Classification of Endodontic Flaps

7/25/2019 Classification of Endodontic Flaps

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CLASSIFICATION OF ENDODONTICCLASSIFICATION OF ENDODONTIC

FLAPSFLAPS

According toAccording to Guttmann & HarrissonGuttmann & Harrisson

Full mucoperiosteal flapsFull mucoperiosteal flaps

TriangularTriangular RectangularRectangular

TrapezoidalTrapezoidal

HorizontalHorizontal

Limited mucoperiosteal flapsLimited mucoperiosteal flaps

Submarginal curved(semilunar)Submarginal curved(semilunar)

Submarginal scalloped rectangular (luebke- ochsenbien)Submarginal scalloped rectangular (luebke- ochsenbien)


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According ToAccording ToFranklin.S. WieneFranklin.S. Wiene

SemilunarSemilunar

Full verticalFull vertical

Luebke !chsenbeinLuebke !chsenbein


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ADVANTAGESADVANTAGES

Good wound healingGood wound healing

Easy repositioning oEa

sy repositioning owound edgeswound e

dges

DISADVANTAGESDISADVANTAGES

Li!ited surgi"al a""essLi!ited sur

gi"al a""ess

Postoperati#e re"essionPosto

perati#e re"ession

ADVANTAGESADVANTAGES

$apid % predi"ta&le re"ession ree$apid % predi"ta&le re"ession ree

healing o papilla'healing o papilla'

Less s"ar or!ationLess s"ar or!ationAde(uate surgi"al a""ess to the rootAde(uate surgi"al a""ess to the root

ape)ape)

La"* o e)posure o "restal &one'La"* o e)posure o "restal &one'

DISADVANTAGESDISADVANTAGES

Te"hni(ue sensiti#eTe"hni(ue sensiti#e

Need o two in"isions to a#oidNeed o two in"isions to a#oid

e)"essi#e s"ar or!atione)"essi#e s"ar or!ation

INDICATIONSINDICATIONS

For repair o peroration % resorptionFor repair o peroration % resorption

in "er#i"al third o the root'in "er#i"al third o the root'

For periradi"ular surgeries+ su"h asFor periradi"ular surgeries+ su"h as

api"oe"to!y+retrograde ,lling et"'api"oe"to!y+retrograde ,lling et"'

In periodontally healthy sites+In periodontally healthy sites+

parti"ularly when su&gingi#allyparti"ularly when su&gingi#allypla"ed "rown !argins are present'pla"ed "rown !argins are present'

CONT$AINDICATIONSCONT$AINDICATIONS

In periodontally "o!pro!ised patientsIn periodontally "o!pro!ised patients

Surgery in the area o interdental papillaSurgery in the area o interdental papilla


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"#$"%T"&'S"#$"%T"&'S

Increased surgical access to the root apex.Increased surgical access to the root apex.

The Trapezoidal Flap is similar ecept verticalThe Trapezoidal Flap is similar ecept vertical

releasing incision meet at sulcular incision atreleasing incision meet at sulcular incision at

obtuse angle "ssumption that provide a betterobtuse angle "ssumption that provide a better

blood suppl* to the flapped tissues+although thisblood suppl* to the flapped tissues+although this

particularl* hold true in other tissuesparticularl* hold true in other tissues

#,S"#$"%T"&'S#,S"#$"%T"&'S

#ifficult* in reapproimation of the flap margins .ound closure#ifficult* in reapproimation of the flap margins .ound closure

More recession compared to Papilla Based Flap .More recession compared to Papilla Based Flap .


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"#$"%T"&'S"#$"%T"&'S

R'#/0' 1!T'%T,"L F!R &,%&,$"LR'#/0' 1!T'%T,"L F!R &,%&,$"LR'0'SS,!%R'0'SS,!%

"00'SS T! "1'2 ,S &!!#"00'SS T! "1'2 ,S &!!#

EASILY REPOSIIO!E"EASILY REPOSIIO!E"

#,S"#$"%T"&'S#,S"#$"%T"&'S

POSOPERAI#E S$ARPOSOPERAI#E S$AR

!E$ROSIS OF FLAP!E$ROSIS OF FLAP


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"#$"%T"&'"#$"%T"&'

TH' !%L3 "#$"%T"&' !F TH,STH' !%L3 "#$"%T"&' !F TH,S

FL"1 ,S %! 1!ST!1'R"T,$'FL"1 ,S %! 1!ST!1'R"T,$'

R'0'SS,!%R'0'SS,!%

#,S"#$"%T"&'S#,S"#$"%T"&'S

LIMIE" A$$ESS %LIMIE" A$$ESS %

POSOPERAI#E !E$ROSISPOSOPERAI#E !E$ROSIS

& S$AR FORMAIO!& S$AR FORMAIO!+ H'%0' ,T+ H'%0' ,T

,S %! L!%&'R R'0!44'%#'#,S %! L!%&'R R'0!44'%#'#


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RIA!'(LAR FLAPRIA!'(LAR FLAP

"#$"%T"&'S"#$"%T"&'S &ood .ound healing&ood .ound healing 'as* repositioning of .ound'as* repositioning of .ound

edgesedges

5 #,S"#$"%T"&'S#,S"#$"%T"&'S Limited surgical accessLimited surgical access 1ostoperative recession1ostoperative recession

5 ,%#,0"T,!%S,%#,0"T,!%S For corrections of problems inFor corrections of problems in

cervical midroot positioncervical midroot position

such as resorption such as resorption perforationsperforations


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R'0T"%&/L"R FL"1R'0T"%&/L"R FL"1

"#$"%T"&'S"#$"%T"&'S

,ncreased surgical access,ncreased surgical accessto the root apeto the root ape

#,S"#$"%T"&'S#,S"#$"%T"&'S

#ifficult* in reapproimation#ifficult* in reapproimationof the flap margins .oundof the flap margins .ound

closureclosure

,%#,0"T,!%S,%#,0"T,!%S/seful in lo.er anteriors /seful in lo.er anteriors

teeth .ith long roots+.hereteeth .ith long roots+.here

traingular flap istraingular flap is

contraindicatedcontraindicated


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TR"1'6!,#"L FL"1TR"1'6!,#"L FL"1Similar to rectangularSimilar to rectangular

flap ecept verticalflap ecept verticalreleasing incision meetreleasing incision meet

at sulcular incision atat sulcular incision at

obtuse angleobtuse angle

"ssumption that"ssumption that

provide a better bloodprovide a better bloodsuppl* to the flappedsuppl* to the flapped

tissues+although thistissues+although this

particularl* hold true inparticularl* hold true in

other tissuesother tissues


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L/'78'-!0HS'%7',%L/'78'-!0HS'%7',%

"#$"%T"&'S"#$"%T"&'SReduce potential for gingival recessionReduce potential for gingival recession

"ccess to ape is good"ccess to ape is good

'asil* repositioned'asil* repositioned


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#,S"#$"%T"&'S#,S"#$"%T"&'S

postoperative scarpostoperative scar

necrosis of flapnecrosis of flap


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S'4,L/%"R FL"1S'4,L/%"R FL"1

The onl* advantage ofThe onl* advantage ofthis flap is nothis flap is no

postoperativepostoperative

recession+ but it hasrecession+ but it has

man* disadvantagesman* disadvantagessuch as limited access+such as limited access+

postoperative necrosispostoperative necrosis

scar formation+ hence scar formation+ hence

it is no longerit is no longer

recommendedrecommended


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"#$"%T"&'S"#$"%T"&'S

Rapid predictable recession free healingRapid predictable recession free healingof papillaof papilla

Less scar formationLess scar formation

"de9uate surgical access to the root ape"de9uate surgical access to the root ape

Lack of eposure of crestal boneLack of eposure of crestal bone

#,S"#$"%T"&'S#,S"#$"%T"&'S

Techni9ue sensitiveTechni9ue sensitive%eed of t.o incisions to avoid ecessive%eed of t.o incisions to avoid ecessivescar formationscar formation


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,%#,0"T,!%S,%#,0"T,!%S

For repair of perforation resorption in cervicalFor repair of perforation resorption in cervical

third of the rootthird of the root

For periradicular surgeries+ such asFor periradicular surgeries+ such as

apicoectom*+retrograde filling etcapicoectom*+retrograde filling etc

,n periodontall* health* sites+ particularl* .hen,n periodontall* health* sites+ particularl* .hensubgingivall* placed cro.n margins are presentsubgingivall* placed cro.n margins are present

0!%TR",%#,0"T,!%S0!%TR",%#,0"T,!%S,n periodontall* compromised patients,n periodontall* compromised patients

Surger* in the area of interdental papillaSurger* in the area of interdental papilla


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$hoice o) Flap "esign$hoice o) Flap "esign

In almost all cases% the )ull )lap designIn almost all cases% the )ull )lap designshould *e considered *e)ore an+thingshould *e considered *e)ore an+thing

else.else.

he choice )or limited )lap designs ishe choice )or limited )lap designs is

mainl+ *ecause o) the disad,antages thatmainl+ *ecause o) the disad,antages thatha,e *een considered and are related toha,e *een considered and are related to

dental aesthetics.dental aesthetics.


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he ad,antage o) the su* marginalhe ad,antage o) the su* marginalrectangular )lap o,er the )ull )lap design isrectangular )lap o,er the )ull )lap design is

that it does not in,ol,e interdental andthat it does not in,ol,e interdental andmarginal gingi,al tissues.marginal gingi,al tissues.

For the maxillar+ incisors% premolars% andFor the maxillar+ incisors% premolars% andmolars% the triangular and rectangular )lapmolars% the triangular and rectangular )lapdesigns are )irst choice except in thosedesigns are )irst choice except in thosecases in -hich cro-n margins dictate thecases in -hich cro-n margins dictate theuse o) the limited )lap design.use o) the limited )lap design.

Flap design )or palatal surger+ is restrictedFlap design )or palatal surger+ is restrictedto a triangular or a horiontal )lap.to a triangular or a horiontal )lap.


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/hen using a triangular )lap% the ,ertical/hen using a triangular )lap% the ,erticalincision should *e made mesial to the )irstincision should *e made mesial to the )irst

premolar to limit *leeding )rom the greaterpremolar to limit *leeding )rom the greaterpalatine arter+.palatine arter+.

Additional access can *e pro,ided -ith aAdditional access can *e pro,ided -ith a

small distal relaxing incision.small distal relaxing incision.

In the lo-er incisor area% the triangular )lapIn the lo-er incisor area% the triangular )lapdoes not pro,ide enough access to the apicaldoes not pro,ide enough access to the apicalarea.area.

In these cases% the extra ,ertical incision o)In these cases% the extra ,ertical incision o)the rectangular )lap is mandator+.the rectangular )lap is mandator+.


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For the lo-er premolar and molar area% theFor the lo-er premolar and molar area% the

onl+ )lap design possi*le is the triangularonl+ )lap design possi*le is the triangular)lap *ecause o) the location o) the mental)lap *ecause o) the location o) the mental)oramen.)oramen.

he ,ertical incision can *e made mesial tohe ,ertical incision can *e made mesial tothe )irst premolar or distal to the cuspid.the )irst premolar or distal to the cuspid.

/hen necessar+% a distal relaxing incision/hen necessar+% a distal relaxing incisioncan *e made.can *e made.

his is a short incision made in attached andhis is a short incision made in attached andmarginal gingi,a to reduce the )lap retractionmarginal gingi,a to reduce the )lap retractiontension .tension .

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Classification of Endodontic Flaps