Different types of Surgical Flaps

Periodontal Surgery Flaps Types


Periodontal disease, affecting the supporting structures of the teeth, is a prevalent issue in dental health. As dental professionals, it's crucial to understand the various surgical techniques available for treating this condition. Among these, periodontal surgery flaps stand out as essential tools. This blog aims to delve into the different types of periodontal surgery flaps, examining their design, technique, purpose, and specifically, their impact on keratinized gingiva.

Question 1

What Are the Different Types of Periodontal Surgery Flaps?

Full Thickness Flap (Mucoperiosteal Flap):

  • Design & Technique: Involves elevating the entire thickness of the soft tissue, including the gingiva and periosteum.
  • Description: Allows access to the underlying bone and tooth roots.
  • Purpose: Used for extensive bone grafting, recontouring, or osseous surgery.
  • Effect on Keratinized Gingiva: Can reduce keratinized gingiva due to potential postoperative recession.

Partial Thickness Flap (Split-Thickness Flap):

  • Design & Technique: Elevates only the gingiva and a portion of the underlying connective tissue.
  • Description: Provides limited exposure of the underlying structures.
  • Purpose: Suitable for minor gum grafts and less invasive procedures.
  • Effect on Keratinized Gingiva: May lead to a reduction in keratinized gingiva due to possible recession.

Papilla Preservation Flap:

  • Design & Technique: Incisions are made to preserve the interdental papilla while elevating surrounding gum tissue.
  • Description: Focuses on minimizing gum recession and maintaining aesthetics.
  • Purpose: Ideal for aesthetic areas to preserve gum contours.
  • Effect on Keratinized Gingiva: Aims to maintain existing keratinized gingiva.

Modified Widman Flap:

  • Design & Technique: Involves minimal elevation of the flap for root surface cleaning.
  • Description: The flap is repositioned close to its original place.
  • Purpose: Designed for deep cleaning and root smoothing.
  • Effect on Keratinized Gingiva: Generally preserves keratinized gingiva, though minor changes may occur.

Apically Positioned Flap:

  • Design & Technique: The flap is repositioned and sutured at a lower level on the teeth.
  • Description: Exposes more of the tooth or root surface.
  • Purpose: Used for reducing pocket depth or crown lengthening.
  • Effect on Keratinized Gingiva: Often reduces keratinized gingiva.

Coronally Advanced Flap:

  • Design & Technique: The flap is elevated and repositioned higher on the teeth.
  • Description: Increases gum coverage over exposed root surfaces.
  • Purpose: Used in gum grafting to cover exposed roots.
  • Effect on Keratinized Gingiva: Increases keratinized gingiva.

Lateral Pedicle Flap:

  • Design & Technique: A flap is moved sideways to cover an adjacent defect.
  • Description: Utilizes adjacent gum tissue for coverage.
  • Purpose: Effective for covering root exposures and recession gaps.
  • Effect on Keratinized Gingiva: Preserves or increases keratinized gingiva in the recipient area, might reduce it in the donor site.

Double Papilla Flap:

  • Design & Technique: Two adjacent papillae are elevated and sutured together over a root surface.
  • Description: Uses adjacent healthy tissue for root coverage.
  • Purpose: Used for root coverage in areas with limited gum tissue.
  • Effect on Keratinized Gingiva: Preserves or slightly increases keratinized gingiva.

Envelope Flap:

  • Design & Technique: Created without vertical incisions, resembling an envelope opening.
  • Description: Provides broad access with minimal tissue disturbance.
  • Purpose: Used for regenerative procedures requiring wider exposure.
  • Effect on Keratinized Gingiva: Typically preserves existing tissue.

Free Gingival Graft:

  • Design & Technique: Involves transplanting gum tissue from one area to another.
  • Description: Adds tissue to augment gum thickness.
  • Purpose: Increases gum tissue thickness in areas with thin or receding gums.
  • Effect on Keratinized Gingiva: Directly increases keratinized gingiva.

Question 2

Which Flap is Used for Bone Grafting Procedures After Extraction?

The Full Thickness Flap, also known as a Mucoperiosteal Flap, is the preferred choice for bone grafting procedures post-tooth extraction.

  • Design & Technique: This flap involves the elevation of the entire soft tissue, encompassing both the gingiva and the periosteum (the tissue covering the bone). The technique requires precise incisions around the tooth, or the extraction site, to fully access the underlying bone.
  • Rationale: The full thickness flap provides extensive visibility and access to the alveolar bone, which is crucial for bone grafting. This access is essential for meticulously cleaning the site, assessing the bone's condition, and placing the graft material effectively.
  • Bone Grafting Context: After a tooth extraction, the alveolar bone that supported the tooth can resorb or lose volume. Bone grafting is a critical procedure to preserve or augment the bone structure, especially if dental implants are planned for the future. The full thickness flap facilitates the placement of bone graft materials (like autografts, allografts, or synthetic substitutes) into the extraction site.
  • Considerations: While effective, the use of this flap requires careful management due to its potential impact on keratinized gingiva and the risk of postoperative recession. The flap must be meticulously repositioned and sutured post-grafting to ensure optimal healing and gum contour restoration.

Question 3

Which Flap is Used for Aesthetic Procedures?

The Papilla Preservation Flap is the go-to choice for aesthetic procedures in periodontal surgery, particularly in the front region of the mouth.

  • Design & Technique: This flap is characterized by incisions that are carefully planned to preserve the interdental papilla – the small amount of gum tissue found between teeth. The technique demands precision to avoid unnecessary trauma to the delicate papillary tissue.
  • Aesthetic Importance: In the anterior region of the mouth, where aesthetics are paramount, maintaining the natural contour and position of the gums is essential. The Papilla Preservation Flap is designed to minimize gum recession and postoperative changes in gum contour, which are crucial in these visually prominent areas.
  • Application in Treatment: This flap is often employed in procedures like root coverage, gum reshaping, and other periodontal plastic surgery techniques. The ability to preserve the natural look of the gum line is especially beneficial in patients with high smile lines, where the gums are highly visible.
  • Benefits and Challenges: The primary benefit of this flap is its ability to maintain the aesthetic integrity of the gum line. However, the technique requires significant skill and experience, as it involves working in tight spaces and managing delicate tissue structures. The successful use of this flap can significantly impact the patient's satisfaction, particularly in terms of cosmetic outcomes.
Periodontal Surgery Flaps


Periodontal surgery flaps are intricate and varied, each serving a specific purpose in the treatment of gum disease and related conditions. Understanding these procedures' designs, techniques, and impacts on keratinized gingiva is crucial for any dental professional. By selecting the appropriate flap type and technique, clinicians can effectively manage periodontal health, ensuring both functional and aesthetic success in treatments. As always, the choice of technique should be tailored to each patient's unique needs, keeping in mind the overall goal of preserving and enhancing periodontal health.

Periodontal surgery flaps are complex and diverse, each uniquely tailored to address specific aspects of gum disease and associated conditions.

- Dr. Isaac Sun, DDS