title: Flap approaches in plastic periodontal and implant surgery: critical elements in design and execution.
abstract: OBJECTIVE
  To identify critical elements in design and execution of coronally advanced flap, lateral positioned flap and their variations for the treatment of facial gingival recessions or peri-implant soft tissue dehiscences.
  
  
  METHODS
  Clinical studies were identified with both electronic and hand searches, and examined for the following aspects: flap design and incision techniques, flap elevation, root conditioning, flap mobility, flap stability and suturing. Moreover, prognostic factors for complete recession coverage were identified.
  
  
  RESULTS
  Some critical elements are evident in flap design and execution: the dimension and the thickness of tissue positioned over the denuded roots; the use on root surface of enamel matrix derivate; the stability and suturing of the flap in a position coronal to the cemento-enamel junction. The pre-determination of the clinical cemento-enamel junction, smoking status, operator surgical skills and the compliance to a supportive care programme have a role in obtaining and maintaining a complete root coverage.
  
  
  CONCLUSIONS
  Different flap approaches are available when performing periodontal plastic surgery, resulting in a great variability in clinical outcomes. The possibility of using pedicle flaps alone to achieve complete soft tissue coverage of facial implant dehiscence has not yet been investigated.
authors.affiliation: Department of Periodontology, Tuscany Dental School, Univesity of Siena-Florence, Siena, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: de Sanctis
authors.forename: Marco
authors.initials: M
authors.lastname: Clementini
mesh_terms: D003746:Dental Enamel Proteins / Q000627:therapeutic use; D003758:Dental Implantation, Endosseous / Q000379:methods*; D005882:Gingival Diseases / Q000601:surgery*; D005889:Gingival Recession / Q000601:surgery; D006801:Humans; D010347:Patient Care Planning; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000145:classification / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000601:surgery; D013536:Suture Techniques; D014092:Tooth Root / Q000601:surgery
chemical_list: D003746:Dental Enamel Proteins; C109069:enamel matrix proteins
keywords: complete root coverage; coronally advanced flap; flap design; gingival recession; lateral positioned flap; peri-implant plastic surgery; periodontal plastic surgery; prognostic factors; semilunar flap; soft tissue dehiscence