Periodontal Flap Designs for Access and Osseous Surgery



In the sequence of treatment of the periodontal patient, surgical intervention may become necessary after completion of the nonsurgical phase. Periodontal surgical techniques aim to gain access to root surfaces for debridement and root planing and/or to remove soft and hard tissue structures to reestablish physiologic contours. Surgical techniques can be divided into resective, minimally resective, and non-resective techniques. Periodontal resective surgery includes removal of soft tissue, hard tissue, or a combination of both. Soft tissue resection includes gingivectomy, gingivoplasty, and distal wedge procedures. Moreover, combined soft and hard tissue resection procedures also aim to provide the restorative dentist to deliver biologically stable restorations that are compatible with a healthy periodontium. Periodontal minimally resective surgery includes two main flap designs that have been modified over the years to reflect changing perspectives and updated technology. Periodontal non-resective surgery includes flap designs to gain access to the roots and bony defects while maintaining the soft tissue. While periodontal surgical therapy allows for improved outcomes following nonsurgical therapy, cigarette smoking, inadequate oral hygiene, and poor maintenance compliance can all negatively influence outcomes. Decisions for flap design and concomitant bacterial biofilm control are individualized based on the patient’s needs and commitment to treatment for periodontal disease.


Periodontal disease Flap surgery Resective surgery Osseous surgery 


  1. 1.
    Barrington EP (1981) An overview of periodontal surgical procedures. J Periodontol 52(9):518–528CrossRefGoogle Scholar
  2. 2.
    Kronfeld R (1935) The condition of the alveolar bone underlying periodontal pockets. J Periodontol 6(1):22–29CrossRefGoogle Scholar
  3. 3.
    Orban B (1939) Gingivectomy or flap operation? J Am Dent Assoc 26(8):1276–1283CrossRefGoogle Scholar
  4. 4.
    Goldman HM (1950) The development of physiologic gingival contours by gingivoplasty. Oral Surg Oral Med Oral Pathol 3(7):879–888CrossRefGoogle Scholar
  5. 5.
    Robinson RE (1966) The distal wedge operation. Periodontics 4(5):256–264PubMedGoogle Scholar
  6. 6.
    Schluger S (1949) Osseous resection—a basic principle in periodontal surgery. Oral Surg Oral Med Oral Pathol 2(3):316–325CrossRefGoogle Scholar
  7. 7.
    Kaldahl WB, Kalkwarf KL, Patil KD (1993) A review of longitudinal studies that compared periodontal therapies. J Periodontol 64(4):243–253CrossRefGoogle Scholar
  8. 8.
    Hempton TJ, Dominici JT (2010) Contemporary crown-lengthening therapy: a review. J Am Dent Assoc 141(6):647–655CrossRefGoogle Scholar
  9. 9.
    Melker DJ, Richardson CR (2001) Root reshaping: an integral component of periodontal surgery. Int J Period Restorat Dent 21(3):296–304Google Scholar
  10. 10.
    Ramfjord SP, Nissle RR (1974) The modified Widman flap. J Periodontol 45(8):601–607CrossRefGoogle Scholar
  11. 11.
    Widman L (1918) The operative treatment of pyorrhea alveolaris: A new surgical method. Sv. Tandl. Tidsk. apud Ramfjord SP & Nissle RR 1974. The modified Widman flap. J Periodontol 45(8):601–607Google Scholar
  12. 12.
    Sanz-Moliner JD et al (2013) The effect of an 810-nm diode laser on postoperative pain and tissue response after modified Widman flap surgery: a pilot study in humans. J Periodontol 84(2):152–158CrossRefGoogle Scholar
  13. 13.
    Aena PJ et al (2015) The clinical efficacy of laser assisted modified Widman flap: A randomized split mouth clinical trial. Indian J Dent Res 26(4):384CrossRefGoogle Scholar
  14. 14.
    Yukna RA et al (1976) A clinical study of healing in humans following the excisional new attachment procedure. J Periodontol 47(12):696–700CrossRefGoogle Scholar
  15. 15.
    Yukna RA, Williams JE Jr (1980) Five year evaluation of the excisional new attachment procedure. J Periodontol 51(7):382–385CrossRefGoogle Scholar
  16. 16.
    Martin IS, David K (2014) A prospective 9-month human clinical evaluation of Laser-Assisted New Attachment Procedure (LANAP) therapy. Periodontics 34:21–27Google Scholar
  17. 17.
    Mills MP, Rosen PS, Chambrone L et al (2018) American Academy of Periodontology best evidence consensus statement on the efficacy of laser therapy used alone or as an adjunct to non-surgical and surgical treatment of periodontitis. J Periodontol 89(7):737–742CrossRefGoogle Scholar
  18. 18.
    Caffesse RG, Sweeney PL, Smith BA (1986) Scaling and root planing with and without periodontal flap surgery. J Clin Periodontol 13(3):205–210CrossRefGoogle Scholar
  19. 19.
    Kirkland O (1931) The suppurative periodontal pus pocket; its treatment by the modified flap operation. J Am Dent Assoc 18(8):1462–1470Google Scholar
  20. 20.
    Becker W et al (1986) Clinical and volumetric analysis of three-wall intrabony defects following open flap debridement. J Periodontol 57(5):277–285CrossRefGoogle Scholar
  21. 21.
    Graziani F et al (2015) Clinical performance of access flap in the treatment of class II furcation defects. A systematic review and meta-analysis of randomized clinical trials. J Clin Periodontol 42(2):169–181CrossRefGoogle Scholar
  22. 22.
    Friedman N (1962) Mucogingival surgery: The apically repositioned flap. J Periodontol 33(4):328–340CrossRefGoogle Scholar
  23. 23.
    Trombelli L et al (2009) Single-flap approach with buccal access in periodontal reconstructive procedures. J Periodontol 80(2):353–360CrossRefGoogle Scholar
  24. 24.
    Takei HH et al (1985) Flap technique for periodontal bone implants: Papilla preservation technique. J Periodontol 56(4):204–210CrossRefGoogle Scholar
  25. 25.
    Trombelli L et al (2018) Simplified procedures to treat periodontal intraosseous defects in esthetic areas. Periodontology 77(1):93–110CrossRefGoogle Scholar
  26. 26.
    Graziani F et al (2012) Clinical performance of access flap surgery in the treatment of the intrabony defect. A systematic review and meta-analysis of randomized clinical trials. J Clin Periodontol 39(2):145–156CrossRefGoogle Scholar
  27. 27.
    Kotsakis GA et al (2015) Impact of cigarette smoking on clinical outcomes of periodontal flap surgical procedures: a systematic review and meta-analysis. J Periodontol 86(2):254–263CrossRefGoogle Scholar
  28. 28.
    Bunæs DF et al (2015) Site-specific treatment outcome in smokers following non-surgical and surgical periodontal therapy. J Clin Periodontol 42(10):933–942CrossRefGoogle Scholar
  29. 29.
    Nyman S, Rosling B, Lindhe J (1975) Effect of professional tooth cleaning on healing after periodontal surgery. J Clin Periodontol 2(2):80–86CrossRefGoogle Scholar
  30. 30.
    Becker W, Becker BE, Berg LE (1984) Periodontal treatment without maintenance: a retrospective study in 44 patients. J Periodontol 55(9):505–509CrossRefGoogle Scholar
  31. 31.
    Farooqi OA et al (2015) Appropriate recall interval for periodontal maintenance: a systematic review. J Evid Based Dent Pract 15(4):171–181CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of PeriodontologyUniversity of North Carolina at Chapel HillChapel HillUSA

Personalised recommendations