusal surface. Hemostasis is essential.
For the first week the patient has been given appropriate analgesic tablets and instructed not to brush or floss in the area of the dressing. The dressing is gently removed. The dressing has protected the surgical sites from mechanical trauma to the flaps.
You can see that the palatal tissues have healed well and are well-adapted around the teeth. The buccal tissues also show good tissue adaption and normal healing.
The area is lightly cleansed with saline and the sutures are removed. The patient will be given oral hygiene instruction and seen again in 1 week.

Do you wish to take this course for continuing education credit? Yes

PERIODONTICS INFORMATION CENTER