**7.4 Neumann flap**

This flap involves intrasulcular incision in its triangular and trapezoidal versions and offers perfect access for periapical surgery, with sufficient access to the affected bone and lesion-related roots. The intrasulcular incision may be triangular or trapezoidal (**Figure 25**). The most common intrasulcular flap involves a triangular incision with a single vertical releasing incision located one or two teeth distal to the lesion (**Figure 26**). This flap is characterized by increased tension, and the traction forces increase especially at the fixed extremity. This technique allows for easy flap repositioning after periapical surgery.

**Figure 25.** *Luebke-Ochsenbein flap is used clinically for periapical surgery.*

**Figure 26.** *Semilunar flap in a form of crescent.*

Advantage

• This technique allows easy flap repositioning after periapical surgery

extending to the base of the papillae (**Figure 27**). The papillae adhere for posterior suturing of the flap. A vertical releasing incision is made to maximize

• Produces less recession at the interdental papillary level than a sulcular

• A surgically complicated flap requiring adequate surgeon experiences

• Requires the presence of enough healthy attached gingiva for suturing

the exposure. Advantage

**Figure 28.**

**Figure 27.**

*Clinical application of Partsch flap for periapical surgery.*

*Flap Techniques in Dentoalveolar Surgery DOI: http://dx.doi.org/10.5772/intechopen.91165*

incision [23]

*Trapezoidal flap with two releasing incisions.*

Limitations

**219**

Limitation

• Increased tension and traction forces

#### **7.5 Papilla base incision flap**

This flap, which was originally described by Velvart, is characterized by a horizontal incision following the dental sulcus along the neck of the teeth and *Flap Techniques in Dentoalveolar Surgery DOI: http://dx.doi.org/10.5772/intechopen.91165*

**Figure 27.** *Clinical application of Partsch flap for periapical surgery.*

**Figure 28.** *Trapezoidal flap with two releasing incisions.*

extending to the base of the papillae (**Figure 27**). The papillae adhere for posterior suturing of the flap. A vertical releasing incision is made to maximize the exposure.

Advantage

• Produces less recession at the interdental papillary level than a sulcular incision [23]

Limitations


Advantage

*Semilunar flap in a form of crescent.*

**Figure 26.**

**218**

**Figure 25.**

*Oral Diseases*

Limitation

**7.5 Papilla base incision flap**

• Increased tension and traction forces

*Luebke-Ochsenbein flap is used clinically for periapical surgery.*

• This technique allows easy flap repositioning after periapical surgery

This flap, which was originally described by Velvart, is characterized by a horizontal incision following the dental sulcus along the neck of the teeth and

**Figure 29.** *Triangular flap with a single releasing incision.*

**Figure 30.** *Clinical application for the intrasulcular trapezoidal flap.*

**7.6 Papilla-preserving flap**

*The raised palatal full mucoperiosteal flap for palatal periapical surgery.*

**Figure 33.**

**221**

**Figure 32.**

*The raised papilla preservation mucoperiosteal flap.*

*Flap Techniques in Dentoalveolar Surgery DOI: http://dx.doi.org/10.5772/intechopen.91165*

A horizontal incision is made following the dental sulcus to the dental papilla, and the vertical releasing incision is seated away from the papilla (**Figures 28**–**33**) [19].

**Figure 31.** *The papilla adhered to the bone and the raised full mucoperiosteal flap.*

*Flap Techniques in Dentoalveolar Surgery DOI: http://dx.doi.org/10.5772/intechopen.91165*

**Figure 32.** *The raised papilla preservation mucoperiosteal flap.*

**Figure 29.**

*Oral Diseases*

**Figure 30.**

**Figure 31.**

**220**

*Triangular flap with a single releasing incision.*

*Clinical application for the intrasulcular trapezoidal flap.*

*The papilla adhered to the bone and the raised full mucoperiosteal flap.*

**Figure 33.** *The raised palatal full mucoperiosteal flap for palatal periapical surgery.*
