Flap advancement: practical techniques to attain tension-free primary closure.

BACKGROUND Primary and tension-free closure of a flap is often required after particular surgical procedures (e.g., guided bone regeneration). Other times, flap advancement may be desired for situations such as root coverage. METHODS The literature was searched for articles that addressed techniques, limitations, and complications associated with flap advancement. These articles were used as background information. In addition, reference information regarding anatomy was cited as necessary to help describe surgical procedures. RESULTS This article describes techniques to advance mucoperiosteal flaps, which facilitate healing. Methods are presented for a variety of treatment scenarios, ranging from minor to major coronal tissue advancement. Anatomic landmarks are identified that need to be considered during surgery. In addition, management of complications associated with flap advancement is discussed. CONCLUSIONS Tension-free primary closure is attainable. The technique is dependent on the extent that the flap needs to be advanced.