**5. Incision and flap design**

Surgical access is a compromise between the need for visibility of the surgical site and the potential damage to adjacent structures. A properly designed and carefully reflected flap results in good access and uncomplicated healing. Although several possibilities exist, the three most common incisions are


**Figure 1.** Semilunar incision

**Figure 2.** Submarginal incision

**Figure 3.** Full mucoperiosteal incision

## **6. Semilunar incision**

Despite the commonly use of semilunar incision among practitioners, it's limitations and potential complications should be considered deply before surgery. Semilunar incision

is a slightly curved half-moon horizontal incision in the alveolar mucosa. Although the location allows easy reflection and quick access to the periradicular structures, it limits the clinician in providing full evaluation of the root surface. The incision is based primarily in the unattached or alveolar mucosa, which heal more slowly with a greater chance of dehiscence than a flap based primarily in attached or keratinized tissue. In addition, the flap design carries the flap over the inflamed surgical site, and this inflamed mucosa is at a high risk of breakdown. Other disadvantages to this incision include excessive hemorrhage, delayed healing, and scarring; this design is therefore contraindicated for most endodontic surgery.
