A periodontal flap is a section of gingiva or mucosa surgically separated to provide access to the bone and root surfaces. Flaps are classified based on the amount of tissue removed and whether the flap is replaced in its original position or moved. Common flap types include the modified Widman flap, undisplaced flap, and apically displaced flap. The modified Widman flap involves making internal bevel incisions and reflecting the flap to allow root debridement before suturing back in place. The undisplaced flap removes the pocket wall with incisions before reflection. The apically displaced flap can be used to eliminate pockets or widen attached gingiva by reflecting the flap and suturing it in a more ap

1. THE P E R IO D O N TAL FLAP
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2. Aperiodontal flap is a section of gingiva or mucosa surgically separated from the
underlying tissues toprovide visibility of and access to the bone and rootsurface.
Aflap also allows the gingiva to be displaced to a different location in patients with
mucogingivalinvolvement.
INTRODUCTION
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3. Based on bone exposure after flapreflection :
Classification of Periodontal flaps
Full thickness flap Partial thickness flap
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4. Based on placement of flap after surgery:
• displaced flap : The flap is placed apically, coronally, or laterally to itsoriginal position
• non displaced flap :The flap is returned and sutured in its originalposition.
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5. Split the papilla (conventional flap)
Preserve it (papilla preservation flap)
Based on management of papilla :
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6. Common types of flaps
Modified Widman flap
Undisplaced flap
Apically displaced flap
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7. Modified Widman flap
Presented by Ramfjord and Nissle In 1974
Indications:
1- To remove the pocket in cases where the base of the pocket is coronally relative to the MG and the marginal bone
is not very thick
2- To reduce shallow to medium pockets where beauty is important
Contraindication :
1 - When the increase in gingival volume or overgrowth that should be treated with Gingivectomy or Gingivoplasty
2 - When the attached gingiva is very thin
3 - When the bone thickness is large or exostosis There is to be removed
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8. Modified Widman flap
ADVANTAGES:
 Root cleaning done with direct vision.
 Healing by primary intention.
 Minimal crestal bone resorption.
 Lack of post operative discomfort.
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9. Modified Widman flap
PROCEDURE:
A) Internal bevel incision should be made to the alveolar crest starting0.5 to 1 mm away from the gingival margin.
INTERNAL BEVEL INCISION INFACIAL AND PALATALASPECTS
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10. Modified Widman flap
B) Flap is elevated
C) Crevicular incision is made from the bottom of the pocket to bone
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11. Modified Widman flap
D) Interdental incision sectioning the base of the papilla.
E) Tissue tags and granulation tissue are removed.
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12. Modified Widman flap
F) Scaling and root planing of exposed root surfaces
G) Suturing done and with a periodontal surgical pack
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13. THE UNDISPLACED FLAP:
It differs from the modified Widman flap in that the soft tissue pocket wall is
removed with the initial incision; thus it considered an internal bevel gingivectomy.
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14. THE UNDISPLACED FLAP:
PROCEDURE :
A) The pockets are measured with periodontal probe and a bleeding point is produced on the
outer surface of gingiva to mark the pocket bottom
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15. THE UNDISPLACED FLAP:
B) Internal bevel incision in the facial and palatal aspects
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16. THE UNDISPLACED FLAP:
C) Crevicular incision is made and Flap is elevated
D) Interdental incision is made
E) Triangular wedge of tissues is removed with curette
F) All tissue tags and granulation tissue are removed
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17. THE UNDISPLACED FLAP:
7)After the scaling and root planing the flap edge should rest on the root
bone junction.
8)Flaps have been placed in their original site and Sutured.
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18. THE APICALLY DISPLACED FLAP:
It can be used for both pocket eradication as well as widening the zone of attached gingiva.
It can be a full thickness (mucoperiosteal) or a split thickness (mucosal) flap.
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19. PROCEDUREfor apicallydisplacedflap
A.An internal bevel incision is made, it should be no more than 1mm from the crest
of the gingiva and directed to the crest ofgingiva.
B . Crevicular incisions are made, followed by initial elevation of the flap; then
interdental incision and the wedge of tissue containing pocket wall is removed
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20. THE APICALLY DISPLACED FLAP:
C.Vertical incisions are made extending beyond the mucogingivaljunction.
Full thickness flap elevated by blunt
dissection with periosteal elevator
Split thickness flap elevated using sharp
dissection with a bard- parker knife
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21. D) After debridement of theareas
E) Sutures in place
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22. FLAP APICALLY POSITIONEDAND SUTURED POST-TREA
TMENT
CROWN LENGTHENING BY APICALLY DISPLACED FLAP
PRE-TREATMENT BEFORE OSSEOUS RESECTION
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24. SUTURING :
 Interrupted interdental :
Direct or simple loop
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25. SUTURING :
• Figure – eight
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26. SUTURING :
Mattress sutures are used for greater flap security and control
They permit more precise flap placement, especially when combined with periosteal stabilization.
They also allow for good papillary stabilization and placement.
Mattress Sutures:
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27. The flap is stabilized and needle is inserted 7 to 10 mm apical to the tip of the papilla.
It is passed through the periosteum , emerging again from the epithelialized surface of the
flap 2 to 3 mm from the tip of the papilla.
The needle is brought through the embrasure, where the technique is again repeated lingually
The suture is then tied buccally
Vertical Mattress
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28. Horizontal Mattress
A needle is inserted 7 to 8 mm apical to and to one side of the midline of the papilla, emerging again 4 to 5 mm
through the epithelialized surface on the opposing side of the midline.
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29. Sling Suture
 The sling suture is primarily used for a flap that has been raised on only one side of a tooth, involving
only one or two adjacent papillae.
 It is most often used in coronally and laterally positioned flaps.
 The technique involves use of one of the interrupted sutures, which is either anchored about the adjacent
tooth or sling around the tooth to hold both papillae
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30. Sling suture about single tooth
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31. Continuous Sutures Sling
When multiple teeth are involved, the continuous suture is perfect
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32. Locking
The continuous locking suture is indicated primarily for long edentulous areas, tuberosities, or retromolar areas.
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33. 33
periodontal instruments

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kirkland knife

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orban knife

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merrifield knife

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surgical blade

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prichard curette

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krikland curette

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ball scaler

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woodson elevator

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prichard elevator

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back action chisel

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ochsenbein chisel

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rhodes back action chisel

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debakey forceps

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goldman fox scissors

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castroviejo needle holder

49. THE END
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