Apically positioned flap

Apically Positioned Flap

The apically positioned flap (APF) is a periodontal surgical procedure used to treat gingival recession, periodontal pockets, and to increase the width of keratinized gingiva. This technique involves the repositioning of the gingival tissue in an apical direction to achieve better periodontal health and aesthetics.

Indications

The apically positioned flap is indicated in the following situations:

• Treatment of periodontal pockets, especially in the anterior region where aesthetics are a concern.
• Management of gingival recession to cover exposed root surfaces.
• Increasing the width of keratinized gingiva to improve oral hygiene and reduce inflammation.
• Correction of mucogingival defects.

Contraindications

Contraindications for the APF procedure include:

• Insufficient gingival tissue to reposition apically.
• Poor oral hygiene that could compromise healing.
• Systemic conditions that affect healing, such as uncontrolled diabetes.
• Patients with high aesthetic demands where other techniques might be more suitable.

Surgical Technique

The surgical procedure for an apically positioned flap involves several steps:

Pre-Surgical Preparation

• Thorough scaling and root planing to remove plaque and calculus.
• Patient education on oral hygiene practices.
• Administration of local anesthesia to ensure patient comfort.

Incision and Flap Design

• A horizontal incision is made along the gingival margin of the affected teeth.
• Vertical releasing incisions may be made at the ends of the horizontal incision to facilitate flap mobility.
• A full-thickness or partial-thickness flap is elevated, depending on the clinical situation.

Flap Repositioning

• The flap is repositioned apically to the desired level, ensuring that the underlying bone and root surfaces are adequately covered.
• The flap is sutured in place using appropriate suturing techniques to ensure stability and promote healing.

Post-Surgical Care

• Patients are advised to maintain excellent oral hygiene and may be prescribed antimicrobial mouth rinses.
• Follow-up visits are scheduled to monitor healing and remove sutures if necessary.

Advantages

• Provides access for thorough debridement of root surfaces and osseous defects.
• Increases the width of keratinized gingiva, improving periodontal health.
• Can be combined with other procedures, such as bone grafting or guided tissue regeneration.

Disadvantages

• May result in increased root exposure, leading to sensitivity.
• Aesthetic concerns due to the apical repositioning of the gingival margin.

Complications

Potential complications of the APF procedure include:

• Post-operative pain and swelling.
• Gingival recession if the flap is not properly positioned.
• Root sensitivity due to increased exposure.

Conclusion

The apically positioned flap is a versatile periodontal surgical technique that can effectively manage periodontal pockets and gingival recession. Proper case selection and surgical technique are crucial for achieving optimal outcomes.

References

• Periodontology textbooks and peer-reviewed articles on periodontal surgery.
• Clinical guidelines from professional periodontal associations.