Peri-Implant Surgery
Incisions and Flaps in Periodontal and Peri-Implant Surgery
Felipe Bravo, Bruna de C. F. Vajgel, Estela S. Gusmão and Renata Cimões
The principles of periodontal surgery, in general, do not differ from the surgical principles applied to other parts of the body. In order to perform a successful surgical procedure there are several important aspects to consider, namely: gentle tissue manipulation; firm and precise incisions; careful retraction of the flap; use of a traumatic suture techniques, and promotion of stable wound healing. Well-planned incisions are essential to gain access to the surgical site. When planning the incision, the main considerations must be the anatomy, surgical goal, and the design and a traumatic management of the flap. It is worth emphasizing the importance of a well-sharpened cutting instrument, in order to prevent unnecessary tissue damage. Clean and defined incisions will lead to better healing and less discomfort to the patient.
1 External Bevel
This is an incision contained in the gingiva and directed toward the crown of the tooth, with the object of eliminating pockets, improving gingival contour, and gaining access to the roots. This type of incision is frequently used in conjunction with flap surgeries when it is necessary to thin the tissue externally. It must be performed before folding the flap1. This incision is highly prevalent when performing gingivectomy surgeries [3-8].
1.1 Technique
The incision is contained in the gingiva and made in the direction toward the crown of the tooth. The instrument is placed at an angle of 45 degrees in the direction toward the pocket or gingival sulcus, or in relation to the root of the tooth. It may be linear or it may outline the gingival parabola (Figure 1). In the external bevel incision, the angle is 45 degrees in relation to the root.
