Flap Designs for Flap Advancement During Implant Therapy: A Systematic Review

Purpose: Guided bone regeneration (GBR) procedures allow ridge augmentation before or at time of implant placement. GBR outcomes rely on primary passive tension-free wound closure, which may be achieved by a variety of flap designs and surgical procedures. A comprehensive literature review of flap design and management is provided, including material types, incision design, reflection, releasing, and suturing techniques. Materials and Methods: Two reviewers completed a literature search using the PubMed database and a manual search of relevant journals. Relevant articles from January 1990 to September 2015 published in the English language were considered. Results: A variety of flap designs aim to achieve primary passive closure during GBR were introduced. To facilitate case selection and treatment planning, flap designs have been categorized based on their ability to achieve minor (<3 mm), moderate (3-6 mm), and major (>= 7 mm) degrees of flap advancement. Conclusions: Techniques such as vertical releasing incisions, periosteal releasing incisions, and splitthickness flaps may be used alone or combined to achieve passivity during GBR. GBR complications may be prevented by imaging and preoperative planning and careful surgical technique especially flap advancement.