Superficial-Layer Split-Thickness Flap for Maximal Flap Release and Coronal Positioning: A Surgical Technique

The aim of this report is to describe the superficial-layer split-thickness flap, which provides maximal flap release and mobilization for coronal positioning. The traditional split-thickness flap technique dissects following the contour of the buccal alveolar plate, leaving a periosteal layer on the osseous surface, while the muscular layer remains with the flap. This limits flap mobilization and can lead to flap retraction during healing because of muscle pull from lip and cheek movement. The superficial-layer split-thickness flap technique dissects following the contour of the external surface of the flap, toward the lip or cheek, and separates the epithelium and connective tissue from the underlying muscular and periosteal layers, which remain attached to bone. The advantages of this technique are: (1) the extreme flap release that allows complete, passive flap coverage for virtually all root coverage, ridge preservation, and ridge augmentation procedures; and (2) the absence of muscle pull during healing, which prevents flap retraction and promotes more rapid union of flap margins. Four cases are presented to demonstrate the flap technique and healing advantages.