Triangular

There is a horizontal sulcular incision and only one vertical releasing incision (A triangular flap made with one vertical incision. This is a very practical flap for short roots, premolars and molars, preventing damage to important landmarks and allowing access for a bone graft donor area). Both extend at least one or two teeth away from the bone lesion.

The triangular flap design is especially useful in mandibular premolars when the mental nerve is involved (Exposure of the mental nerve. Making the vertical releasing incision one or two teeth before (see arrow) the nerve exit point, and a short distal releasing incision or enlarging the horizontal incision up to the molar area, dramatically relieves the tension of the flap). It is also useful when a bone graft is necessary, the enlargement of the horizontal incision allowing access to donor areas like the bone external oblique line, retromolar area and ramus. The triangular flap design is also useful when working on palatal roots of maxillary molars. The vertical incision towards the midline can be made in the premolar area and only the horizontal incision on the molar, in order to prevent damage to the greater palatine artery5. Additional access can be provided with a small distal relaxing incision.

Incisions

During surgery, soft tissue management is commonly overlooked because, once the flap is retracted, attention is usually concentrated on the defect.

Rationale

To achieve neat flap edges, incisions should be made with a firm and continuous movement of the blade that maintains permanent contact with the bone surface. Use a lower magnification of the operating microscope (4x).

Armamentarium

• Blade #15, 15c (Blades #15 and #15c are good for horizontal and vertical releasing incisions)
• Miniblades (SM63 Swan-Morton, series CK EIE, Surgistar)(Single- and double-sided cutting miniblades: CK-1 for buccolingual incisions; CK-2 and CK-3 for all incisions; CK-4 for mucogingival incisions; CK-5 for posterior applications; CK-6 for palatal incisions. Miniblades are good for incisions in the tight interdental spaces)

The #15 blades are designed to provide greater control and feedback (Blade #15 is designed to be applied perpendicularly to bone along 2 mm and provides the surgeon with good feedback). "Pencil" holding is the most used hand position. The normal contact angle of the blade to the soft tissues and bone is 90 degrees (Ninety degrees is the standard cutting angle).