Classification and types of flaps in endodontic surgery

Wael Hisham Rajkhan, Naif Mayouf Alrasheedi, Hatton Khalid Alsaper, Reem Abdulwahed Aljishi, Reem Badi Alahmadi, Rogaya Hassan Abdulbagi, Kholoud Shergawi Kernshi, Afnan Hassan Almalki, Sarah Hussain Aloqayli, Hanan Sulaiman Alrehaili, Ghaida Ghazi Aljohani


The success of endodontic surgeries can be significantly associated with the selected dental flap. Many flaps have been reported among studies in the literature with variable frequencies of advantages and disadvantages and with different indications for each flap. This literature review discusses the most commonly reported types of endodontics flaps along with the reported advantages and disadvantages, in addition to the uses, applications, and most probable indications and contraindications for each designed flap. Among the reported flap designs, clinical success and favorable outcomes were observed with the ones that limited the damage to the root-attached tissues. Moreover, crestal bone loss has been reported to be minimal when using the full mucoperiosteal flap designs. Many previous studies have reported that using triangular and rectangular flap designs has been associated with favorable events regarding crestal bone loss, with the observed complete healing of the resorption damaging events and absent alternations of the heights of the crestal bone that were potentially affected. Further details of each flap design are provided within the full manuscript of this article based on the obtained evidence from previous investigations.


Flaps, Endodontics, Management, Classification

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Suresh N. Newer classification of endodontic flaps. Endodontology. 2005.

Hashan MR, Ghozy S, Qushayri AE, Pial RH, Hossain MA, Kibria GM. Association of dengue disease severity and blood group: A systematic review and meta-analysis. Rev Med Virol. 2021;31(1):1-9.

Qushayri AE, Ghozy S, Abbas AS, Dibas M, Dahy A, Mahmoud AR, Afifi AM, et al. Hyperimmunoglobulin therapy for the prevention and treatment of congenital cytomegalovirus: a systematic review and meta-analysis. Expert Rev Anti Infect Ther. 2021;19(5):661-9.

Gopikrishna D, Kandaswamy DD, Nandini DS. Newer Classification Of Endodontic Flaps. Endodontology. 14-9.

Gutmann JL, Harrison JW. Surgical endodontics. Boston: Blackwell scientific publications; 1991.

Velvart P, Zimmermann U, Ebner JP. Comparison of long-term papilla healing following sulcular full thickness flap and papilla base flap in endodontic surgery. Int Endod J. 2004;37(10):687-93.

Gutmann JL, Harrison JW. Posterior endodontic surgery: anatomical considerations and clinical techniques. Int Endod J. 1985;18(1):8-34.

Vreeland DL, Tidwell E. Flap design for surgical endodontics. Oral Surg Oral Med Oral Pathol. 1982;54(4):461-5.

Harrison JW, Jurosky KA. Wound healing in the tissues of the periodontium following periradicular surgery. 2. The dissectional wound. J Endod. 1991;17(11):544-52.

Harrison JW, Jurosky KA. Wound healing in the tissues of the periodontium following periradicular surgery. I. The incisional wound. J Endod. 1991;17(9):425-35.

Kohler CA, Ramfjord SP. Healing of gingival mucoperiosteal flaps. Oral Surg Oral Med Oral Pathol. 1960;13:89-103.

Wilson TG, Kornman K. Fundamentals of periodontics. Batavia, IL: Quintessence; 1996.

Gartner AH, Dorn SO. Advances in endodontic surgery. Dent Clin North Am. 1992;36(2):357-78.

Cutright DE, Hunsuck EE. Microcirculation of the perioral regions in the Macaca rhesus. I. Oral Surg Oral Med Oral Pathol. 1970;29(5):776-85.

Reddy S. Essentials of Clinical Periodontology & Periodontics. 5th ed. India: Jaypee Medical; 2017.

Hoag PM, Pawlak EA. Essentials of periodontics. Mosby; 1990.

Kim S, Kratchman S. Modern endodontic surgery concepts and practice: a review. J Endod. 2006;32(7):601-23.

Gutmann JL. Surgical endodontics: past, present, and future. Endodontic Topics. 2014;30(1):29-43.

Lubow RM, Wayman BE, Cooley RL. Endodontic flap design: analysis and recommendations for current usage. Oral surgery, oral medicine, and oral pathology. 1984;58(2):207-212.

Weine FS. Nonsurgical re-treatment of endodontic failures. Compend Contin Educ Dent. 1995;16(3):324.

Cheung GS. Endodontic failures--changing the approach. Int Dent J. 1996;46(3):131-8.

Moiseiwitsch JR, Trope M. Nonsurgical root canal therapy treatment with apparent indications for root-end surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;86(3):335-40.

Lovdahl PE. Endodontic retreatment. Dental clinics of North America. 1992;36(2):473-490.

Nieuwenhuysen JP, Aouar M, Hoore W. Retreatment or radiographic monitoring in endodontics. Int Endodontic J. 1994;27(2):75-81.