[Diversity of incision and flap design in periodontal regenerative surgery: clinical practice].

This article reviews the recent advancements in incision and flap design for periodontal regenerative surgery, with a particular focus on the application of minimally invasive surgical techniques and non-crestal approaches. When applied to periodontal regeneration, traditional flap designs, such as the modified Widman flap, present disadvantages including wound dehiscence and gingival recession, compromising regenerative outcomes. To address these issues, researchers have developed a series of novel techniques, including papilla preservation techniques, minimally invasive techniques, and single-flap techniques. However, these techniques usually involve horizontal or oblique incisions near the interdental papilla adjacent to the intrabony defect, which may still lead to wound dehiscence, limiting periodontal regeneration. Also they may cause gingival recession and reduction in papilla height, resulting in "black triangles". In recent years, a series of new techniques utilizing non-crestal approaches have emerged, altering incision placement to preserve the interdental papilla. Examples include the entire papilla preservation technique using a lateral incision approach, non-incised papilla surgical approaching by an apical incision, and apically incised coronally advanced surgical technique. By placing incisions away from the papilla, these methods achieve complete papilla preservation and provide greater space for regeneration, effectively promoting the regeneration of both intrabony and suprabony periodontal tissues. This article systematically analyzes the key surgical points, indications, and clinical efficacies of different incision designs in periodontal regenerative surgery. Detailed case presentations illustrate the step-by-step procedures of these techniques, demonstrating their favorable outcomes in treating intrabony defects. The aim is to encourage future clinical studies to validate the effectiveness and safety of these novel techniques.