Types of Mucoperiosteal Flaps

1. Envelope/sulcular incision
2. Envelope with one releasing incision (three-
corner flap)
3. Envelope with two releasing incisions (four-
corner flap)

Full-thickness
mucoperiosteal flap
Types of Mucoperiosteal Flaps

1. Envelope/Sulcular flap
2 teeth anterior
1 tooth posterior
Types of Mucoperiosteal Flaps

2. Three-corner flap
1 tooth anterior
1 tooth posterior

Greater access in an apical direction,

especially in the posterior aspect of the
mouth
Types of Mucoperiosteal Flaps

3. Four-corner flap
1 tooth anterior
1 tooth posterior

rarely indicated
Common Periodontal Flap

•1 Modified Widman Flap

• Apically positioned
2
(full-thickness)
• Apically positioned
3
• (partial-thickness)

•4 Palatal Flap
 •1 Modified Widman Flap

1. Inverse bevel incision 0.5~2mm, extending to the alveolar

crest. Thins gingival tissue and permits compete closure of
the interdental osseous defects postoperatively.
 •1 Modified Widman Flap

2. Flap reflection. Full thickness mucoperiosteal flap is

reflected to permits visualization.
 •1 Modified Widman Flap

3. Crevicular incision between the hard tooth and the

diseased pocket epi., to the depth of the junctional epi.
 •1 Modified Widman Flap

4. Horizontal incision carried along the alveolar crest

 •1 Modified Widman Flap

5. Root planing with direct vision

 •1 Modified Widman Flap

6. Complete coverage of interdental defects

 • Apically positioned
2
(full-thickness)

1. Sulcularly, crestally, or full-thickness flap labially positioned

inverse beveled incision to bone
2. Flap completed, reflected off bone
3. Flap is apically positioned and sutured
• Apically positioned
2
(full-thickness)

A: The internal bevelled,

scalloped incision is used
for pocket elimination
through apical
repositioning of the flap.

B: The flap
positioned apically for
pocket elimination.
 • Apically positioned
3
• (partial-thickness)

1. Crestal incision with blade, partial-thickness flap parallel to long

axis of tooth
2. Flap raised by sharp dissection, periosteum retained over bone
3. Flap is apically positioned at or below alveolar crest
•4 Palatal Flap

1. No alveolar mucosa is
present on the palate to
permit apical positioning.
2. Pocket elimination by
palatal flap that just
covers the contours of
the bone to eliminate
osseous defects.
3. Requires skill and
experience.
Osteoplasty

Osseous grooving,
peprmits better
adaption of flaps to
facilitate plaque
removal alter
healing
Osteoplasty
Osteoplasty
Suturing for Flap Surgery
Simple Loop Modification of
Interrupted
Figure 8 Modification of Interrupted
Vertical mattress suture
Horizontal mattress suture
Single Interrupted Sling
Thanks for your attention!