For general dentists, and for any surgeon really, good “surgical extractions” require knowing the envelope flap. The envelope flap is a fundamental step for any surgical extraction. It includes severing gingival attachments connecting to the root with a blade or sharp periosteal elevator (PE). Attachments often don’t break on their own as a tooth comes out, and can cause vertical tears in adjacent soft tissue. Follow along with Dr. Karl Koerner as he describes in detail instructions for making the perfect envelope flap.
The Benefits of a Good Flap for Surgical Extraction
An envelope flap made with a PE creates a narrow “gap” between tooth and soft tissue, allowing the forcep beaks down to the bone, and allowing elevators to fulcrum off the interseptal bone, See photo 1 which shows the forcep beaks sliding down to the bone.
Minimize Soft Tissue Damage With a Good Flap
A good envelope flap prevents unnecessary tissue trauma by not allowing the elevator to crush the papilla or other soft tissue. Photo 2 shows the elevator reaching the bone and allowing it to fulcrum off the interseptal bone, avoiding soft tissue injury.
Widening the Flap to Aid Visibility and Access
Widening the envelope flap by reflecting the facial and lingual about 2-3 millimeters provides more light, visibility and better access for instrumentation. This is especially helpful when extracting roots or root tips. You can reflect the flap wider than 2-3 millimeters if needed. See Photo 3.
Lengthening the Flap
When doing multiple extractions, it is often necessary to not only widen the envelope flap, but also lengthen it. A longer envelope (beyond the tooth being extracted to the mesial and distal) is often helpful when doing multiple extractions. See photo 4.
Get Better Closure With a Good Flap
A longer envelope flap ( three teeth wide coronally) and deeper (into the MB fold) allows more closure over a single socket graft. In photo 5, you can see that it’s possible to get 2-3 more millimeters of closure from buccal to lingual in the lower arch. This stretch is enabled from the looser alveolar mucosa apical to the MG line. See photo 5 on a patient with a PTFE membrane.
Master These Skills and More in July or September at KCSI’s Continuum 1: Hands-On Surgical Extractions Course
Get what you need to know, from the basics to advanced surgical extraction skills during the 22 hour Continuum 1. This course includes extensive work on lifelike models. Participate virtually using Zoom and your webcam, or join us in person. The Houston course is scheduled for July 15-16, and there is still time to register and receive your materials before the course. If you can’t make the July date, then join us in Chicago, or online this September for Continuum 1. This course covers everything you need to become faster, more predictable and more successful with surgical extractions.
Participants who complete this course most often move onto Continuum 3- Live Patient Treatment course, which includes 3 days of non-stop surgical extractions and related procedures on patients.
You can find our complete course schedule and registration information on our website here.
