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Surgical Training for Dentists

FLAP DESIGNS OPTIONS FOR IMPLANTS

PUNCH APPROACH
Appropriate when tissue quality is good with 2-3mm of attached and keratinized
gingiva. It can be done with a blade, a punch tool or punch drill. For accuracy, it
works best using a surgical guide and a planning software.

PUNCH APPROACH
Can be used when the buccal tissue is deficient. Create a mid-crestal incision and reflect
a full thickness flap. Then use a punch approach to remove only enough lingual/palatal
tissue to place an implant. Appropriate for a 1-stage procedure with possible
simultaneous grafting.

MID CRESTAL
Incision is made in the middle of the crest with intra-sulcular on the adjacent teeth. Full
thickness buccal and lingual/palatal flaps are reflected. Can be used for a 1 or 2-stages
procedure, with simultaneous grafting or for grafting alone.

PALATAL/LINGUAL CRESTAL
Used when buccal tissue is deficient to mobilize good tissue quality to the buccal aspect
of the implant perform and with possible simultaneous contour grafting. It can be used
for 1 or 2-stage procedures.

MESIAL PAPILLA PRESERVATION

The mesial papilla is preserved by using a vertical releasing incision connected to a
crestal incision and an intra-sulcular incision on the distal tooth. This allows for a 2-
stage placement and uncovering to maximize esthetics by not loosing the more
important mesial papilla.

DISTAL PAPILLA PRESRVATION

The distal papilla is preserved by using a vertical releasing incision connected to a
crestal incision and intra-sulcular incision on the mesial tooth. This allows for a
preparatory bone grafting procedure.

DOUBLE PAPILLA PRESERVATION

Both, mesial and distal papilli, are preserved with 2 vertical releasing incisions
connected with a lingual/palatal crestal incision. This can be used for a 2-stage
approach and/or uncovering to mobilize good tissue quality to the buccal

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