**3.3 Window excision of the soft tissue**

**Figure 4** shows the window excision of the soft tissue when the canine crown is coronal to the mucogingival junction.

Advantages


Limitations


### **3.4 Apically positioned flap**

**Figures 5** and **6** show the apically positioned flap if there is insufficient attached gingiva.

**3.5 Closed eruption technique**

*attached gingiva around the exposed tooth.*

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

aligned mesiodistally. Advantage

**Figure 5.**

Limitation

extrusion

**201**

**Figure 7** shows that highly impacted canine and the crown tip are properly

*An apically repositioned flap: (a) outline of the flap; (b) flap repositioned apically to provide a collar of the*

• Uncontrollable orthodontic forces on the nonvisible tooth during orthodontic

• The closed mucosal flap is more comfortable for patients

Advantage

• Preserve attached gingiva

#### Limitation

• Not suitable in highly impacted canine

#### **Figure 5.**

critical to make the right decision about the choice of a proper surgical technique to

*Window excision at the labial soft tissue opposite to the crown of the impacted upper canine.*

The proposed flap techniques include the window excision of the soft tissue (**Figure 4**), apically positioned flap, closed eruption technique, and sequential

**Figure 4** shows the window excision of the soft tissue when the canine crown is

**Figures 5** and **6** show the apically positioned flap if there is insufficient attached

expose labially impacted teeth.

**3.3 Window excision of the soft tissue**

coronal to the mucogingival junction.

• Directly expose the crown part

• Sacrifice the gingival tissue

**3.4 Apically positioned flap**

• Preserve attached gingiva

• Not suitable in highly impacted canine

• Require wider attached gingiva

approach.

**Figure 4.**

*Oral Diseases*

Advantages

Limitations

gingiva.

**200**

Advantage

Limitation

• Easy to perform

*An apically repositioned flap: (a) outline of the flap; (b) flap repositioned apically to provide a collar of the attached gingiva around the exposed tooth.*

#### **3.5 Closed eruption technique**

**Figure 7** shows that highly impacted canine and the crown tip are properly aligned mesiodistally.

Advantage

• The closed mucosal flap is more comfortable for patients

Limitation

• Uncontrollable orthodontic forces on the nonvisible tooth during orthodontic extrusion

**Figure 6.**

*Window is created (top image) labially opposite to the crown of the impacted canine, and (bottom image) the attached free gingival margin is placed apically.*

if adequate keratinized gingival is available over lateral incisor. Pedicle flap can be the second option and can be dissected from both the central and lateral incisor

*Mesially exposed impacted canine that may require two-stage surgery to achieve minimal attached gingiva.*

• Achieve 3–4 mm keratinized gingiva in highly impacted canine [9]

*Gingival margin flap with bracket and chain bond it to the crown of the impacted canine.*

areas to transfer to cover the recipient bed (**Figure 9**).

Advantage

**Figure 8.**

**203**

**Figure 7.**

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

Limitations

• Two-stage surgery

• Donor site morbidity is expected

#### **3.6 A sequential approach**

If a maxillary canine is highly impacted, its crown protrudes labially, or its cusp tip is displaced mesially (**Figure 8**), two-stage approaches may be indicated, in which exposure is carried out first (**Figure 6**) and mucogingival surgery such as gingivoplasty is performed at a later stage. Laterally sliding flap (**Figure 9**) provides additional keratinized tissue with natural color and consistency at the recipient site

**Figure 7.** *Gingival margin flap with bracket and chain bond it to the crown of the impacted canine.*

#### **Figure 8.**

*Mesially exposed impacted canine that may require two-stage surgery to achieve minimal attached gingiva.*

if adequate keratinized gingival is available over lateral incisor. Pedicle flap can be the second option and can be dissected from both the central and lateral incisor areas to transfer to cover the recipient bed (**Figure 9**).

Advantage

• Achieve 3–4 mm keratinized gingiva in highly impacted canine [9]

Limitations


**3.6 A sequential approach**

*attached free gingival margin is placed apically.*

**Figure 6.**

*Oral Diseases*

**202**

If a maxillary canine is highly impacted, its crown protrudes labially, or its cusp

*Window is created (top image) labially opposite to the crown of the impacted canine, and (bottom image) the*

tip is displaced mesially (**Figure 8**), two-stage approaches may be indicated, in which exposure is carried out first (**Figure 6**) and mucogingival surgery such as gingivoplasty is performed at a later stage. Laterally sliding flap (**Figure 9**) provides additional keratinized tissue with natural color and consistency at the recipient site

**Figure 9.**

*The principle of lateral pedicle repositioned flap. R, recipient tooth; D, donor tooth; F, flap; S, split-thickness dissection.*
