A partially detached piece of tissue produced either as a result of trauma or surgically to repair a defect or to gain access to structures underneath e.g. a periodontal flap where surgical access may be required to treat a periodontally involved root surface, to remove a retained root, or to perform an apicectomy. An apically repositioned flap is the repositioning of a periodontal tissue flap to reduce or eliminate gingival pocket depth or more commonly as a crown lengthening procedure to expose more tooth substance while maintaining the width of the attached gingiva. Incisions are first made to outline the gingival tissue for its complete removal; a further incision is made distant from the area of recession preserving the papilla adjacent to the defect and a full thickness flap is positioned apically to expose the root surface and reduce pocket depth. For a lateral sliding flap the incised tissue is positioned laterally to cover the area of gingival recession and sutured in position. A coronally repositioned flap is used mainly to cover exposed root surfaces during the treatment of gingival recession. An advanced flap reaches its final destination without rotation or lateral movement. It is used mainly in periodontal reconstructive surgery. A periodontal flap may be modified with the removal of a superficial collar of the soft tissue wall of the pocket ( modified Widman flap) by means of a scalloped inverse bevel incision made 1mm from the gingival margin with the knife blade aimed at the crest of the alveolar bone, followed by crevicular and horizontal incisions. It allows healthy connective tissue to contact the tooth surface in an attempt to improve post-surgical healing (this is a modification of the original Widman flap first described by Leonard Widman in 1918). The periodontal tissue should be plaque-free and not inflamed prior to flap surgery. (See also gingivectomy; gingivoplasty.)
A pedicle flap is a stem-shaped piece of tissue consisting of the full thickness of the skin epithelium and subcutaneous tissue attached by tissue from which it receives its blood supply. A pericoronal flap is a flap of gingival tissue partially covering an unerupted tooth, especially the lower third molar. See also graft.
Saha S., Bateman G. J. Mucogingival grafting procedures—an update. Dent Update 2008;35:561–8.