Flap design for periodontal healing.

The aim of this chapter was to describe flap designs aimed at establishing favorable circumstances which may eventually enhance the clinical outcome of reconstructive procedures in periodontal intraosseous defects. The selection of a specific flap design and related suture technique must be based on the predictability to achieve optimal primary closure of the healing wound, thus creating an essential biologic prerequisite for periodontal regeneration. The surgical reconstruction of the lost attachment apparatus is a highly technique-sensitive procedure, where the choice and the technical performance of the flap design in a specific patient with a specific defect plays a key role. The clinical value to adapt the selection of the surgical approach to the anatomy of the treated area as well as the physical and biological characteristics of the regenerative materials adopted has been emphasized (Trombelli et al.2002, 2006; Cortellini and Tonetti 2005; Trombelli 2005, 2010). Along with the use of the appropriate regenerative technology, the surgical procedures should provide conditions for primary intention healing supporting adequate wound stability allowing uneventful tissue formation and maturation. In this respect, flap design and suture technique appear of paramount importance to maximize the reconstructive potential of membrane, graft biomaterials and biological agents.