No further deterioration was observed in the periodontal condition of most of the teeth during a 2year period of supportive periodontal therapy spt. The clinical efficacy of laser assisted modified widman flap. Professor and chairman, department of periodontics, the university of michigan school of. A report of laserassisted modified widman flap for periodontal regeneration. Lack of or very thin and narrow attached gingiva can render the technique difficult, because a narrow band of. The modified widman flap procedure is frequently used in periodontal therapy ramfjord 1977 7.
Treatment of intrabony defects with access flap surgery. The original widman flap the flap was elevated to expose 23 mm of the alveolar bone. The modified widman flap mwf, one of the most common and conservative surgical approaches, aims to eliminate the inflamed gingival tissue and also provide access for root debridement. This bone repair was never accompanied by new connective tissue attachment. Graziani f, gennai s, cei s, cairo f, baggiani a, miccoli m, et al. Lack of or very thin and narrow attached gingiva can render the technique. Periodontal flap is a section of gingiva andor mucosa which is separated from underlying tissues to provide visibility of and access to bone and root surface demontmorency college of dentistry, lahore. Learn modified widman flap with free interactive flashcards. Widman made a scalloped gingival incision around the neck of the.
Simple flap procedures include the simple apically repositioned flap and the modified widman reverse bevel flap. Shallow sites lose attachment, while moderate and deep sites gain attachment. The original widman flap the main advantages of this technique as compared to gingivectomy were claimed to be less discomfort, since healing. Control sites group a were randomly selected to receive an. Posteriorly, conventional modified widman flap surgery was performed. Open flap debridement, gingivectomy, gingival curettage.
The patient was placed on a 2 to 3month maintenance protocol. Ultrasonic and hand curette debridement, scaling, and root planing was performed to the point of visual cleanliness of the roots and any associated bony defects. Effect of modified widman flap surgery and systemic. Open flap debridement includes conventional surgical procedures such as the modified widman flap procedure. Ramfjord professor and chairman, department of periodontics, the university of michigan school of dentistry, ann arbor, michigan 48104. Widman made a scalloped gingival incision around the neck of the teeth. May 15, 2009 introductory periodontal surgery techniques. After a reevaluation, functional rehabilitation was implemented with a removable maxillary partial denture and a fixed mandibular bridge. Pdf periodontal surgery involving modified widman flap. Flap techniques the modified widman flap the undisplaced flap the palatal flap the apically displaced flap flaps for regenerative surgery the papilla preservation flap. Periodontic surgery an overview sciencedirect topics.
Many patients may experience pain, discomfort or tooth mobility before this surgery as symptoms of severe periodontal disease. Twentyfive patients between the ages of 20 and 50 years with generalized chronic periodontitis were selected for the study. Widman1 introduced the reverse bevel scalloping type of gingival incisions in 1916 as a modification of neumanns2 periodontal flap surgery. It does not attempt to reduce the pocket depth, but it does eliminate the pocket. Modified widman flap and nonsurgical therapy using chlorhexidine.
Clinical performance of access flap surgery in the treatment of the intrabony defect. The purpose of this study was to evaluate the postoperative pain experience and gingival indexes with and without the use of periodontal dressing after modified widman flap procedure. Modified widman flap flashcards and study sets quizlet. The modified widman flap periodontal disease click to. A report of laserassisted modified widman flap for. Microsurgery, open flap debridement, modified widman flap introduction periodontitis is a chronic inflammatory disease of multifactorial origin which results in pocket formation, loss of attachment, gingival recession, bone loss, mobility and eventually loss of tooth 1. In angular bony defects a certain degree bone fill was noted. Periodontal therapy for severe chronic periodontitis with. Periodontal surgery involving modified widman flap. View the article pdf and any associated supplements and figures for a period of 48 hours.
The data revealed that treatment of periodontal pockets using the modified widman flap procedure produced no gain in connective tissue attachment and no increase in crestal bone height. The modified widman flap facilitates instrumentation for root therapy. Change in clinical indices following laser or scalpel. Surgical procedures, however, have a number of disadvantages and hence efforts have been on at improving various nonsurgical approaches, which are directed more specifically at the microbial nature of periodontal disease. A periodontal flap is a section of gingiva andor mucosa surgically separated from the underlying tissues to provide visibility and access to the bone and root surface. Flaps are then apically positioned and closed with sutures. I lie modified widman flap does not intend to remove the pocket wall, but it does eliminate the pocket lining. Conventional flap for regenerative surgery distal molar surgery. Ramfjord and nissle in 1974 modified the original widman flap procedure and coined the term modified widman flap. Abstract the present investigation was performed in the rhesus monkey to determine the effect of the modified widman flap procedure on the level of the connective tissue attachment and supporting alveolar bone. Clinical and radiographic evaluation sanjeev kumar salaria, veenu madaan, deepak bala department of periodontology, maharishi markandeshwar college of dental sciences and research, mullana ambala, india. Aug 28, 2014 video demonstrating modified widman flap surgery.
The objective of the study was to compare the clinical efficacy of use of a diode laser dl 810 nm as an adjunct to modified widman flap mwf surgery to that of mwf alone. The original widman flap was comprised of a mucoperiosteal flap. The most commonly practiced technique is based upon the modified widman flap. Treatment of periodontitis is aimed at disease prevention, slowing.
Periodontal disease can be successfully treated and further destruction avoided, regardless of surgical technique, as long as optimum oh is. It is one of the conservative surgical approaches to eliminate the inflamed gingival tissue and also provide access for root debridement. Postoperative complications bleeding ibuprofen increased bleeding during oral surgery two fold braganza, bissada et al. The three different categories of flap techniques used in periodontal flap surgery are as follows. Abstract 33 subjects with evidence of active destructive periodontal disease were treated by modified widman flap surgery and systemic tetracycline 1 gday for 21 days. An ode to kirkland flap obituary to modified widman flap. Twenty patients requiring comparable bilateral flap procedures were selected. A modified widman flap procedure was then performed on sites with residual periodontal pockets. Effect of modified widman flap surgery on maximum molar. It mainly aims at reattachment and readaptation of the pocket. Pdf we report a case of generalized aggressive periodontitis agp requiring periodontal treatment including flap surgery and ridge.
Subgingival plaque samples were taken from 41 sites in 12 of these subjects before and 6 months after therapy for predominant cultivable microbiota studies. Aug 27, 2017 modified widman flap flap debridement surgery is defined. Article pdf available in open journal of stomatology 0203. Surgical therapy included flap with or without osseous resection i. The main goals of the procedure include optimum mechanical sub gingival root planing with direct vision. The mwf is a standard three incision approach with fullthickness flap reflection to gain access to the root surfaces and crestal bone.
Papillary retention flap design for pocket reduction. Reset share links resets both viewing and editing links coeditors shown cirugia preprotesica are not affected. Periodontal surgery involving modified widman flap procedure. It differs from the modified widman flap in that the soft tissue pocket wall is removed with the initial incision. Modified widman flap flap debridement surgery is defined. Microscopic demonstration of tissue reaction incident to removal of subgingival calculus. Many patients may experience pain, discomfort or tooth mobility before this. Professor and chairman, department of periodontics, the university of michigan school of dentistry, ann arbor, michigan 48104. The term modified widman flap was adopted to designate a flap procedure which has been modified by several persons and came to designate an open subgin gival curettage for reattachment, although the original purpose of the widman flap was surgical pocket elimi nation. Several studies2,4,7,21,24,27,32,33,38,39demonstrated that surgical therapy produced greater probing depth reduction than nonsurgicaltherapy over the shortterm.
The purpose of this program is to demonstrate the technique for using a modified widman or reversed double flap procedure to remove gingival pockets on six anterior maxillary teeth. Access flap surgery, open flap debridement ofd modified. Design of the flap split the papilla conventional flap preserve it papilla preservation flap 10. I, replacement of flap in its original position j, interdental sutures in place. Coronally advanced flap for multiple recession defects.
Modified widman flap and nonsurgical therapy using. It is classified with the access flap operations because. Eighteen contralateral pairs of periodontal pockets were produced in a standardized manner. Modified widman flap presented by ramfjord and nissle in 1974 11. Open flap debridement, gingivectomy, gingival curettage, enap. One quadrant of each jaw randomly received periodontal dressing after the surgery while the other one didnt. Sulcular or submarginal incisions are made initially, and fullthickness flaps are elevated beyond the mucogingival junction for debridement, scaling, and root planing.
Effect of modified widman flap surgery on maximum molar bite. This study is an attempt to compare the timetested surgical approach, the modified widman flap, with the new technique of combined therapy consisting of srp. Plaque index pi, sulcus bleeding index sbi and probing. Lec 1 oral hygiene methods toothbrushing and flossing. Normal periodontium gingiva clinical periodontology. Pdf on jan 1, 2012, kazuhiro murakami and others published modified widman flap procedure. To gain access to the deeper periodontal structures using a flap reflected from the root and alveolar surfaces. One quadrant of each jaw randomly received periodontal dressing after the surgery while the other one didn.
Nov 05, 2009 open flap debridement includes conventional surgical procedures such as the modified widman flap procedure. Flap techniques and flaps in the treatment of pocket therapy. The technique for the modified widman flap surgery has been described in detail in 1974,1 2 so only a brief summary will be given here. Therefore the internal bevel incision starts close no more than 1 to 2 mm apically to the gingival margin and follows the normal scalloping of the gingival margin figs. Present status of the modified widman flap procedure. Postoperative instructions following periodontal surgery 1 do not eat anything or drink hot fluids until the numbness has worn off to avoid injury from accidental biting or burning. Modified widman flap procedure for sites with a pd of. The clinical efficacy of laser assisted modified widman. C, internal bevel incision d, elevation of the flap, leaving a wedge of tissue still attached by its base. An ode to kirkland flap obituary to modified widman flap ashish kumar editor, journal of indian society of periodontology, professor, department of periodontology, institute of dental studies and technologies, kadrabad, modinagar 201 201, ghaziabad, uttar pradesh, india. The kind of surgery performed, the number of sites included and the moment at which it should performed is decided after evaluating for the initial causerelated therapy results.
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