Indications for flap reflection in guided surgery

Guided surgery has in many places become synonymous with flapless surgery. Although well-planned cases and guides do offer more confidence in performing flapless surgery, in many cases flap reflection is still indicated. Below are some indications for flap reflection in guided surgery:

  1. Flared healing abutments: these abutments hang up on adjacent bone if any portion of the implant perimeter is below the osseous crest. Flap exposure is needed for  access to remove interfering bone
  2. Preservation of attached gingiva:  if the width of the  attached gingiva is minimal relative to the implant diameter, an incision along the midpoint of the band of attached gingiva with flap reflection allows the attached gingiva to be mobilized along the buccal and lingual of aspects of the healing abutment. In contrast, the buccal and/or lingual attached gingiva would have been completely removed with a tissue punch
  3. Buried implant: if the implant must be buried for any reason, a flap must be reflected
  4. Ridge reduction
  5. Thin or knife edge ridge: although properly used surgical stents guide the drill to within 0.5 mm of the planned position, a thin or knife edge ridge should be exposed and visualized before an osteotomy is initiated

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About Guided Surgery Solutions, LLC
Guided Surgery Solutions, LLC designs, manufactures, and sells 3D image-based surgical guides for dental implant surgery. The ThinLayer® Drill Guide System was developed in the founder’s clinical practice, in response to design limitations found in existing products. The solution makes guided surgery technically and economically feasible for all implant surgeons, allowing them to provide better treatment to more patients. Please visit for more information.