of flap is used when access to the bone is not required, such as in

gingivectomy procedures.

1. What is a periodontal flap?

a) A type of toothbrush

b) A section of gingiva and/or mucosa surgically separated from the underlying tissues to provide
visibility and access to the bone and root surface

c) A type of dental filling

d) A type of dental implant

e) A type of dental crown

Answer: b) A section of gingiva and/or mucosa surgically separated from the underlying tissues to
provide visibility and access to the bone and root surface.

Explanation: A periodontal flap is a surgical technique used to provide visibility and access to the bone
and root surface. It involves separating a section of gingiva and/or mucosa from the underlying tissues.

2. What are the classifications of periodontal flaps?

a) Based on the type of tooth involved

b) Based on the color of the gingiva

c) Based on the amount of anesthesia required

d) Based on bone exposure after flap reflection, placement of the flap after surgery, and management
of the papilla

e) Based on the type of dental instrument used

Answer: d) Based on bone exposure after flap reflection, placement of the flap after surgery, and
management of the papilla.

Explanation: Periodontal flaps can be classified based on bone exposure after flap reflection,
placement of the flap after surgery, and management of the papilla.

3. What is a full-thickness flap?

a) A flap that includes epithelium, connective tissue, and periosteum

b) A flap that includes only epithelium

c) A flap that includes only connective tissue

d) A flap that includes only periosteum

e) A flap that includes only bone

Answer: a) A flap that includes epithelium, connective tissue, and periosteum.

Explanation: A full-thickness flap is a type of flap that includes epithelium, connective tissue, and
periosteum. It is the most common type of flap used when access to the bone is indicated for resective
or regenerative procedures.

4. When is a partial-thickness flap used?

a) When access to the bone is required

b) When access to the bone is not required

c) When the papilla needs to be preserved

d) When the flap needs to be displaced

e) When the flap needs to be non-displaced

Answer: b) When access to the bone is not required.

Explanation: A partial-thickness flap is used when access to the bone is not required, such as in
gingivectomy procedures. It is called a partial-thickness or split thickness flap because the periosteum
is not included in the flap.

5. What is a papilla preservation flap?

a) A flap that includes the papilla and is used to preserve the papilla

b) A flap that excludes the papilla and is used to preserve the papilla

c) A flap that includes the papilla and is used to remove the papilla

d) A flap that excludes the papilla and is used to remove the papilla

e) A flap that includes the papilla and is used to displace the papilla

Answer: a) A flap that includes the papilla and is used to preserve the papilla.

Explanation: A papilla preservation flap is a type of flap that includes the papilla and is used to preserve
the papilla. It is used in cases where the papilla needs to be preserved, such as in esthetic procedures.

1. What is a partial-thickness flap?

a) A flap that includes the periosteum

b) A flap that excludes the periosteum

c) A flap that includes both mucosal and periosteal layers

d) A flap that is used only in esthetic crown lengthening procedures

e) A flap that is used only in posterior areas of the mandible

Answer: b) A flap that excludes the periosteum

Explanation: A partial-thickness flap is a type of flap that is used extensively in mucogingival surgery. It
excludes the periosteum and leaves an underlying blood supply where soft tissue grafting is performed
to correct deformities in the morphology, position, or amount of gingiva.

2. When is a combined technique of full and partial-thickness flap used?

a) In all mucogingival procedures

b) In esthetic crown lengthening procedures only

c) In posterior areas of the mandible only

d) In areas where the gingiva is thin (1 mm) only

e) In some mucogingival and esthetic crown lengthening procedures

Answer: e) In some mucogingival and esthetic crown lengthening procedures

Explanation: A combined technique of full and partial-thickness flap is used in some mucogingival and
esthetic crown lengthening procedures. Part of the flap may be full thickness and the other part may be
partial thickness.

3. What is a full-thickness flap?

a) A flap that includes the periosteum

b) A flap that excludes the periosteum

c) A flap that includes both mucosal and periosteal layers

d) A flap that is used only in mucogingival surgery

e) A flap that is prepared by making an incision through the mucosal layers and the periosteum until the
bone is felt

Answer: e) A flap that is prepared by making an incision through the mucosal layers and the periosteum
until the bone is felt

Explanation: A full-thickness flap is prepared by making an incision through the mucosal layers and the
periosteum until the bone is felt. A periosteal elevator is then used to gently separate the periosteum
along with the superficial mucosal layers from the bone.

4. In which areas should a partial-thickness flap not be attempted?

a) In all areas of the mouth

b) In areas where the gingiva is thick (1 mm)

c) In posterior areas of the mandible where the vestibule is deep

d) In areas where the gingiva is thin (1 mm)

e) In anterior areas of the mandible where the vestibule is shallow

Answer: d) In areas where the gingiva is thin (1 mm)

Explanation: A partial-thickness flap should not be attempted in areas where the gingiva is thin (1 mm).
It should also not be attempted in posterior areas of the mandible where the vestibule is shallow and
access is difficult.

1. Which of the following areas should not be attempted in flap placement?

a) Areas with thick gingiva

b) Areas with shallow vestibule

c) Areas with easy access

d) Areas with thick connective tissue

e) None of the above

Answer: b) Areas with shallow vestibule

Explanation: Flap placement should not be attempted in posterior areas of the mandible where the
vestibule is shallow and access is difficult.

2. What is the purpose of using tissue forceps during flap dissection?

a) To split the connective tissue layer

b) To stabilize and retract the flap margin

c) To create better visibility

d) To reduce tension on the flap

e) None of the above

Answer: b) To stabilize and retract the flap margin

Explanation: Tissue forceps aid in the stabilization and retraction of the flap margin as the dissection is
carried out laterally and apically, creating better visibility and reducing tension on the flap.

3. Which of the following may lead to flap perforation or tearing of the delicate flap?

a) Poor visibility

b) Excessive tension
c) Both a and b

d) None of the above

e) All of the above

Answer: c) Both a and b

Explanation: Poor visibility and excessive tension may lead to flap perforation or tearing of the delicate
flap, thus compromising wound healing.

4. Which type of flap placement involves splitting the interdental papilla?

a) Apically positioned flap

b) Coronally positioned flap

c) Pedicle flap

d) Undisplaced flap

e) Conventional flap

Answer: e) Conventional flap

Explanation: In the conventional flap, the interdental papilla is split beneath the contact point of the two
approximating teeth to allow reflection of buccal and lingual flaps, maintaining gingival morphology with
as much papilla as possible.

5. Which type of flap placement preserves the interdental papilla?

a) Apically positioned flap

b) Coronally positioned flap

c) Pedicle flap

d) Undisplaced flap

e) Papilla preservation flap

Answer: e) Papilla preservation flap

Explanation: The papilla preservation flap is a type of flap placement that preserves the interdental
papilla, making it an ideal choice for esthetic areas.

the adjacent teeth to ensure adequate papilla preservation.

•Which of the following is an indication for using the Papilla Preservation Flap technique?
A) When the flap is to be displaced

B) When the interdental spaces are too wide

C) When the interdental spaces are too narrow

D) When the patient has a history of periodontal disease

E) When the surgical intervention involves treatment of buccal osseous defects

Answer: C) When the interdental spaces are too narrow. The Papilla Preservation Flap technique is
used when the interdental spaces are too narrow, precluding the possibility of preserving the papilla.

•What is the difference between the Conventional Flap and the Papilla Preservation Flap?

A) The Conventional Flap involves making incisions through the interdental papillae, while the Papilla
Preservation Flap does not.

B) The Conventional Flap is used for esthetic reasons, while the Papilla Preservation Flap is not.

C) The Conventional Flap is used in the surgical treatment of anterior tooth regions, while the Papilla
Preservation Flap is used in posterior tooth regions.

D) The Conventional Flap is a newer technique than the Papilla Preservation Flap.

E) There is no difference between the two techniques.

Answer: A) The Conventional Flap involves making incisions through the interdental papillae, while the
Papilla Preservation Flap does not. The Papilla Preservation Flap technique involves making
intra-sulcular incisions at the facial and proximal aspects of the teeth without making incisions through
the interdental papillae, while the Conventional Flap does involve making incisions through the
interdental papillae.

•What is the purpose of the semilunar incision in the Papilla Preservation Flap technique?

A) To ensure adequate papilla preservation

B) To make the incision less noticeable

C) To reduce bleeding during the procedure

D) To make the procedure faster

E) To reduce post-operative pain

Answer: A) To ensure adequate papilla preservation. The semilunar incision should dip apically at least
5 mm from the line angles of the adjacent teeth to ensure adequate papilla preservation.

surgical site and promote healing.

1. What is the purpose of the semilunar incision in the Papilla Preservation Flap technique?
a) To remove the interdental tissue

b) To elevate the facial flap

c) To reflect the lingual/palatal surface

d) To scale and root plane the exposed root surfaces

e) None of the above

Answer: b) To elevate the facial flap. The semilunar incision should dip apically at least 5 mm from the
line angles of the teeth, which will allow the interdental tissue to be dissected from the lingual/palatal
aspect so that it can be elevated intact with the facial flap.

2. What instrument is used to free the interdental papilla in the Papilla Preservation Flap technique?

a) Scissors

b) Forceps

c) Curette or interproximal knife

d) Periosteal elevator

e) None of the above

Answer: c) Curette or interproximal knife. A curette or interproximal knife is used to free the interdental
papilla carefully from the underlying hard tissue.

3. What is done with the detached interdental tissue in the Papilla Preservation Flap technique?

a) It is removed

b) It is pushed through the embrasure with a blunt instrument

c) It is sutured back in place

d) It is left to heal on its own

e) None of the above

Answer: b) It is pushed through the embrasure with a blunt instrument. The detached interdental tissue
is pushed through the embrasure with a blunt instrument.

4. What type of flap is reflected in the Papilla Preservation Flap technique?

a) Partial-thickness flap

b) Full-thickness flap

c) Mucoperiosteal flap
d) Gingival flap

e) None of the above

Answer: b) Full-thickness flap. A full-thickness flap is reflected with a periosteal elevator on both facial
and lingual/palatal surfaces.

5. What is done with the margins of the flap and the interdental tissue in the Papilla Preservation Flap
technique?

a) They are left untouched

b) They are scraped to remove pocket epithelium and excessive granulation tissue

c) They are sutured back in place

d) They are trimmed to maintain maximum thickness of tissue

e) None of the above

Answer: b) They are scraped to remove pocket epithelium and excessive granulation tissue. While
holding the reflected flap, the margins of the flap and the interdental tissue are scraped to remove
pocket epithelium and excessive granulation tissue.

ngual with the lingual flap.

1. What is the purpose of using cross mattress sutures in the Papilla Preservation Flap technique?

a) To increase the space for regeneration

b) To achieve and maintain primary closure of the flap in the interdental area

c) To remove the surgical dressing after 1 week

d) To protect the surgical area

e) None of the above

Answer: b) To achieve and maintain primary closure of the flap in the interdental area.

Explanation: Cross mattress sutures are used in the Papilla Preservation Flap technique to achieve and
maintain primary closure of the flap in the interdental area.

2. What is the purpose of the Modified Papilla Preservation technique?

a) To increase the space for regeneration

b) To achieve and maintain primary closure of the flap in the interdental area

c) To remove the surgical dressing after 1 week

d) To protect the surgical area

e) None of the above

Answer: a) To increase the space for regeneration.

Explanation: The Modified Papilla Preservation technique was developed in order to increase the space
for regeneration.

3. What is the Simplified Papilla Preservation Flap technique used for?

a) To increase the space for regeneration

b) To achieve and maintain primary closure of the flap in the interdental area

c) To remove the surgical dressing after 1 week

d) To protect the surgical area

e) None of the above

Answer: b) To achieve and maintain primary closure of the flap in the interdental area.

Explanation: The Simplified Papilla Preservation Flap technique has been proposed for narrower
interdental spaces in order to achieve and maintain primary closure of the flap in the interdental area.

4. What is the approach used in the Simplified Papilla Preservation Flap technique?

a) An oblique incision across the defect-associated papilla

b) A vertical incision across the defect-associated papilla

c) A horizontal incision across the defect-associated papilla

d) A circular incision around the defect-associated papilla

e) None of the above

Answer: a) An oblique incision across the defect-associated papilla.

Explanation: The Simplified Papilla Preservation Flap technique includes an oblique incision across the
defect-associated papilla, starting from the buccal angle of the defect-associated tooth to reach the
mid-interdental part of the papilla at the adjacent tooth under the contact point.

vertical incision is made at the base of the pocket to separate the pocket lining from the underlying
connective tissue.

•The pocket lining is then removed using a curette or ultrasonic scaler.

•The exposed root surface is thoroughly cleaned and planed.

Question: What is the purpose of using periodontal flaps in surgical periodontal therapy?

A) To reduce pocket depth

B) To remove calculus from the root surface

C) To regenerate periodontal tissue

D) To provide access for root instrumentation

E) To perform gingival resection

Answer: D) To provide access for root instrumentation

Explanation: Periodontal flaps are used in surgical periodontal therapy to provide access for root
instrumentation, which involves removing calculus and plaque from the root surface. The Modified
Widman flap is a specific flap technique that facilitates root instrumentation by eliminating the pocket
lining and providing intimate postoperative adaptation of connective tissue to tooth surfaces.

1. What is the purpose of the second crevicular incision in the Modified Widman procedure?

a) To remove tissue tags and granulation tissue

b) To detach the interdental tissue and gingival collar from the bone

c) To reflect full-thickness flaps away from the alveolar crest

d) To circumscribe the triangular wedge of tissue containing the pocket lining

e) To stabilize the flaps with sutures and periodontal dressing

Answer: d) To circumscribe the triangular wedge of tissue containing the pocket lining. This step allows
for the removal of the pocket lining and any diseased tissue, which is essential for successful
periodontal treatment.

2. What is the purpose of removing tissue tags and granulation tissue in the Modified Widman
procedure?

a) To detach the interdental tissue and gingival collar from the bone

b) To reflect full-thickness flaps away from the alveolar crest

c) To check and scale/plan the root surfaces

d) To remove any residual periodontal fibers attached to the tooth surface

e) To promote healing and prevent reinfection of the treated area

Answer: e) To promote healing and prevent reinfection of the treated area. Tissue tags and granulation
tissue can harbor bacteria and prevent proper healing, so their removal is important for successful
treatment.
3. What is the purpose of thinning the flaps in the Modified Widman procedure?

a) To allow for close adaptation of the gingiva around the entire circumference of the tooth

b) To remove tissue tags and granulation tissue

c) To detach the interdental tissue and gingival collar from the bone

d) To reflect full-thickness flaps away from the alveolar crest

e) To stabilize the flaps with sutures and periodontal dressing

Answer: a) To allow for close adaptation of the gingiva around the entire circumference of the tooth.
Thinning the flaps allows for better adaptation and healing, which can improve the overall success of
the procedure.

e mucogingival junction.

Step 4: The internal bevel incision is made at the level of the pocket to discard the tissue coronal to the
pocket if remaining attached gingiva is sufficient.

Step 5: The flap is raised and the root surface is thoroughly debrided.

Step 6: The flap is repositioned and stabilized with sutures and covered with a periodontal dressing.

1. What is the purpose of the undisplaced flap technique?

a) To remove the periodontal pocket

b) To provide root surface access

c) To evaluate the amount of attached gingiva

d) To assess the mucogingival junction

e) To eliminate the need for sutures

Answer: b) To provide root surface access. Explanation: The undisplaced flap technique is used to
provide access to the root surface for thorough debridement and removal of calculus and plaque.

2. What is the location of the internal bevel incision in an undisplaced flap?

a) At the bottom of the pocket

b) At the mucogingival junction

c) At the level of the gingival crevice

d) At the level of the bone

e) At the level of the cementoenamel junction

Answer: c) At the level of the gingival crevice. Explanation: The internal bevel incision is made at the
level of the pocket to discard the tissue coronal to the pocket if remaining attached gingiva is sufficient.

3. What is the purpose of stabilizing the flap with sutures and covering it with a periodontal dressing?

a) To eliminate the need for post-operative care

b) To prevent infection

c) To reduce bleeding

d) To promote healing

e) To prevent the flap from reopening

Answer: d) To promote healing. Explanation: Stabilizing the flap with sutures and covering it with a
periodontal dressing helps to promote healing and prevent post-operative complications.

1. What is the initial placement of the submarginal scalloped internal bevel incision based on?

a) The thickness of the gingiva

b) The alveolar bone

c) The transgingival interdental probing depth and the mucogingival junction

d) The aesthetic area

e) The crevicular incision

Answer: c) The transgingival interdental probing depth and the mucogingival junction.

Explanation: The initial placement of the submarginal scalloped internal bevel incision is based on the
transgingival interdental probing depth and the mucogingival junction.

2. What is the purpose of the short mesial vertical incision in the apical flap?

a) To allow flap release on the palate

b) To avoid extension of the horizontal incision into the aesthetic area

c) To eliminate defects and reestablish positive architecture

d) To detach the attachment apparatus from the root

e) To remove the gingival collar and granulation tissue

Answer: b) To avoid extension of the horizontal incision into the aesthetic area.
Explanation: A short mesial vertical incision may be employed to allow flap release on the palate or to
avoid extension of the horizontal incision into the aesthetic area.

3. What is the purpose of osseous recontouring in the procedure?

a) To detach the attachment apparatus from the root

b) To remove the gingival collar and granulation tissue

c) To eliminate defects and reestablish positive architecture

d) To scale and plane the root surfaces

e) To coapt the flaps on the alveolar crest

Answer: c) To eliminate defects and reestablish positive architecture.

Explanation: Osseous recontouring is performed to eliminate defects and reestablish positive

architecture.

4. What is the thickness of the tissue dependent on in the procedure?

a) The thickness of the gingiva

b) The alveolar bone

c) The transgingival interdental probing depth and the mucogingival junction

d) The aesthetic area

e) The crevicular incision

Answer: a) The thickness of the gingiva.

Explanation: The angulation of the incision may be altered depending on the thickness of the gingiva,
as well as the initial placement of the submarginal scalloped incision, to produce a thin flap margin.

5. Where is the crevicular incision made in the procedure?

a) In the gingival crevice

b) In the alveolar bone

c) In the transgingival interdental probing depth

d) In the mucogingival junction

e) In the gingival collar

Answer: a) In the gingival crevice.

Explanation: The crevicular incision is made in the gingival crevice to detach the attachment apparatus
from the root.
1. What is the purpose of Step 8 in the Kirkland Flap procedure?

a) To stabilize the flaps with sutures

b) To trim and rescallop the flaps if necessary

c) To coapt the flaps on the alveolar crest with the flap margin well adapted to the roots

d) To cover the flaps with a surgical dressing

e) None of the above

Answer: c) To coapt the flaps on the alveolar crest with the flap margin well adapted to the roots.

Explanation: Step 8 in the Kirkland Flap procedure involves coapting the flaps on the alveolar crest with
the flap margin well adapted to the roots. This is important to ensure proper root debridement and
treatment of periodontal pus pockets.

2. What is the difference between the Kirkland Flap and the Apically Repositioned Flap?

a) The Kirkland Flap is undisplaced while the Apically Repositioned Flap is displaced

b) The Kirkland Flap is a full thickness flap while the Apically Repositioned Flap is a partial thickness
flap

c) The Kirkland Flap is used for root debridement while the Apically Repositioned Flap is used for bone
grafting

d) The Kirkland Flap is a conventional flap while the Apically Repositioned Flap is a modified flap

e) None of the above

Answer: a) The Kirkland Flap is undisplaced while the Apically Repositioned Flap is displaced.

Explanation: The Kirkland Flap is a type of undisplaced, full thickness flap used for root debridement.
The Apically Repositioned Flap, on the other hand, is a displaced, full thickness flap used for bone
grafting.

3. What is the purpose of the distal wedge flaps?

a) To stabilize the flaps with sutures

b) To thin the facial and lingual tissues before reflection of the flaps

c) To allow proper root debridement

d) To resect tissue and create adequate keratinized tissue

e) None of the above

Answer: d) To resect tissue and create adequate keratinized tissue.

Explanation: The distal wedge flaps are used when the secondary objective of surgery is resective and
adequate keratinized tissue is present buccolingually. The purpose of these flaps is to resect tissue and
create adequate keratinized tissue.

ap coverage with osseous resection resulted in

greater attachment gain.

1. What type of incisions are best accomplished with an Orban knife or a 12B scalpel?

a) Triangular distal wedge

b) Distal Wedge

c) Linear Distal wedge

d) Incisions diverge buccolingually toward the ridge

e) Parallel extending distally away from the tooth

Answer: d) Incisions diverge buccolingually toward the ridge.

Explanation: The content states that incisions diverge buccolingually toward the ridge and are best
accomplished with an Orban knife or a 12B scalpel.

2. What is the purpose of a releasing "T" incision in periodontal surgery?

a) To reduce pocket depths

b) To gain access to the underlying bone

c) To promote healing after surgery

d) To reposition the flap apically

e) To contour the bone

Answer: b) To gain access to the underlying bone.

Explanation: The content states that a releasing "T" incision is placed for greater flap reflection/access
to the underlying bone.

3. Which surgical procedure results in the greatest short-term reduction in pocket depths?

a) Healing after periodontal surgery

b) Healing after Gingivectomy

c) Healing after Apically repositioned Flap

d) Healing after Modified Widman Flap

e) Healing Probing Pocket depths

Answer: d) Healing after Modified Widman Flap.

Explanation: The content states that surgical procedures with bone recontouring result in the greatest
short-term reductions in pocket depths.

4. What is the effect of surgical procedures on attachment levels in shallow sites?

a) Attachment loss for both surgical and nonsurgical treatments

b) Greater gain of clinical attachment is observed

c) No difference was found between surgery with and without osseous resection

d) Flap coverage with osseous resection resulted in greater attachment gain

e) Data is inconclusive

Answer: a) Attachment loss for both surgical and nonsurgical treatments.

Explanation: The content states that short and long-term results of shallow sites show attachment loss
for both surgical and nonsurgical treatments.

5. What is the observed effect of surgical procedures on clinical attachment levels in sites with pocket
depths of ≥7 mm?

a) Attachment loss for both surgical and nonsurgical treatments

b) Greater gain of clinical attachment is observed

c) No difference was found between surgery with and without osseous resection

d) Flap coverage with osseous resection resulted in greater attachment gain

e) Data is inconclusive

Answer: b) Greater gain of clinical attachment is observed.

Explanation: The content states that in sites with pocket depths of ≥7 mm, a greater gain of clinical
attachment is observed following surgery with and without osseous resection.

1. What is the critical probing depth (CPD) concept developed by Lindhe et al. (1982b)?

a) The depth at which periodontal surgery should be performed

b) The depth at which clinical attachment level change occurs

c) The depth at which gingival recession is inevitable

d) The depth at which bone fill is seen in angular defects

e) The depth at which non-surgical scaling and root planing is effective

Answer: b) The depth at which clinical attachment level change occurs. Explanation: Lindhe et al.
(1982b) developed the concept of critical probing depth (CPD) in relation to clinical attachment level
change.

2. Which type of periodontal surgery produces a greater gain in clinical attachment levels?

a) Flap surgery with osseous resection

b) Flap surgery without osseous resection

c) Non-surgical scaling and root planing

d) Gingival recession surgery

e) None of the above

Answer: b) Flap surgery without osseous resection. Explanation: Clinical attachment levels following
surgery with and without osseous resection, either no difference was found or flap surgery without
osseous resection produced a greater gain.

3. Which type of bone defect shows the poorest prognosis for bone fill?

a) Three wall defects

b) Two wall defects

c) One wall defects

d) Angular defects

e) Marginal bone loss defects

Answer: c) One wall defects. Explanation: Three wall and two wall defects show better bone fill than
one wall defect (poor prognosis).

4. What is the general finding in short-term follow-up studies of periodontal therapy?

a) Non-surgical scaling and root planing causes more gingival recession than surgical therapy

b) Gingival recession is not an inevitable consequence of periodontal therapy

c) Deeper pocket sites experience less pronounced signs of recession of the gingival margin than sites
with shallow initial probing depths

d) Surgical therapy causes less gingival recession than non-surgical scaling and root planing

e) None of the above

Answer: d) Surgical therapy causes less gingival recession than non-surgical scaling and root planing.
Explanation: Non-surgically performed scaling and root planing causes less gingival recession than
surgical.

1. Which type of periodontal therapy causes less gingival recession?

a) Non-surgical scaling and root planing

b) Surgical therapy involving osseous resection

c) Both cause the same amount of recession

d) There is no correlation between the type of therapy and recession

e) None of the above

Answer: a) Non-surgical scaling and root planing. Explanation: According to the given content,
non-surgically performed scaling and root planing causes less gingival recession than surgical therapy.

2. What happens to the amount of recession over time after surgical treatment?

a) It increases

b) It decreases

c) It remains the same

d) It varies depending on the type of surgery

e) None of the above

Answer: b) It decreases. Explanation: Long-term studies reveal that initial differences seen in amount of
recession between various treatment modalities diminish over time due to a coronal rebound of the soft
tissue margin following surgical treatment.

3. What did Lindhe and Nyman find after an apically repositioned flap procedure?

a) The buccal gingival margin shifted to a more apical position

b) The buccal gingival margin shifted to a more coronal position

c) There was no change in the position of the gingival margin

d) The gingival tissue receded significantly

e) None of the above

Answer: b) The buccal gingival margin shifted to a more coronal position. Explanation: According to the
given content, Lindhe and Nyman found that after an apically repositioned flap procedure, the buccal
gingival margin shifted to a more coronal position (by about 1 mm) during 10 –11 years of maintenance.
4. What did van der Velden find in interdental areas denuded following surgery?

a) No significant change in gingival tissue

b) Significant recession of the gingival tissue

c) An up-growth of around 4 mm of gingival tissue

d) A down-growth of around 4 mm of gingival tissue

e) None of the above

Answer: c) An up-growth of around 4 mm of gingival tissue. Explanation: According to the given

content, van der Velden found an up-growth of around 4 mm of gingival tissue 3 years after surgery in
interdental areas denuded following surgery.

5. What is the recommended base for a flap?

a) Narrow

b) Broad

c) It depends on the type of surgery

d) It does not matter

e) None of the above

Answer: b) Broad. Explanation: According to the given content, the base of a flap should be broad to
maintain an optimal blood supply to the tissue.

A. What is the recommended flap length-to-base ratio for crown lengthening?

1. 1:1

2. 1:2

3. 1:3

4. 1:4

5. 1:5

Answer: 2. 1:2

Explanation: The recommended flap length-to-base ratio for crown lengthening should be no greater
than 1:2.

B. Where should the incision not be made during crown lengthening?

1. On the papilla

2. On the gingiva

3. On the bone

4. On the tooth

5. On the root

Answer: 1. On the papilla

Explanation: The incision should not be made on the papilla during crown lengthening.

C. What is the advantage of flap operations during crown lengthening?

1. Existing gingiva is removed

2. The marginal alveolar bone is not exposed

3. Furcation areas are not exposed

4. The flap can be repositioned at its original level or shifted apically

5. The post-operative period is usually more unpleasant to the patient

Answer: 4. The flap can be repositioned at its original level or shifted apically

Explanation: The flap can be repositioned at its original level or shifted apically during crown
lengthening, making it possible to adjust the gingival margin to the local conditions.

D. What is the key point to remember during periodontal access surgery?

1. The flap should be designed for overexposure of bone

2. The incision should be made on the papilla

3. The margins should be placed over unsound bone

4. Primary closure should not be done

5. Periodontal access surgery should occur

Answer: 5. Periodontal access surgery should occur

Explanation: The key point to remember during periodontal access surgery is that it should occur.

E. Why is the post-operative period usually less unpleasant for the patient during flap procedures?

1. Existing gingiva is removed

2. The marginal alveolar bone is not exposed

3. Furcation areas are not exposed

4. The flap procedure preserves the oral epithelium

5. The flap cannot be repositioned

Answer: 4. The flap procedure preserves the oral epithelium

Explanation: The post-operative period is usually less unpleasant for the patient during flap procedures
because the flap procedure preserves the oral epithelium and often makes the use of surgical dressing
superfluous.

1. What is the primary objective of periodontal access surgery?

a) Pocket reduction through soft tissue resection

b) Osseous resection

c) Periodontal regeneration

d) Access for root instrumentations

e) None of the above

Answer: d) Access for root instrumentations

Explanation: The primary objective of periodontal access surgery is to provide access for root
instrumentations. This allows for the removal of calculus and biofilm from the root surface, which is
essential for successful periodontal treatment.

2. When should periodontal access surgery be performed?

a) Before effective biofilm control has been demonstrated

b) After effective biofilm control has been demonstrated

c) It doesn't matter if effective biofilm control has been demonstrated

d) Only if the patient requests it

e) None of the above

Answer: b) After effective biofilm control has been demonstrated

Explanation: Periodontal access surgery should only be performed once the patient has demonstrated
effective biofilm control. Without effective biofilm control and maintenance, the surgery will result in
failure and recurrence of disease.

3. What is subgingival curettage?

a) The removal of calculus and biofilm from the root surface

b) The scraping of the gingival wall of a periodontal pocket to remove chronically inflamed tissue

c) The removal of the entire periodontal pocket

d) The removal of the tooth from the socket

e) None of the above

Answer: b) The scraping of the gingival wall of a periodontal pocket to remove chronically inflamed
tissue

Explanation: Subgingival curettage is a procedure that involves the scraping of the gingival wall of a
periodontal pocket to remove chronically inflamed tissue. It was historically thought that this tissue
hindered healing and new attachment, but it is now understood that thorough scaling and planing, along
with the removal of biofilm and calculus, can resolve inflammation without the need for tissue curettage.

1. What is the effect of inflammation in the tissue?

a) It automatically resolves without any intervention

b) It requires tissue curettage to resolve

c) It worsens without any intervention

d) It requires medication to resolve

e) None of the above

Answer: a) It automatically resolves without any intervention

Explanation: The inflammation in the tissue automatically resolves without tissue curettage.

2. What is the effect of curettage on inflamed granulation tissue?

a) It eliminates the inflamed granulation tissue

b) It worsens the inflammation

c) It has no effect on the inflammation

d) It is necessary to eliminate the inflammation

e) None of the above

Answer: a) It eliminates the inflamed granulation tissue

Explanation: The use of curettage to eliminate the inflamed granulation tissue is unnecessary.

3. What is the effect of scaling and root planing with additional curettage on periodontal tissues?
a) It improves the condition of the periodontal tissues beyond the improvement that results from scaling
and root planning alone

b) It worsens the condition of the periodontal tissues

c) It has no effect on the condition of the periodontal tissues

d) It is necessary to improve the condition of the periodontal tissues

e) None of the above

Answer: c) It has no effect on the condition of the periodontal tissues

Explanation: It has been shown that scaling and root planing with additional curettage do not improve
the condition of the periodontal tissues beyond the improvement that results from scaling and root
planning alone.

4. What should be avoided during gingival curettage and root planing in the anterior maxilla?

a) Removal of the junctional epithelium and the disruption of the connective tissue attachment

b) Removal of non diseased cementum

c) Removal of the periodontal pocket

d) Removal of the inflamed granulation tissue

e) None of the above

Answer: a) Removal of the junctional epithelium and the disruption of the connective tissue attachment

Explanation: In the anterior maxilla, gingival curettage and root planing apical to the base of the
periodontal pocket should be avoided. The removal of the junctional epithelium and the disruption of the
connective tissue attachment expose non diseased cementum. Root planing and the removal of non
diseased cementum may result in attachment loss and gingival recession.

5. What is the potential consequence of root planing and the removal of non diseased cementum?

a) Attachment gain and gingival recession

b) No effect on attachment and gingival recession

c) Attachment loss and gingival recession

d) Attachment gain and no effect on gingival recession

e) None of the above

Answer: c) Attachment loss and gingival recession

Explanation: Root planing and the removal of non diseased cementum may result in attachment loss
and gingival recession.