1. Flap Technique for
Periodontial Bone Implants
H. H. Takei, T. J. Han, F. A. Carranz, Jr., E. B. Kenney and V. Lekovict

2. Introduction
• Difficulty:
1. Immediate, partial or complete exfoliation of the
implant materials
2. Plaque retention, persistent soft tissue
inflammation and/or delayed sequestration of
implant materials.
Papilla preservation techniques
Papilla preservation techniques

3. Incision (Fig. 1)
• Facial
– Sulcular incision around each tooth without
involving the interdental papilla.
• Lingual
– Sulcular incision along each tooth with a
semilunar incision across each interdental papilla.
– From the line-angles, papillary incision line is > 5
mm from the gingival margin.

4. Description
• Presurgical Preparation
– The gingiva, especially the interdental papilla,
must be free of inflammation and firm.
– Oral hygiene

5. Description
• Surgical Technique
– Probing  the extent of the bone defect
– Incision: > 3 mm apical to the margin of the
interproximal bony defect
– Defect involves lingual side semilunar incision
on the facial side
– Tip of the scalpel blade in contact with the root
– Blood supply, maximum amount of tissue
interdentally

6. Description
• Reflection of Flap (Fig. 2)
– Curette/interproximal knife
– Make sure the interdental tissue is completely free
and mobile
– Carefully pushed with a blunt instrument
– Full-thickness flap is reflected with a periodontal
elevator on both facial and lingual side
– Small back-action chisels  scrape the margins of the
flap  remove pocket epi. and granulation tissue
– Fine tissue scissors  trim the excess granulation
tissue (Fig. 3)

7. Description
• Reflection of Flap
– Thickness of the interdental papilla must be > 2 mm
 blood supply and provide the graft material
– Anterior area, horizontal bone loss, minimal trimming
to prevent gingival recession

8. Description
• Placement of Implant Material and Closure of
Flap
– Retention of the material
– Cross mattress suture (Fig. 4): very loose prior to the
placement of graft  prevents dislodgement of the
graft during the suturing  optimal flap closure
without stitches touching the graft.  Tightened
– Soft, surgical dressing  reduced thbrishinge
likelihood of post-op flap displacement by
mastication, tongue action or.
– Antibiotics

9. Description
• Postoperative Care
– Dressing is replaced 7 days later
– Cleaned with NS and new dressing for another week.
– 2 weeks later, cleaned with H2O2
– Oral hygiene instruction
– The pocket should not be probed until 3 months later

10. Discussion
• Interdental soft tissue craters didn’t develop
• Normal pyramidal-shaped interdental papilla
• Regular flap technique  a small crater
• Can also used in the anterior area.