Modified Widman Flap vs Fibre Retention Osseous Resective Surgery

At buccal and lingual/palatal side, a full thickness incision parallel to the long axis of the tooth will be performed. In case of buccal or lingual pockets deeper than 2 mm, this initial incision will be placed approximately 1 mm apically to the free gingival margin. All soft tissues will be removed from the bony surface of intrabony defects. In case of incomplete adaptation between the flaps and the teeth or between the buccal and lingual flaps, the flaps will be thinned, and an amount of bone removal will be performed. Only osteoplasty will be allowed, while these patients will not receive ostectomy.

At the buccal sites, internally beveled incisions will be positioned at intra-sulcular or extra-sulcular level based on the apico-coronal dimension of the keratinized tissue. A split thickness flap beyond the MGJ will be then elevated. Vertical releasing incisions will be used to augment surgical access as needed. At lingual site split-full-thickness flap was used positioning an extra-sulcular internally beveled primary incision, while at the palatal area, the thinned palatal flap technique will be performed.