ABOUT THE BOOK:

•The book Is complete, condse, comprehensive and easy to read book on the subjects of perlodontologyand oral

go
lmplantology.

ett covers various aspects of oral histology, dental anatomy, din/cal diagnosis, pathogenals of periodontal disease
and various treatment modal/tie<. It de<crlbe< In detail the procedures in oral implantology.

0 "'m

ESSEITIALS
ett has extensive 11/ustratlons Including line diagrams and now charts are presented to help the students and clinicians

::a "'
grasp the subject easily .
eNumerous c/lnlcal photographs are Included for easier comprehension of varied diseases and their management .
m
•The book showcases latest cutting-edge Information on various topics In pertodontology.
)> -tz
r-
OF PERIODOITICS
ett provide< updated lnfa,mat/on on the subject In a simple and lucid manner.
ett briefly explains all the topics of the MDS In Periodontics according to the Curriculum of Dental coundl of Ind/a.
ett comprehensively addresses the 2020 vision of the American academy of Perlodontology.
-►
3: I;;
ett also covers the perlodo nto/ogycurrlculum or global universities Including in Middle East and Malaysia.

-c 0
6 ORAL IMPLAITOLD6Y
•The authors have excellent academic records and hold reputable positions In their respective fields

r- "T1
•The book has contributions from 35 authors of eminence from within the count,yand across the globe to shed light
with the/r reasonlng on the latest trends and updates In the field of perladantalogy and lmplantalagy.

)> �
etn-depth discussion of the rundamentals In anatomy, physiology, etiology and pathology with reference ta Its

z
diagnosis, treatment planning and management.
estep.lJy-step procedures and pre<entatlans ornumerous problems In perladantology with their possible therapeutic

-I :!!
solutions.
eFresh perspectives on key topics and new Information throughout the book that gives the up-to-date coverage of
0
08
complete spectrum In pertodontalogy and oral implantology. .
ett targets the undergraduates, post graduates and din/clans

r- z
•It can be used by undergraduates due to Its simpler fo,mat

0 ::!
•The clinicians can update their knowledge with the latest developments In this field.

c:, L1

.
i-
,\llOChod
G...,,o

I MuooG..,...,
Junc1lor"I
f
AIY'Odor MUCOSO

SARANRAJ JPS PUBLICATION DR. SYED WALi PEERAI

Bl. IAITHIIEYAI IAMAL/lliAM
Essentials of
PERIODONTICS &
ORAL IMPLANTOLOGY

DR. SYED WALi PEERAN

DR. KARTHIKEYAN RAMALINGAM
Essentials Of
PERIODONTICS & ORAL IMPLANTOLOGY
Published by Dr. Syed Wali Peeran and Dr. Karthikeyan Ramalingam @
Saranraj JPS Publication,
Tamil Nadu, India

© Dr. Syed Wali Peeran &

Dr. Karthikeyan Ramalingam
1st Edition 2021
ISBN: 978-81-950475-4-3
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopy, recording or any information storage and retrieval system without the permission in writing from the
publisher.
Note: As new information becomes available, changes become necessary. The editors/author/contributors and the publishers have,
as far as it is possible, taken care to ensure that the information given in this book is accurate and up to date. In veiw of the possibility
of human error or advances in medical science neither the editor nor the publisher nor any other party who has been involved in the
preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete. Readers
are strongly advised to conirm. This book is for sale in India only and cannot be exported without the permission of the publisher in
writing. Any disputes and legal matters to be settled under Chennai jurisdiction only.

Published in India
 Dr. Syed Wali Peeran is Professor of Periodontology and Oral lmplantology.
He finished his postgraduation in Periodontology in 2008 and has a doctoral degree.
He has a postgraduate certificate in advanced oral implantology and a
fellowship from international congress of oral implantologists.
He is the Editor in Chief and the founding editor for the journals-
Dentistry & Medical Research and Case Reports in Odontology.
He has over 63 national and international publications to his credit.
He has attended various national and international conferences and workshops.
He has also authored "Perio-Quest- MCQs in Periodontics with Self-Assessment
Picture Test" published by EMMESS publishers. He has been a reviewer for Libyan
Journal of Medicine,Journal of Nature, Biology and Medicine and various other
journals. He is a Life member of Indian Academy of Osseo Integration,
Indian Society of Periodontology, Indian immunological Society,
Indian Society of Oral lmplantologists and Indian Dental association.

Dr. Syed Wali Peeran, B.D.S, M.D.S (Peria), Ph.D. FICO/., PGCOI.
Professor, Department of Periodontics & Oral lmplantology,Faculty of Dentistry, Sebha
University, Sebha, Libya.

Dr. Karthikeyan Ramalingam is a Professor of Oral Pathology and Microbiology.

He finished his graduation and post graduation from Saveetha Dental College,
Chennai. He was the College topper in Part I and Part II postgraduate University
examinations.
He had secured the Gold medal in Pathology & Microbiology and Community
Dentistry in University examinations.He has guided postgraduates in oral pathology for
their seminars, research studies, journal discussions, library dissertations, thesis
preparation and in submitting articles for publication in various national and
international journals. He has also handled lectures and practical demonstrations
for undergraduates in oral histology,dental anatomy, forensic odontology, oral
pathology and microbiology. He has 65 international and national publications to his
credit. He is the Co-author of Textbook of Prosthodontics by Jaypee Brothers Medical
Publishers (P) Ltd. He has also contributed multiple choice questions and clinical
pictures to Perio-Quest- MCQs in Periodontics with Self-Assessment Picture Test by
EMMESS publishers. He is the Editor for Journals - Dentistry and Medical Research &
Case reports in Odontology.He is also the Reviewer for Journal of Oral and
Maxillofacial Pathology and North American Journal of Medical Sciences
(Indexed with PUBMED) and Journal of Cranio-Maxillary diseases.
He is a member of International Association of Oral Pathologists since 2016.
He is a Life member of Tamilnadu Dental Council since 2001, Life member of
Indian Association of Oral and Maxillofacial Pathologists since 2006 and a Life
member of Saveetha Dental College Old Students Association since 2001.
Dr. Karthikeyan Ramalingam, B.D.S, M.D.S
Professor, Department of Oral Pathology & Microbiology,Faculty of Dentistry, Sebha University,
Sebha,Libya
 Dr. ABDULNASIR MAQBOOL AHMED. Dr. MOHAMMAD NAZISH ALAM. Dr. Syed Nahid Basheer.
MSc, FICOI (U.S.A), Private Practice, BOS., MOS. BOS., MOS.
U.A.E. Asst. Prof, Department of Periodontics, Assistant Professor, Department of Restorative
College of Dentistry, Jazan university Dental Science, College of Dentistry, Jazan
Dr. Abhilash. University, Gizan, Kingdom of Saudi Arabia.
P.R. M.D.S Dr. Nagabushan.
(Oral Pathology and Microbiology), B.D.S., M.D.S Dr. Syeda Nikhat Mohammadi.
Reader, Department of Oral Pathology (Oral Medicine and Radiology), BOS., MOS.
and Microbiology, Department of Oral Medicine and Radiology, Senior lecturer, public health dentistry,
Oxford Dental College & Hospitals, India. Pravara institute of dental sciences, Loni.
Bangalore, Karnataka, India. Dr. Neha. Maharashtra.
MOS., Dr. Tazeen.D
Dr. Ahmed Taher El-Hassan. Department Of Periodontics and lmplantology, B.D.S., M.D.S (Peria).
M.Sc (Oral Sciences-Periodontics), Surendera Dental College and Research Institute, Assistant Professor, Department of Periodontics,
Diplomate of American Board of Sriganganagar, Rajasthan. Jazan University, Jazan, KSA.
Periodontics, NOBE, WREB.
Assistant Professor, Benghazi University, Dr. R. Ganesh. Prof. Dr. Abdul Hafeez Khan
B.D.S., M.D.S. (Pedodontics) M.Sc., Ph.D.
Benghazi, Libya.
Reader, Department of Pediatric and Chairman, Department of Parasitology, Faculty
Dr. Aisha Ahmed. Preventive dentistry, SRM University, of Medicine, Sebha University, Sebha, Libya.
MB.ChB Tamil Nadu, India.
ECFMG Certified Physician. Prof. Dr. Abdul Hafeez Khan
Dr. Rashmi Rai.
Department of Medicine, Faculty of M.Sc., Ph.D.
BOS., MOS.
Medicine, Sebha University, Sebha, Chairman, Department of Parasitology, Faculty
Senior lecturer, public health dentistry,lndex
Libya. of Medicine, Sebha University, Sebha, Libya.
institute of dental sciences, Indore
Dr. Bandar M.A. AL-Makramani. Prof. Dr. Madhumala Thiruneervannan
Dr. Santosh Kumar.BB
BOS, HOD, MDSc, Ph.D BOS., M.D.S (Peria),
BOS, MOS (Peria), M.Perio RCSEd (U.K),
Assistant Professor, Fixed Prosthodontics, Head, Department of Periodontics, Vinayaka
MICOI (U.S.A) ), Specialist Periodontist and
Department of Prosthodontics, College Mission's Sankarachariyar Dental College,
lmplantologist, Kuwait.
of Dentistry, Jazan University, Kingdom Salem, India.
of Saudi Arabia. Dr. Salhya Selhuraman.
Prof. Dr. Marei Hamad Al Mugrabi.
B.D.S, M.A, PG0CA,
Dr. Fatma Mojtaba Al Said. B.D.S., M.Dent.Sc. (Periodontics-Dublin),Ph.D.
Surendra Dental College and Research
BOS., MPH (USA), Head, Department of Periodontics, Benghazi
Institute, Sriganganagar, Rajasthan. India.
Faculty of Dentistry, Sebha University, University, Libya.
Sebha, Libya. Dr. Shaesta Begum.
BOS, MOS (Periodontics), Prof. Dr. Nurgul KOMERIK.
Reader, Depatment of Periodontics, Farooqia DDS., Ph.D.
Dr. Franciso AL.
Dental College & Hospital, Mysore, Karnataka. Post Doc. Biruni University, Dental School,
College of Dentistry, Jizan University, Dept. of Oral Surgery, Istanbul, TURKEY
India.
KSA
Dr. Shamimul Hasan. Prof. Dr. P.G. Naveen Kumar.
Dr. Fuad Al Sanabani. BOS, MOS B.D.S., M.D.S., (Community Dentistry),
MSc, PhD Assistant Professor, Department of Oral Head, Department of Community and
Department of Oral and Maxillofacial Medicine and Radiology, Faculty of Dentistry, Preventive dentistry, College of Dental
Prosthodontics, Jazan University, Jazan, Jamia Milia lslamia, New Delhi.India Sciences, Davangere, Karnataka, India.
Kingdom of Saudi Arabia Prof. Dr. PC Anila Namboodiripad.
Dr. Soumya K Nair.
B.D.S., MOS., BDS, MDS., Department of Oral and M axillofacial
Dr. Ismail Abbas Darout. Pathology, India
DDS, Ph.D. (Dr .odont), Private practitioner, Mysore, India.
Postdoc Peria, Associate Professor Prof. Dr. R Thiruneervannan
Dr. Suchelra N. Malleshi. BDS., MDS.
and Head, Department of Preventive
B.D.S., M.D.S (Oral Medicine and Radiology), Principal, Vinayaka Mission's Sankarachariyar Dental
Dental Sciences, College of Dentistry,
Department of Oral Medicine and Radiology, College, Salem, Tamil Nadu, India.
Jazan University, Kingdom of Saudi
J.S.S Dental College, Karnataka, India.
Arabia.
Prof. Dr. Syed Khalid Alla!.
Dr. Supriya Ebenezer. MDS.
Dr. Khaled Awidat Abdalla. BOS., MOS. Associate Fellow AAID, Department of oral
B.D.S., C.E.S., DuODF (France), Reader, Department of Periodontics, mplantology, Vivekenanda dental college,
Assistant Professor, Department of Mathrusri Ramabai Ambedkar Dental TN, India
Oral Biology and Orthodontics, College and Hospital, Bangalore, India.
Sebha University, Sebha, Libya. Prof. Dr. V.Gopinalh.
Dr. Syed Ali Peeran. M.D.S.
M.D.S. (Prostho)., MBA(HA), M.Phil (H.A), Professor, Department of Periodontology and
Dr. Manohar Murugan
Department of Prosthodontics, Assistant lmplantology, Chhattisgarh dental college
M.Sc. (Microbiology), Ph.D.,
Professor, Jazan University, Jazan, KSA. and research institute, Rajnandgaon, India
Assistant Professor, Department of
Medical Microbiology, Faculty Prof. DR.V.HARIKRISHNA.
of Medicine, Sebha University, Sebha, Dr. Syed Kuduruthullah. S.K M.D.S.
Libya. M.0.S.(Oral Path) Department of Orthodontics and Dentofacial
Lecturer, Ajman University, Orthopaedics. Chhattisgarh Dental college
Ajman, U.A.E. and research institute, Rajnandgaon, India.

Powered by TCPDF (www.tcpdf.org)

Chapter 1 Incision in Periodontal Surgery
CHAPTER

47a Incisions in Periodontal

Surgery

Syed Wali Peeran

Chapter Outline:
• Incision.
• Preconditions for selection of the appropriate
incision technique.
• Incisions used in Periodontics

INCISION: A cut or surgical wound made by a knife, electrosurgical scalpel, laser, or other such instrument. (Glossary
of Periodontal terms,2001)
Preconditions for selection of the appropriate incision technique:

Periodontics & Oral Implantology 1

 Table 47a.1: Incisions used in periodontics

Incision in Periodontal Surgery

Periosteal
2
External Bevel Internal Bevwel Inci- Sulcular Inci- Releasing Thinning Cut Back
Incision (EBI) sion (IBI) sion Incision Incision Incision Incision
Synonyms Gingivectomy Reverse bevel(its bevel Intra-Sulcular/ Vertical Internal/ Periosteal
incision is in areverse position Crevicular incision under-mining Releasing
of EBI), inverted incision incision Incision
bevel or inverse bevel
incision. It is the
most common type
of incision used in
periodontics.
Descrip- Reduces the Reduces the thickness The surgical Made to Extendsfrom Placed in Incision at the
tion thickness of the of the mucogingival scalpel is enhance the gingival the alveolar base of the
Periodontics & Oral Implantology

mucogingival complex from the inserted into mobility of a margin mucosa at flap severing
complex from the sulcular side.(Glossary the crevice/ periodontal toward the apical the underlying
outside surface, as of Periodontal terms, pocket and flap. the base of aspect of periosteum.
in a gingivectomy. 2001)It is apically carried apically (Glossary of the flap to a releasing
(Glossary of directed, placed at the beyond its Periodontal decrease incision and
Periodontal terms, crest of the gingival base. It is terms, 2001) the bulk of directed
2001) margin or stepped commonly It is placed connective toward the
It is a coronally back, an acute angle is followed perpen- tissue on the base of the
directed incision;an formed between the by the dicular to underside of flap.
obtuse angle is tooth crown and the elevation of the gingival the flap.
formedbetween scalpel.It is a horizontal full thickness margin at the
the tooth crown incision. flap. It is a line angles
and the scalpel. It horizontal of teeth
is totally contained incision. and extend
within the gingiva. through the
It is a horizontal muco gingival
incision. junction.
Indications Gingival Excisional new Access surgery To increase Palatal flaps, Pedicle To release
enlargement- attachment procedure. for GTR access to distal wedge flaps: flap tension
Gingival Basic incision for Narrow allow apical procedures, laterally allowing
hyperplasia: flap procedures. (esp. keratinized or coronal internal positioned, coronal
External bevel Modified Widman Flap) gingiva positioning bevel rotational advancement

Section - VIII
gingivectomy. ≤ 3 mm. of flap. gingivectomy, flap. Etc. of the flap.
Crown lengthening. bulky
Gingivoplasty. Aesthetically
Gingival enlargement. papillae
Crown lengthening. relevant areas.
 Chapter 47a
External Bevel Internal Bevel Inci- Sulcular Inci- Releasing Thinning Cut Back Periosteal
Incision (EBI) sion (IBI) sion Incision Incision Incision Incision
Contra- When access to Inadequate attached For certain
indications underlying bone is gingiva. anatomic
a necessity. reasons
Unfavourable e.g.to
anatomic prevent
conditions trauma-
such as shallow tization of
palatal vault or the mental
a pronounced nerve-in
external oblique Mandi-bular
ridge. canine
premolar
Periodontics & Oral Implantology

High caries index.

region, the
Pre-existing branches of
thermal sensitivity. the palatine
artery and
palatine vein-
in maxillary
second
molar area.
Radicular
promi-nence
and the
middle of the
papilla.
Advan- Simple and easy to Removal of pocket wall. Simplest It relaxes Relieves the

Incision in Periodontal Surgery

tages perform. Conserves the incision. the flap and flap tension
relatively uninvolved increases and enable
outer gingival surface access to the flap to
hence provides direct underlying rotate on a
apposition of healthy structures. pivot more
connective tissue to freely.
the root surface.
Produces a thin
adaptable flap margin.
3
 Incision in Periodontal Surgery Section - VIII

♦ Crescent incision: A paramarginal internal bevel

Periosteal

Parkerblade blades no; 15.

incision (IBI), which is used in cases of crown

Bard-parker
Incision

lengthening, restricted to the buccal crown

surface and does not involve the
interdental gingiva.
♦ Crestal incision: An incision directed towards
Cut Back

the crest of the alveolar process.

Incision

11 or 15
♦ Extra sulcular incision: An incision placed

Bard-
between the gingival margin and
the mucogingival junction, dictated by the
depth of the pocket, width of the attached

Bard-parker
Thinning
Incision

gingiva and the volume of the gingiva.

blade 12,
♦ Marginal incision: An IBI that is made on the top

12B.
of the gingival margin. It is difficult to perform in
thin gingival biotypes.
♦ Parapapillary incision: An incision that is taken
Bard-Parker
blade no: 11
Releasing
Incision

not into the interdental space but past it to

the next tooth (line angle to line angle) and thus
&12.

completely retaining the interdental gingiva.

♦ Paramarginal incision: A scalloped IBI placed at a
Sulcular Inci-

distance from the gingival margin creates an

Bard-Parker
blade no: 11

apposition of healthy gingival tissue to the teeth

sion

and a new interdental papilla. Used in flap

&12.

procedures for pocket reduction and crown

lengthening. It is contraindicated in cases of
inadequate keratinized gingiva and when
Internal Bevel Inci-

Bard-Parker blade no

aesthetics is critical.
Loss of keratinized

♦ Sub marginal incision: IBI placed towards the

sion (IBI)

bony crest away from the gingival margin.

11, 12 & 15.

♦ Interdental incision:The third incision in flap

procedures, is used to dislodge the
tissue.

triangular tissue created by the IBI and sulcular

incision. The incision is submarginal and is
placed by the interdental knife.
mentation Orban’s knife, Bard
antages heals by secondary

and post-operative

Entails a great loss

Disadv- Broad wound that
External Bevel

not in use except

Incision (EBI)

of tissue hence is

♦ The papilla base incision consisted of a

Parker blade 11
Intra-operative

Post-operative

Kirkland knife,
enlargements,

shallow first incision at the base of the papilla

in treatment
discomfort.

and a second incision directed to the crestal

of gingival
intention.

bleeding.

bone, creating a split thickness flap in the area

&15.

of the papilla base.

♦ Semilunar incision: A crest shaped incision used
in periodontal plastic surgery to coronally
Instru-

displace the flap.

4 Periodontics & Oral Implantology