The importance of the soft tissue management is crucial if a correct esthetic and functional result is to be achieved. At least two aspects are of equal importance in reaching this goal: the design and management of the flap and the suturing technique.
The flap design is extremely important because it must allow sufficient blood supply to the mobilized and non-mobilized soft tissues. Also, all factors, possible incidents and modifications of the ongoing surgery must be taken into consideration before the first incision is made.
If the surgeon is dealing with an apicomarginal bone defect and expects to have to take some bone for grafting, the flap should be large enough to give access to a donor site close the surgery area, to avoid the patient having to suffer another surgery area.
Tension on the flap introduced during surgery leads to extra postoperative pain and inflammation, and this tension is directly related to the flap design.
If the guided bone regeneration (GBR) technique is going to be used, more space will be necessary under the flap to completely cover the bone graft and membrane, but the final tension must be the lowest possible, so a larger flap design will be necessary.
Modifications to the flap after the incisions have been made can jeopardize the final result.