A periodontal flap is a section of gingiva and/or mucosa surgically elevated to provide access to the bone and root surfaces. There are several types of flaps classified by thickness, management of papilla, and placement after surgery. The basic requirements are that the base and size allow for adequate blood supply and exposure of underlying defects without damaging vessels or nerves. Incisions for conventional and papilla preservation flaps are also described. Healing takes several weeks as the blood clot is replaced by granulation tissue and collagen fibers form to reattach the gingiva.

1. Jаffaя яaza Syзd Page 1
Periodontal Flap
A periodontal flap is a section of gingiva and/or mucosa surgically-elevated from
the underlying tissues to provide visibility of and access to the bone and root
surface.
INDICATIONS/OBJECTIVES OF FLAP SURGERY
1. Gain access for root debridement.
2. Reduction or elimination of pocket depth, so that patient can maintain the
root surfaces free of plaque.
3. Reshaping soft and hard tissues to attain a harmonious topography
(physiologic architecture).
4. Regeneration of alveolar bone, periodontal ligament and cementum.

2. Jаffaя яaza Syзd Page 2
CLASSIFICATION OF PERIODONTAL FLAPS
A. According to flap reflection or tissue content:
a. Full thickness flap
b. Split-thickness flap
B. According to management of papilla:
a. Conventional flap
b. Papilla preservation flap
C. According to flap placement after surgery:
a. Non displaced flap
b. Displaced flap:
• Apical displaced flap
• Coronal displaced flap
• Lateral displaced flap

3. Jаffaя яaza Syзd Page 3
Basic flap requirements:
• Base of the flap must be wide enough to maintain an adequate
blood supply
• Flap must be big enough to expose any underlying bone
defects
• No important vessels or nerves should be damaged in raising
the flap
• Incisions must allow movement of flap without tension.

4. Jаffaя яaza Syзd Page 4

5. Jаffaя яaza Syзd Page 5

6. Jаffaя яaza Syзd Page 6

7. Jаffaя яaza Syзd Page 7

8. Jаffaя яaza Syзd Page 8

9. Jаffaя яaza Syзd Page 9

10. Jаffaя яaza Syзd Page 10
INCISIONS
For Conventional Flap
1. Horizontal Incision:
• Internal bevel incision
• Crevicular incision
• Interdental incision
2. Vertical incision
• Oblique releasing incision
For Papilla Preservation Flap
Crevicular incision with no incisions across the interdental
papilla is given.

11. Jаffaя яaza Syзd Page 11

12. Jаffaя яaza Syзd Page 12

13. Jаffaя яaza Syзd Page 13

14. Jаffaя яaza Syзd Page 14

15. Jаffaя яaza Syзd Page 15

16. Jаffaя яaza Syзd Page 16

17. Jаffaя яaza Syзd Page 17
Modified Widman Flap
Presented in 1974 by Ramfjord and Nissle.
Step 1: It is an initial, internal bevel incision 0.5 to 1 mm
away from the gingival margin, directed to the
alveolar crest. Vertical releasing incisions are not
required (different from Widman flap).
Step 2: Gingiva is reflected with a periosteal elevator
Step 3: A crevicular incision is made.
Step 4: After the flap is reflected, third incision is made in
the interdental spaces with Orban's knife and the
gingival collar is removed.
Step 5: Tissue tags and granulation tissue are removed with
a curette. The root surfaces are examined and scaled.
Step 6: Bone architecture is not corrected, good approximation of flaps
is necessary, hence sometimes flaps may have to be thinned.
Step 7: Interrupted direct sutures are placed.

18. Jаffaя яaza Syзd Page 18

19. Jаffaя яaza Syзd Page 19

20. Jаffaя яaza Syзd Page 20

21. Jаffaя яaza Syзd
Undisplaced Flap (internal bevel gingivectomyinternal bevel gingivectomy)
Page 21

22. Jаffaя яaza Syзd Page 22

23. Jаffaя яaza Syзd Page 23

24. Jаffaя яaza Syзd Page 24

25. Jаffaя яaza Syзd Page 25

26. Jаffaя яaza Syзd Page 26

27. Jаffaя яaza Syзd Page 27

28. Jаffaя яaza Syзd Page 28
HEALING AFTER FLAP SURGERY
0 to 24 hours  blood clot
1-3 days after flap surgery  epithelial cells migrate over the border of the flap
One week after flap surgery  epithelial attachment to the root has
been established by means of hemidesmosomes
and a basal lamina
 The blood clot is replaced by granulation
tissue derived from gingival connective tissue,
bone marrow and the periodontal ligament
Two weeks after surgery  collagen fibers begin to appear parallel to the
tooth surface. Union of the flap and the tooth
is still weak (due to immature collagen fibers)
but clinically it appears almost normal
One month after surgery  a fully-epithelialized gingival crevice with a
well-defined epithelial attachment is present