Preprosthetic Periodontal Surgery – the Apically Positioned Flap - Dental Online College
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Preprosthetic Periodontal Surgery – the Apically Positioned Flap

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Duration:

13:55

Surgeon:

Prof. Dr. Wachtel

The molars 46 and 47 are to be restored. For there are carious defect of the hard tissue Professor Dr. Hannes Wachtel, Munich/Germany does a preprosthetic treatment. In the vestibular and lingual area of the posterior region of the forth quadrant as well as in the region distal of the terminal tooth the gingiva is apically positioned. While in the buccal area a split thickness flap is needed for the apical positioning, in the lingual area a full thickness flap is appropriate.

Surgical crown lengthening with an apically positioned flap is often needed in order to maintain the biologic width. The restorative margin must not be placed closer than 2 mm to the crestal bone in order to not irritate attachment structure. The surgical procedure of an apically positioned flap is demonstrated by Prof. Dr. Wachtel.

In this case, new restorations are planned in the posterior region of the right mandible. Prior to the restoration, the teeth 46 and 47 will be prepared with an apically positioned flap in the vestibular and lingual region. First, a paramarginal incision is performed on the buccal side following the tooth shape. In the interdental area, the incisions cross each other so that new papilla tips are created parallel to the original ones.

In the next step, Prof. Dr. Wachtel prepares a split flap in the vestibular area. Not removing periosteum from the bone surface is important for the success of this surgery since later the flap needs to be fixed at the periosteum to remain in the intended apical position. In contrary, on the lingual side a full thickness flap is prepared following the paramarginal incision in order to avoid any damage of the lingual artery and nerve. However, due to the anatomy in this region the lingual flap does not move coronally but rather stays in the desired apical position. Following an intrasulcular incision all the tissue within the incision lines as well as excess interdental soft tissue has to be thoroughly removed. In addition, the soft tissue in the distal area of the terminal tooth 47 is reduced with a distal wedge procedure and is placed in a more apical position as well.

Once the mobilization of the buccal and lingual flap is completed, the alveolar bone around the teeth is reduced, reshaped and smoothened using a round diamond burr. The flaps are fixed applying microsurgical sutures, which in the buccal area are guided from the mobile part of the flap through the attached areas of the periosteum. The fixation of the buccal split thickness flap to the underlying periosteum ensures the apical positioning. A connection to the lingual full-thickness flap can be established through the interproximal spaces. In the distal area Gore-Tex sutures are applied.

Finally, the wound is covered with a dressing. After a healing period of about three months the prosthetic restoration of 46 and 47 can be started.

Content of the expert video

The paramarginal incision should be performed perpendicular to the bone surface.
The paramarginal incision should be performed perpendicular to the bone surface.
An incision on the interdental papillae creates new papilla tips.
An incision on the interdental papillae creates new papilla tips.
In the buccal area, preparation of a split flap is performed.
In the buccal area, preparation of a split flap is performed.
The periodontal dressing helps relieve post-operative discomfort around the wound.
The periodontal dressing helps relieve post-operative discomfort around the wound.
Der Parodontalverband sorgt für eine Linderung postoperativer Wundschmerzen.
Der Parodontalverband sorgt für eine Linderung postoperativer Wundschmerzen.

The expert

Prof. Dr. Hannes Wachtel

Spezialist für Parodontologie in der Bolz/Wachtel Dental Clinic in München

  • Mitherausgeber und im Beirat zahlreicher Fachzeitschriften
  • Referent auf nationaler und internationaler Ebene in den Bereichen Parodontologie, plastische Parodontalchirurgie, parodontale und ossäre Regeneration, Implantologie und Ästhetik
  • Verfasser zahlreicher Publikationen und Buchbeiträgen
  • Mitgründer des Privatinstituts für Parodontologie und Implantologie in München (IPI) und der Bolz/Wachtel dental clinic
  • Lehrauftrag Charité Medizin Berlin und Universität Göteborg, Schweden
...more »
  • CAMLOG
  • Align Technology Inc.
  • BEGO Implant Systems GmbH & Co. KG
  • Kuraray
  • Dentsply Sirona Implants
  • CLINICAL HOUSE EUROPE
  • IDI-PARO
  • DSI DentaScience Institute®
  • IPI München
  • Mectron
  • Henry Schein
  • Komet/Gebr. Brasseler GmbH &Co KG
  • DZR
  • Sirona
  • botiss dental Gmbh
  • W&H Deutschland GmbH
  • Zimmer Dental
  • Health AG

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The Dental Online College is an online learning platform for dental surgeons and students. This service focuses on providing superior-quality professional training videos in the area of dental medicine that can be called up from an Internet platform. As a professional online training platform, the Dental Online College provides dental surgeons and students with instruction in surgical procedure, demonstrating challenging surgical techniques using easy to understand videos, and including interviews that provide further detail, video presentations, and documentation on performing the procedures in question.

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