Perio Flap Designs

1. Flap Design
Homan Zandi 2004

2. Free Gingiva
Attached Gingiva
Mucogingival Junction
Alveolar Mucosa
Homan Zandi
Enamel
Connective Tissue
JE
CEJ

3. Objective
• The flap should offer adequate access and
have an adequate blood supply
• The flap must be of adequate size and
fully reflected
• The edges must lie on the sound bone

4. Mucoperiosteal Flap
• Mucosa
• Connective tissue
• Periosteum
Homan Zandi

5. Considerations
• The number of teeth involved in the surgery
• The length and shape of the roots involved
• The dimensions of the lesion
• The amount of attached gingiva
• The existence and depth of periodontal
pockets
• The locations of muscle attachments and
frenums
• The height or depth of the vestibule
• The location of anatomic structures, such as
the neurovascular bundles and the maxillary
sinus

6. Techniques
• Gingival flap
• Intrasulcular flap (marginal)
– Triangular
– Rectangular
• Semilunar flap
• Submarginal flap
– Ochsentein-Luebke flap

7. Homan Zandi

8. Gingival Flap
• Indications
– Cervical resorptive
defects
– Cervical area
perforations
– Periodontal
procedures Homan Zandi

9. Intrasulcular Flap
(Triangular)
• Indications
– Periapical Sugery
Postrerior areas
Homan Zandi

10. Intrasulcular Flap
(Rectangular)
• Indications
– Multiple teeth
– Large lesions
– Long roots
Homan Zandi

11. Semilunar Flap
• Indications
– Esthetic crowns
Homan Zandi

12. Submarginal Flap
Ochsenbein-Luebke Flap
• Indications
– Prosthetic crowns
Homan Zandi

13. Incision
• Tissue should be handled gently
• Sharp dissection should be used
• Careful hemostasis should be attained
• Tension should be avoided

14. Homan Zandi
# 11 Scalpel # 15C Scalpel

15. Homan Zandi
# 12 Scalpel

16. Most endodontic surgery problems can
be avoided by using the following
incision rules
1. Firm continuous incision

17. 2) An incision should not cross an underlying bony
defect
Homan Zandi

18. 2) An incision should not cross an underlying bony
defect
Homan Zandi

19. 2) An incision should not cross an underlying bony
defect
Homan Zandi

20. 2) An incision should not cross an underlying bony
defect
Homan Zandi

21. 3) The vertical incision should be in the concavities
between bone eminences
Homan Zandi

22. Homan Zandi

23. 4) The vertical incision should not extend into the
muccobuccal fold
Homan Zandi

24. 4) The vertical incision should not extend into the
muccobuccal fold
Homan Zandi

25. 5) The termination of the vertical incision at the gingival
crest must be at the mesial or distal line angle of the
tooth
Homan Zandi

26. 6) The base of the flap must be at least equal to the width
of its free end
Homan Zandi

27. Homan Zandi

28. Homan Zandi

29. Homan Zandi

30. Homan Zandi

31. Most endodontic surgery problems can be
avoided by using the following incision rules
1) Firm continuous incision
2) An incision should not cross an underlying bony
defect
3) The vertical incision should be in the concavities
between bone eminences
4) The vertical incision should not extend into the
muccobuccal fold
5) The termination of the vertical incision at the
gingival crest must be at the mesial or distal line
angle of the tooth
6) The base of the flap must be at least equal to the
width of its free end