**4.1 Background**

The main objective of periodontal flap surgery is to eliminate and reduce the pocket depth that cannot be treated conservatively (evidence of bleeding, loss of attachment, or suppuration) with conventional periodontics treatment. Raising surgical flap facilitates removal of the inflamed tissue inside the pocket, provides access for tooth surface cleaning, and helps remove harmful plaque and calculus.

Advantages

*Hungarian, German, and English.*

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

**Figure 10.**

• Less postoperative teeth sensitivity

• Allow root surface debridement

• Not indicated if osseous surgery is planned

• Cannot be used for full pocket removal

**4.3 The apically repositioned flap**

• Better aesthetic results

the root surface

Limitations

Advantages

defects

**205**

• Allow close adaptation of soft tissues to the root surface with minimal trauma

*Modified Widman flap technique. The image is adapted from The Hungarian higher education in dentistry in*

• The pocket reduction is achieved by long junctional epithelial attachment to

Reverse bevel incision is made at the attached gingiva angled to excise the periodontal pocket in a scalloped fashion. Two releasing incisions are made mesial and distal to the defect. After the flap is elevated, pocketing tissues are discarded, osseous surgery can be performed, and the flap is then apically repositioned and sutured in position as illustrated above in the canine exposure section (**Figure 11**).

• Expose the alveolar bone and allow osseous surgery to correct infrabony

• Allow excellent access to the root surface for debridement

Indications


Contra-indications


#### **4.2 Full-thickness periodontal flap**

Raising full mucoperiosteum exposes the underlying bone. The modified Widman flap [14] is one example of this type of flap. It includes a scalloped incision 1 mm from the crevicular margin involving the interproximal area of the teeth, allowing the flap to be raised without releasing incision (**Figure 10**).

#### **Figure 10.**

**4. Periodontal flap surgery**

The main objective of periodontal flap surgery is to eliminate and reduce the pocket depth that cannot be treated conservatively (evidence of bleeding, loss of attachment, or suppuration) with conventional periodontics treatment. Raising

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

surgical flap facilitates removal of the inflamed tissue inside the pocket, provides access for tooth surface cleaning, and helps remove harmful plaque

• Provide access to the tooth's root surface for instrumentation

• Improve aesthetics and function following gingival recession by the root

Raising full mucoperiosteum exposes the underlying bone. The modified Widman flap [14] is one example of this type of flap. It includes a scalloped incision 1 mm from the crevicular margin involving the interproximal area of the teeth,

allowing the flap to be raised without releasing incision (**Figure 10**).

• Correction of gingival overgrowth by gingivectomy

• Create new periodontal attachment

coverage technique

Contra-indications

• Poor plaque control

• Heavy smokers

**204**

• Uncontrolled systemic disease

**4.2 Full-thickness periodontal flap**

• Teeth with poor long-term prognosis

**4.1 Background**

**Figure 9.**

*Oral Diseases*

*dissection.*

and calculus. Indications

*Modified Widman flap technique. The image is adapted from The Hungarian higher education in dentistry in Hungarian, German, and English.*

## Advantages


#### Limitations


#### **4.3 The apically repositioned flap**

Reverse bevel incision is made at the attached gingiva angled to excise the periodontal pocket in a scalloped fashion. Two releasing incisions are made mesial and distal to the defect. After the flap is elevated, pocketing tissues are discarded, osseous surgery can be performed, and the flap is then apically repositioned and sutured in position as illustrated above in the canine exposure section (**Figure 11**). Advantages


• Crown lengthening (**Figure 12**)

*expose the crown or the gingival overgrowth.*

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

**5. Mucogingival graft surgery**

• Not indicated in case of deep "true" infrabony pocket

control, high frenal attachment, and severe gingival recession.

• Row wound exposes the root surface, making it sensitive and susceptible to

*The stages for crown lengthening. (A) Internal beveling; (B) sulcular incision; (C) removal of excess tissues to*

• Because of the loss of the attached gingiva, some bone remodeling may occur

Mucogingival graft surgery aims at the correction of local gingival defects. It will be conducted if changing the morphology of gingival margin improves the plaque

Raising partial soft tissues and leaving the mucoperiosteum attached to the bone are commonly used techniques to address such mucogingival problems. Moreover, pedicle flap includes either laterally, coronally, or double papilla repositioned flaps. The flaps are indicated in very narrow areas of isolated gingival recession or even in the presence of wide recession with adequate door tissues on

• Not suitable for removal of intrabone lesions

Limitations

**Figure 12.**

caries

**5.1 Background**

either side [15].

**207**

**5.2 Split thickness flap**

#### **Figure 11.**

*Apically repositioned flap for periodontal surgery. (a) The bevel, scalloped incision for pocket elimination. (b) The flap positioned apically.*

#### Limitation

• Not applicable in the palatal tissue

#### **4.4 Gingivectomy**

Beveled incision excises the supra-gingival pocket and allows for gingival recontouring.

Advantages


**Figure 12.** *The stages for crown lengthening. (A) Internal beveling; (B) sulcular incision; (C) removal of excess tissues to expose the crown or the gingival overgrowth.*

• Crown lengthening (**Figure 12**)
