The Effect of Flap Design on Wound Healing after Periapical Surgery: A Comparative Study.


Aims: To assess the clinical effect of different flap design that used in periapical surgery and their
relation to untoward postoperative sequel. Materials and methods: Forty five patients were included
in the present study, they were divided randomly into three groups, each comprised of (15) patients. In
the first group, apicectomy was done using intrasulcular triangular (2–sided) flap. Whereas, in the
second group, a submarginal (Luebke–Ochsenbein) scalloped 2–sided flap was used. While in the third
group, a new experimental (straight mucogingival) 2–sided flap was tested. Postoperative healing was
evaluated clinically in regard to oedema, alteration of soft tissue colour, recession of marginal gingiva,
extent of scarring, and closure of the wound site. Assessment was done at 2, 7, 15 and 30 days
postoperative intervals. Results: Comparison among the three study groups was performed. Statistical
analysis revealed significant differences in the results of experimental flap over the other two types in
regard to oedema, colour and wound closure with the superiority of the former on the latter flaps. Both
experimental and Luebke–Ochsenbein flaps showed significant differences from intrasulcular incision
in their effect on gingival recession. In contrast, scarring was less evident in intrasulcular flap followed
by experimental flap while in Luebke–Ochsenbein incision, this complication was significant.
Conclusion: This study; however, revealed that the experimental flap allows for rapid and recession
free healing following periapical surgery. In addition, inflammatory changes persist for longer time in
the intrasulcular and submarginal (Luebke–Ochsenbein) incision than in experemintal incision. So it
was concluded that the new flap design could provide an alternative.