A flap is a portion of tissue, with its own vascular supply, that has been designed by the surgeon to be able to comfortably access the operative field and because, once at rest, it heals without difficulty. In the oral cavity, the most frequently used flaps are full-thickness flaps, that is, mucoperiosteals.
There are many types of flaps that are designed according to the operative purpose that is required, one of them is the modified Widman flap.
The flap of Widman modified It was described by Ramfjord and Nissle in 1974, also called the open flap curettage technique. It is one of the most used surgical methods for the treatment of periodontal disease. This technique is described as a modification of subgingival curettage, in which small vertical incisions allow the flap to be raised to gain access to the root surface and to remove plaque and calculus more easily.
The modified Widman flap technique
An initial incision is made to make the flap, which is made being parallel to the long axis of the tooth and applied to one millimeter of the vestibular gingival margin. In this way, the epithelium is correctly separated from the bursa on the buccal aspect of the teeth. The similar incision technique is used on the palatal aspect. Generally, vertical incisions called releasing incisions are necessary.
The full-thickness palatal and vestibular flaps are carefully lifted with a periosteum. The lifting of the flap should be limited and allow only a few millimeters of the alveolar ridge to be exposed.
To facilitate gentle separation of the neck from the bursa epithelium and the granulation tissue from the root surfaces, an intracrevicular incision should be made around the teeth up to the alveolar crest, a second incision.
Finally, a third incision is made perpendicular to the root surface and as close to the bony ridge as possible whereby the neck or tissue ridge is separated from the alveolar bone.
After proper debridement and curettage of bone defects, the flaps are carefully adjusted to cover the alveolar bone and sutured. The coating should be as tight as possible on the tooth surface.
This technique implies that there is no displacement of the flap and keeps the bone intact. In addition, there is minimal loss of periodontal tissue, root exposure is minimal, avoiding sensitivity problems, and aesthetics are maintained.
