Flap Design

Palatal Incision is very effective in the anterior maxilla and when there is concern that buccal dehiscence around the neck of the implant may result.Palatal Incision is very effective in the anterior maxilla and when there is concern that buccal dehiscence around the neck of the implant may result.

There are many different flap designs for implant surgery. In practically all situations a mid-crestal incision can be employed (Fig.). This is especially so when the quantity of attached gingiva and the width of the underlying bone is expected to be of adequate width. In the posterior mandible a slightly buccal and in the anterior maxilla a slightly palatal mid-crestal incision provide for good retraction.

Diagrammatic representation of a crestal incision

Vestibular Incision (Hobkirk, et al 4 ) was previously the standard procedure for a two stage dental implant placement, ensuring that the implant was completely covered and protected during the healing phase. It was also claimed to provide a superior vascular supply. However, comparative studies between crestal and vestibular incisions have shown little difference in the outcome.

Palatal Incision is very effective in the anterior maxilla and when there is concern
that buccal dehiscence around the neck of the implant may result.

In posterior mandible a buccal incision avoids lingual nerve and produces
excellent access for implant placement.

Access and elevation of the flaps can usually be improved by the additional use of vertical relieving incisions. Relieving incisions close to adjacent teeth can be made to include the elevation of the (interdental) papilla, but some surgeons preferto avoid raising this in case future aesthetics are compromised.

Care should be taken to ensure that incision lines are not placed over structures

such as the mental nerve and the palatine arteries. All incisions are made through periosteum down to bone. Full thickness mucoperiosteal flaps are raised carefully to expose the entire extent of the edentulous ridge where the implants are to be placed. The flaps should be elevated sufficiently far apically to reveal any bone concavities, especially at sites where perforation might occur. Important anatomical structures in the area of operation which might be damaged, such as the mental nerve, should be identified and protected.