Limitation

alveolus. The surgeon should avoid extending to the vestibular depth or

Flap design in periapical surgery should be adequate for the planned surgical procedure, offering good access to the zone surrounding the affected apexes without altering the soft-tissue circulation. The flap should be a firm continuous incision and not cross an underlying bony defect. If a vertical incision is needed, it should be in the concavities between bone eminences. The vertical incision should not extend into the mesiobuccal fold, and its termination of the gingival crest must be at the mesial or distal line angle of the tooth. Additionally, the base of the flap must be at least equal to the width of its free end. The most frequently used flap in periapical surgery is the Luebke-Ochsenbein flap involving submarginal incision, with semi-

A horizontal incision is made in the attached gingival tissue about 3–4 mm above the gingival margin, with two vertical releasing incisions on either side of the flap

• It is less aggressive with the gingival tissue than an intrasulcular incision flap

located one or two teeth distal to where the lesion is located (**Figure 23**).

*Partial-thickness flap before ridge expansion for future dental implant insertion.*

palatally directed osteotomy

**7. Endodontic surgery flap**

lunar or Partsch flap variants.

**7.2 Luebke-Ochsenbein flap**

• This type of flap is easy to detach

Advantages

**Figure 23.**

**216**

**7.1 Background**

*Oral Diseases*

• Requires extensive flap dissection [17]

• It can leave a postsurgical scar if the repositioning sutures are not performed adequately [20]
