Principles of flap design in dental implantology.

There is no single flap design that serves as the optimal approach for every implant surgery, and as the need for cosmetic procedures with minimally invasive techniques increases, so, too, does the variability in flap design. In other words, there is no single technique that is suited to every surgical situation, and the skilled surgeon must be thoughtful and creative in selecting every incision since the manner in which that incision is designed, executed, and sutured will have an enormous impact on implant success rates and overall aesthetic outcome. The site of implant placement, whether it is in the aesthetic zone or hidden posteriorly, also has an impact on the flap design. Another factor to consider is the width of the ridge in which the implant is placed. Some ridges are wide enough to place an implant with minimal tissue reflection, while other ridges are narrow and require wide flap reflection for better visualization and ridge width determination. Further, narrow ridges sometimes need bone augmentation and guided bone regeneration membranes, which necessitate planning for wide flap design to cover the bone graft and the membrane. This article discusses the principles of flap design in dental implantology in an effort to summarize techniques to aid practitioners with optimal procedure selection.