**5.3 Laterally repositioned flap**

Two horizontal incisions are made on both mesial and distal sides of defects 1 mm away from the gingival margin of the adjacent tooth. Two vertical incisions are then made perpendicular to the initial incisions on either side, which extend into the alveolar mucosa. Partial-thickness pedicles are reflected on either side of the recession area (**Figure 9**). The reflection is carried out to a level that would permit free movements of the mesial and distal pedicle flaps. Both pedicles are rotated over the defect to make sure they would remain over the defect without any tension. Subsequently, both pedicles are sutured with 6-0 polypropylene sutures.

Advantages


#### Limitations


#### **5.4 Coronally repositioned flap**

A partial-thickness flap is raised around the defect with the help of two horizontal and two vertical incisions on either side of the defect without involving the marginal gingiva of adjacent teeth. To facilitate a tension-free coronal displacement, its base can be separated from the periosteum with the help of a periosteal releasing incision. The flap is then advanced coronally and sutured at the level of cementoenamel junction (CEJ) using 5-0 polypropylene sutures (**Figures 13** and **14**).

#### **5.5 Free gingival grafts**

This graft is a harvested tissue and is completely removed from the blood donor area, and it is used to augment the amount of the attached (keratinized) gingiva. This approach can be only used with the combination with another surgical approach.

#### **5.6 Two-stage surgical techniques**

Two-stage surgical techniques use double pedicle flap with a connective tissue graft, followed by coronally advanced flap.

**Figure 13.**

**209**

*raised and sutured coronally.*

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

*Coronally repositioned flap used to cover localized recession. The top image shows the recession area, and the incision line is done 4–5 mm from the gingival margin; the bottom image shows that partial-thickness flap is*

Advantages


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

**5.3 Laterally repositioned flap**

• Rapid wound healing at the donor site

• Cannot be used in a generalized recession

Advantages

*Oral Diseases*

Limitations

sites

(**Figures 13** and **14**).

approach.

**208**

Advantages

**5.5 Free gingival grafts**

**5.6 Two-stage surgical techniques**

graft, followed by coronally advanced flap.

• Treatment for a severe localized gingival recession

• Excellent color matching and dual blood supply to graft

**5.4 Coronally repositioned flap**

Two horizontal incisions are made on both mesial and distal sides of defects 1 mm away from the gingival margin of the adjacent tooth. Two vertical incisions are then made perpendicular to the initial incisions on either side, which extend into the alveolar mucosa. Partial-thickness pedicles are reflected on either side of the recession area (**Figure 9**). The reflection is carried out to a level that would permit free movements of the mesial and distal pedicle flaps. Both pedicles are rotated over the defect to make sure they would remain over the defect without any tension. Subsequently, both pedicles are sutured with 6-0 polypropylene sutures.

• Minimal exposure of the underlying periosteum at the interdental donor sites

• Cannot be used if there is an inadequate amount of keratinized tissues at donor

A partial-thickness flap is raised around the defect with the help of two horizontal and two vertical incisions on either side of the defect without

involving the marginal gingiva of adjacent teeth. To facilitate a tension-free coronal displacement, its base can be separated from the periosteum with the help of a periosteal releasing incision. The flap is then advanced coronally and sutured at the level of cementoenamel junction (CEJ) using 5-0 polypropylene sutures

This graft is a harvested tissue and is completely removed from the blood donor area, and it is used to augment the amount of the attached (keratinized) gingiva. This approach can be only used with the combination with another surgical

Two-stage surgical techniques use double pedicle flap with a connective tissue

#### **Figure 13.**

*Coronally repositioned flap used to cover localized recession. The top image shows the recession area, and the incision line is done 4–5 mm from the gingival margin; the bottom image shows that partial-thickness flap is raised and sutured coronally.*

#### *Oral Diseases*

Limitations

**6.3 Half punch**

**Figure 16.**

**211**

**Figure 15.**

*Punch flap (flapless) at mid-crest of ridge.*

*Half punch flap used for implant bed preparation.*

• Simultaneous bone grafting is not possible

• Require sufficient keratinized mucosa

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

• Minimal exposure to the bone for thickness evaluation

In the case of the presence of inadequate or deficient buccal tissues, half punch

and reflects full-thickness flap buccally. Subsequently, punch approach is used lingually or palatally to remove minimally required tissues for implant placement (**Figure 16**).

approach is used. Half punch flap is conducted with horizontal crestal incision

#### **Figure 14.**

*Free gingival graft is applied to cover the root surface with less amount of attached gingiva.*


## Limitations

