**6.5 Palatal/lingual crestal flap**

The incision is similar to mid-crestal incision; however, it is made more toward the palatal side/lingual. The flap is then raised to perform the bone preparation (**Figure 18**).

Advantages

• Suitable in cases when there are less buccal tissues available to raise fullthickness flap

> In this flap, vertical releasing incision distal to the papilla is made and is connected to a crestal incision on the other side of the defect. An intrasulcular incision on the distal tooth is performed, and the flap is raised, followed by implant

• Used for the second stage of implant surgery to help get maximum aesthetic

This flap is opposite to mesial preservation flap, and the aim is to preserve the

distal side of the defect to allow bone grafting (**Figures 20** and **21**).

bed preparation (**Figure 19**).

*Platatal crestal flap used for implant bed preparation.*

*Mid-crestal incision used during implant bed preparation.*

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

• Good aesthetic results

• Minimal surgery and soft tissue manipulation

• Not suitable if bone grafting is required

results by preserving the papilla

**6.7 Distal papilla preservation**

Advantages

**Figure 19.**

**Figure 18.**

Limitations

**213**


#### **6.6 Mesial papilla preservation flap**

This flap is designed to maintain the interdental papilla for aesthetics in some cases.

**Figure 17.** *The edentulous ridge with minimal attached gingiva. Half punch flap is performed.*

Advantage

*Oral Diseases*

Advantages

Limitation

(**Figure 18**). Advantages

some cases.

**Figure 17.**

**212**

thickness flap

**6.6 Mesial papilla preservation flap**

**6.5 Palatal/lingual crestal flap**

**6.4 Mid-crestal incision**

• One-stage implant surgery with possible simultaneous bone grafting

• This flap can be used for both one- and two-stage implant surgery

• Buccal and palatal/lingual bone grafting is possible

• Requires sufficient buccal and palatal tissues

Mid-crestal incision is performed at the middle of the ridge bone, and buccal and lingual/or palatal flaps are then raised to expose the full surgical site (**Figure 17**).

The incision is similar to mid-crestal incision; however, it is made more toward the palatal side/lingual. The flap is then raised to perform the bone preparation

• Suitable in cases when there are less buccal tissues available to raise full-

This flap is designed to maintain the interdental papilla for aesthetics in

• Bone grafting can be performed buccally or palatally/lingually

• Suitable for both one- and two-stage implant surgery

*The edentulous ridge with minimal attached gingiva. Half punch flap is performed.*

**Figure 18.** *Mid-crestal incision used during implant bed preparation.*

#### **Figure 19.**

*Platatal crestal flap used for implant bed preparation.*

In this flap, vertical releasing incision distal to the papilla is made and is connected to a crestal incision on the other side of the defect. An intrasulcular incision on the distal tooth is performed, and the flap is raised, followed by implant bed preparation (**Figure 19**).

Advantages


#### Limitations


#### **6.7 Distal papilla preservation**

This flap is opposite to mesial preservation flap, and the aim is to preserve the distal side of the defect to allow bone grafting (**Figures 20** and **21**).

**6.9 Full-thickness flap reflection for large edentulous spaces (book flap)**

• Wide exposure allows observing the undercut lingually or buccally

• Bone devitalization and subsequent remodeling resorption in narrow

This is a minimally exposed osteoperiosteal flap to overcome the limitation of full-thickness flap for the wide edentulous area when the resulting vascularity may

• Alveolar width stability, that is, minimal postoperative resorption compared

conceptualization of the alveolar anatomy to not miss the midpoint of the

• The bone is cut blindly; therefore, the surgeon must have a good

• Easy to lean and perform alveoloplasty

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

• Easy to perform bone cutting and splitting

**6.10 Partial-thickness flaps for ridge expansion**

Advantages

Limitations

ridge [17].

Advantages

Limitations

**Figure 22.**

**215**

• Less predictable outcomes

jeopardize the outcomes (**Figure 22**).

with full-thickness flap

• Maintain the integrity of periosteum

• Maintain bone vitality (vascularity)

*Full ridge exposure using the full thickness flap buccally and lingually.*

The buccal or lingual mucoperiosteal flap can be reflected, allowing an alveolar split to be done using thin osteotomes for alveolar ridge expansion if required.

**Figure 20.** *Mesially papilla preserved incision for implant bed preparation.*

**Figure 21.** *Double papilla preservation with two vertical releasing incisions.*
