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Journal of Oral Science & Rehabilitation No. 1, 2018

F l a p d e t a c h m e n t a n d r e t r a c t i o n i n p e r i a p i c a l s u r g e r y Figs. 6A & B A Figs. 6C & D B C Figs. 6E & F E D F Fig. 6A Tomographic scan of an apical lesion of a mandibular second premolar. Fig. 6B Intraoral photograph of the affected tooth. Note the integrity of the gingival margin and the band of keratinized gingiva. Fig. 6C A flap is raised through submarginal incision; after detachment, a narrow groove is made on the most apical portion of the bone tissue, taking care to avoid damage to the flap. Fig. 6D The retractor is positioned in the groove, keeping the soft tissue away from its trajectory. Fig. 6E A continuous suture is used to close the flap. Fig. 6F Intraoral radiograph after surgery. Perfect retrograde filling of the cavity can be observed. G r o o v e T e c h n i q u e A useful option is the so-called groove tech- nique,4 which was developed for mandibular premolar apicoectomies with the aim of avoiding damage to the mental nerve. Nevertheless, it can be applied to any tooth and involves the cre- ation of a narrow groove (of scant depth and measuring about 15 mm in length) using a small rounded drill. The tip of the retractor is inserted into this groove, and after firmly fixing the body of the retractor, gentle separation from the bone is performed to safely keep the soft tissue clear of the surgical field (Figs. 6A–F). It is also possible to place a small piece of dressing impregnated with anesthetic solution between the separator and the flap in order to preserve flap integrity and improve bleeding control (Figs. 7A–E). The tissue tends to dry out when surgery is prolonged. In this case, the flap must be periodically and freely repositioned and humidified with sterile saline solution.4, 6 Opti- mum surgery is rapid, meticulous and decisive, and should be performed correctly and in an orga- nized way.2 Conclusion This meticulous surgical technique allows treat- ment of the soft tissue with delicacy, minimally injuring the vascularization, which is very important in oral surgery, and allowing good healing of the soft tissue and of the incisions. In addition, it achieves an adequate surgical field of work that will aid the clinician in being effec- tive and quick in the surgical procedure, which means a reduced possibility of infection and drying of the tissue. Journal of Oral Science & Rehabilitation Volume 4 | Issue 1/2018 29

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