OS week 4

• ž Type 1/dense bone
• ž Short clinical crowns (attrition)
• ž Hypercementosis & bulbous roots
• (older patients)
• ž Widely divergent or dilacerated
• roots
• ž Extensive caries (root caries)
• ž Large restorations
• ž Retained roots
• ž Close approximation of maxillary
• sinus/IAN
• ž Unsuccessful “closed” (forceps)
• delivery

• 1. Surgical hand piece with fissure bur
• 2. Copious saline irrigation
• 3. Throat pack and bite block
• 4. A steady hand!
• 5. Patience and knowing your limits
•  Provide for adequate visualization an access-FLAP
• ž Create sufficient space- TROUGH
• ž Divide and conquer-SECTION

free gingival margin

• surface mucosa, submucosa and periosteum
• periosteum primary tissue responsible for bone healing

• ž is outlined by an incision
• ž possesses its own blood supply
• ž allows easy access to
• underlying tissues
• ž can be replaced in the original
• position
• ž can be maintained with sutures
• and is expected to heal

• — - extends 2 teeth anterior and 1 tooth posterior
• to the area of the surgery

• — extends 1 tooth anterior and 1 tooth posterior to
• the area of the surgery

• Y: remove torus
• pedicle flap: mobilizes from one to flill defect from other

• avoid trauma to papillae and gingival margin but limited access 
• used with periapical surgery
• do not cross major eminences (canine)

vertical releasing incisions should cross the free gingival margin at the line angle of a tooth and should not be directly on the facial aspect of the tooth or papilla

• mandible:
• 1. lingual nerve (lingual mandibublar 3rd)
• —2. mental nerve (apical mandibular premolar) use envelope flap well anterior/posterior

• ž Solid bone is best
• ž 6-8 mm from bony defect
• ž Prevents wound dehiscence

• ž Risk of removing> leaving
• — Not lack of skill or instrumentation!
• ž Infected
• ž Apical pathology
• ž Close to vital structures-displacement
• — Inferior alveolar nerve
• — Sinus
• ž Excessive damage to bone

• ž Envelope flap to
• expose crestal bone
• ž Teeth luxated with
• straight elevator
• ž Forceps delivery
• ž Buccal and lingual
• plate compression
• ž Removal of bone
• spicules &
• undercuts
• ž Irrigation
• ž Reposition soft
• tissue
• ž Suture

• ž Keep tissue in place
• ž Approximate wound edges
• ž Hemostasis
• ž May aid in maintaining a blood
• clot in socket
• — Not so much