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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. 21 Fig. 22 Fig. 23 Conclusion Designing the flap is a key aspect of periapical surgery: It should ensure adequate exposure of the surgical field and allow the surgeon to work quickly and comfortably. Furthermore, there should be no tension capable of complicating the work of the dental professional or of causing patient discom- fort, and soft-tissue damage due to retractor com- pression is to be avoided. A good flap design with delicate manipulation of the soft tissue is neces- sary for successful periapical surgery. Competing interests The authors declare that they have no compet- ing interests. Fig. 21 Clinical view before the festoon palatal flap. Fig. 22 Design and detachment of a palatal flap. Fig. 23 Ostectomy for accessing the palatal root. References 1. Arens DE. Flap design. → In: Arens DE, editor. Practical lessons in endodontic surgery. Chicago: Quintessence; 1998. p. 51–64. 2. Vreeland DL, Tidwell E. Flap design for surgical endodontics. → Oral Surg Oral Med Oral Pathol. 1982 Oct;54(4):461–5. 3. Von Arx T, Vinzens-Majaniemi T, Bürgin W, Jensen SS. Changes of periodontal parameters following apical surgery: a prospective clinical study of three incision techniques. → Int Endod J. 2007 Dec;40(12):959–69. 4. Kreisler M, Gockel R, Schmidt I, Kühl S, d’Hoedt B. Clinical evaluation of a modified marginal sulcular incision technique in endodontic surgery. → Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Dec;108(6):e22–8. doi:10.1016/j. tripleo.2009.08.005. 5. Von Arx T, Salvi GE, Janner S, Jensen SS. Gingival recession following apical surgery in the esthetic zone: a clinical study with 70 cases. → Eur J Esthet Dent. 2009 Spring;4(1):28–45. 6. Velvart P, Peters CI. Soft tissue management in endodontic surgery. → J Endod. 2005 Jan;31(1):4–16. 7. Peñarrocha M. Técnica quirúrgica. → In: Peñarrocha M, editor. Cirugía periapical. Barcelona: Ars Medica; 2004. p. 45–79. 8. Velvart P, Ebner-Zimmermann U, Ebner JP. Comparison of papilla healing following sulcular full-thickness flap and papilla base flap in endodontic surgery. → Int Endod J. 2003 Oct;36(10):653–9. 9. Velvart P. Papilla base incision: a new approach to recession-free healing of the interdental papilla after endodontic surgery. → Int Endod J. 2002 May;35(5):453–60. 10. Peñarrocha Oltra D, Cervera Ballester J, Zubeldia Masset P, Luis Calvo Guirado J, Peñarrocha Diago M. Técnica quirúrgica básica. → In: Peñarrocha M, Peñarrocha MA, editors. Atlas de cirugía periapical. Madrid: Ergon; 2013. p. 47–97. Journal of Oral Science & Rehabilitation Volume 3 | Issue 3/2017 61