F l a p d e s i g n i n p e r i a p i c a l s u r g e r y Fig. 16 Fig. 17 Fig. 18 Fig. 19 Fig. 20 Fig. 16 Clinical view before periapical surgery of tooth #11. Fig. 17 Flap at the base of the interdental papillae to ensure their preservation. Fig. 18 Clinical view before surgery of tooth #34. Fig. 19 Design and detachment of a papilla-preserving flap. Fig. 20 Intraoperative view after ostectomy. over made (Figs. 16 & 17). This is a surgically complicated flap requiring adequate surgeon experience. The literature shows this technique to produce less recession at interdental papillary level than a sulcular incision.8 4 . P a p i l l a - p r e s e r v i n g i n c i s i o n f l a p In this case, a horizontal incision is made following the dental sulcus to the dental papilla, avoiding incision of the latter and tracing the vertical releas- ing incision at this point.4 This flap is useful in teeth with a generous mesiodistal width, affording an adequate surgical field (Figs. 18–20). 5 . P a l a t a l f l a p A festoon flap is performed at the gingival mar- gins on the palatal side. This flap is used in peri- apical surgery of the palatal roots of the maxil- lary molars. If the flap needs to be expanded to gain greater visibility, the incision can be extended mesial to the canine. Palatal releasing incisions are not necessary, though if any such incision is made, it should be performed between the canine and premolar—which represents the vascularization limit between the nasopalatine artery and the anterior palatine artery—or distal to the second molar, behind the emergence point of the anterior palatine artery (Figs. 21–23).10 60 Volume 3 | Issue 3/2017 Journal of Oral Science & Rehabilitation