CLASSIFICATION OF ENDODONTIC

FLAPS
According to Guttmann & Harrisson

Full mucoperiosteal flaps

Triangular
Rectangular
Trapezoidal
Horizontal

Limited mucoperiosteal flaps

Submarginal curved(semilunar)
Submarginal scalloped rectangular (luebke- ochsenbien)

According To Franklin.S. Wiene

Semilunar
Full vertical
Luebke Ochsenbein

ADVANTAGES
ADVANTAGES
Rapid & predictable recession free
healing
Good wound
healing
of papilla.
Less scar formation
Easy
repositioning
Adequate
surgical
access to of
the root
wound
apexedges
Lack of exposure of crestal bone.
DISADVANTAGES
Technique sensitive
Need of two incisions to avoid
excessive scar formation

INDICATIONS

CONTRAINDICATIONS
In periodontally
compromised patients
DISADVANTAGES

Surgery in
the area
of interdental
Limited
surgical
access papilla
For repair of perforation & resorption
in cervical third of the root.
Postoperative recession
For periradicular surgeries, such as
apicoectomy,retrograde filling etc.
In periodontally healthy sites,
particularly when subgingivally
placed crown margins are present.

ADVANTAGES
Increased surgical access to the root apex.
The Trapezoidal Flap is similar except vertical
releasing incision meet at sulcular incision at
obtuse angle. Assumption that provide a better
blood supply to the flapped tissues,although this
particularly hold true in other tissues.
DISADVANTAGES
Difficulty in reapproximation of the flap margins & wound closure
More recession compared to Papilla Based Flap .

ADVANTAGES
REDUCE POTENTIAL FOR GINGIVAL
RECESSION
ACCESS TO APEX IS GOOD
EASILY REPOSITIONED

DISADVANTAGES
POSTOPERATIVE SCAR
NECROSIS OF FLAP

ADVANTAGE
THE ONLY ADVANTAGE OF THIS
FLAP IS NO POSTOPERATIVE
RECESSION.

DISADVANTAGES
LIMITED ACCESS ,
POSTOPERATIVE NECROSIS
& SCAR FORMATION , HENCE IT
IS NO LONGER RECOMMENDED

TRIANGULAR FLAP
ADVANTAGES
Good wound healing
Easy repositioning of wound
edges
DISADVANTAGES
Limited surgical access
Postoperative recession
INDICATIONS
For corrections of problems in

cervical & midroot position

such as resorption &
perforations

RECTANGULAR FLAP
ADVANTAGES
Increased surgical access
to the root apex
DISADVANTAGES
Difficulty in reapproximation
of the flap margins & wound
closure
INDICATIONS
Useful in lower anteriors &
teeth with long roots,where
traingular flap is
contraindicated

TRAPEZOIDAL FLAP

Similar to rectangular
flap except vertical
releasing incision meet
at sulcular incision at
obtuse angle.
Assumption that
provide a better blood
supply to the flapped
tissues,although this
particularly hold true in
other tissues.

LUEBKE-OCHSENBEIN
ADVANTAGES
Reduce potential for gingival recession
Access to apex is good
Easily repositioned

DISADVANTAGES
postoperative scar
necrosis of flap

SEMILUNAR FLAP
The only advantage of
this flap is no
postoperative
recession, but it has
many disadvantages
such as limited access,
postoperative necrosis
& scar formation, hence
it is no longer
recommended

ADVANTAGES
Rapid & predictable recession free healing
of papilla.
Less scar formation
Adequate surgical access to the root apex
Lack of exposure of crestal bone.
DISADVANTAGES
Technique sensitive
Need of two incisions to avoid excessive
scar formation

INDICATIONS
For repair of perforation & resorption in cervical
third of the root.
For periradicular surgeries, such as
apicoectomy,retrograde filling etc.
In periodontally healthy sites, particularly when
subgingivally placed crown margins are present.
CONTRAINDICATIONS
In periodontally compromised patients
Surgery in the area of interdental papilla

Choice of Flap Design

In almost all cases, the full flap design
should be considered before anything
else.

The choice for limited flap designs is

mainly because of the disadvantages that
have been considered and are related to
dental aesthetics.

The advantage of the sub marginal

rectangular flap over the full flap design is
that it does not involve interdental and
marginal gingival tissues.
For the maxillary incisors, premolars, and
molars, the triangular and rectangular flap
designs are first choice except in those
cases in which crown margins dictate the
use of the limited flap design.
Flap design for palatal surgery is restricted
to a triangular or a horizontal flap.

When using a triangular flap, the vertical

incision should be made mesial to the first
premolar to limit bleeding from the greater
palatine artery.
Additional access can be provided with a
small distal relaxing incision.
In the lower incisor area, the triangular flap
does not provide enough access to the apical
area.
In these cases, the extra vertical incision of
the rectangular flap is mandatory.

For the lower premolar and molar area, the

only flap design possible is the triangular
flap because of the location of the mental
foramen.
The vertical incision can be made mesial to
the first premolar or distal to the cuspid.
When necessary, a distal relaxing incision
can be made.
This is a short incision made in attached and
marginal gingiva to reduce the flap retraction
tension .