FLAP DESIGNS FOR

IMPACTION
INTRODUCTION
Mucoperiosteal flap is a flap in which both mucosa and
underlying periosteum are reflected
Requirements of mucoperiosteal flaps
1. The incision must be carried out with a firm,
continuous stroke, not interrupted strokes.

2. Flap design and incision should be carried out in

such a way that no injury the anatomic structures

3. The width of the flap must be adequate, so that the

operative field is easily accessible, without creating
tension
4. The base of the flap must be
broader than the free gingival
margin, to ensure adequate blood
supply and to promote healing.

5. The flap itself must be larger than

the bone deficit so that the flap
margins are resting on bone at
closure
6. The mucosa and periosteum must be reflected
together. This is achieved (after a deep incision)when
the elevator is pressed firmly against the bone.

7. During the surgical procedure, avoid crushing or

folding of the flap, because the blood supply is
compromised
 Main types of oral surgery flaps
1. Envelope Flap
Indications
 Surgical procedure close to the
cervical lines of the teeth
 Lingual and palatal flaps

Advantages
 Avoidance of vertical incision

Disadvantages
 Great tension with a risk of the ends
tearing, limited
 limited access, possibility
 Gingival recession
2. Triangular Flap ( 3 corner
flap)
Disadvantages
Limited access to long roots
Tension with retraction
Gingival recession
3. Trapezoidal Flap (Pyramidal, 4 corner flap)
Advantages
Excellent access, allows surgery
No tension in the tissues
Easy reapproximation
Disadvantages
Gingival Recession
4. Semilunar Flap

used in apicoectomies and

removal of small cysts and
root tips.

Advantages.
Small incision and easy
reflection
 no recession of gingivae
Disadvantages.
limited access and
visualization
Flap design for impaction
 Impacted upper and lower wisdoms

1. Buccal flap (Triangular flap)

Indicated in shallow bony impactions
2. Extended buccal flap (triangular flap)
 Indicated in deep bony impaction
3. Envelope flap

 For soft tissue impactions

Impacted maxillary canine
1. Labial approach( Trapezoidal flap)
 If canine is localized labialy
2. Palatal approach (envelope flap)
 If localized palatally
3. Combined approach(both buccal and palatal)

 In case of transverse impactions

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