Surgical Periodontitis

Periodontal disease affects 75 percent of adults in Unites States and more severe forms affect 20 to 30 percent of adults. Many epidemiologic studies suggest moderate connection between dental health status and systemic disease (Genco, 2002). Therefore, treating periodontal disease may not only help manage oral health but may also help with the management of other chronic conditions. The first nonsurgical step to treat gum disease involves subgingival scaling and root planing to remove plaque and calculus on the tooth and root surfaces. When periodontal pockets do not heal after scaling and root planing, surgical procedures may be needed to gain access to the root surface. Access flap procedures allow visual access to periodontally involved …show more content…
It is indicated for all types of periodontitis however it is especially effective with pockets depth of 5-7mm. The goal of the procedure is not pocket elimination but healing the periodontal pocket with minimum tissue lost. The modified Widman flap requires three incisions to separate the pocket lining from the tooth surface. The initial incision dissects the pocket epithelium and portions of the subepithelial connective tissue. The gingiva is then reflected using the elevator, but only to the extent that the alveolar crest can be visualized. The second incision is sulcular around each tooth. This separates the pocket epithelium from the root surface to the base of the pocket. The final incision is horizontal and serves to atraumatically release the pocket tissue in the interdental area. The soft tissue and all of the granulation tissue within the pocket are removed. Now, scaling and planing of the root surfaces using curettes or ultrasonic instruments can be performed with direct vision. Supportive alveolar bone is not removed, but minimal osteoplasty may be performed if necessary. Finally, the flaps are repositioned. Because of the shape of the flaps created by the initial scalloping incision, secure and complete coverage of the interdental bone is possible. The flaps of the tissue are tightly adapted over the bone and between …show more content…
This method differs from modified Wildman flap procedure because usually it does not involve elevating the flap of the tissue past the mucogingival junction. Here, the scalloped incision is made from the crest of the free gingival margin to the base of the pocket in the areas being treated. The excised tissue and all of the granulomatous tissue within the pocket area is removed with a curet. The root surfaces are scaled and planed to the base of the incisions. Then, the gingival tissue is repositioned against the tooth as tight as possible and secured with interproximal sutures