Functional and esthetic outcome enhancement of periodontal surgery by application of plastic surgery principles

The closure of surgical wounds in a layer-by-layer fashion a common princip le of plastic surgery is applied in this article to the field of periodonta l surgery with the introduction of a new flap design. The suggested techniq ue is indicated with all periodontal procedures that sim for hard and soft tissue augmentation (guided bone regeneration, mucogingival surgery or plas tic periodontal surgery) where passive, tension-free wound closure is funda mental for wound healing and a successful functional and esthetic outcome. By means of a series of incisions, buccal and lingual flaps are split sever al times; this results in a double-partial thickness flap and a coronally p ositioned palatal sliding flap, respectively. Thus, several tissue layers a re obtained and the passive advancement of flaps becomes possible for the c overage of augmented areas. Wound closure with microsurgical suture materia l is accomplished in a multilayer approach, which ensures adaptation and cl osure of the outer tissue layers without any tension. Two case reports demo nstrate the new plastic periodontal approach.