Access Flap Surgery (Periodontal)
Direct access to root surfaces in residual moderate pockets. No osseous resection or grafting (R6.2).
Evidence Guidelines & evidence
- EFP S3 R6.2
Access flap surgery is recommended for the surgical management of residual moderate (PD = 4–5 mm) or deep (≥ 6 mm) pockets in compliant patients with adequate self-performed plaque control.
1 Flap elevation & access
Local anaesthesia, intracrevicular incision, full-thickness flap reflection. Visualise root surfaces and bony architecture. Confirm pocket depths and absence of regenerable defect morphology.
2 Root surface debridement
Mechanical removal of remaining biofilm and calculus from previously inaccessible root surfaces. Hand curettes (Gracey set) and/or ultrasonic instruments. Root planing only as needed.
3 Soft tissue management
Granulation tissue removal. Tissue management to permit primary closure at the original level.
4 Wound closure
Tension-free flap repositioning at the original level. Suture with fine non-resorbable material. Microsurgical technique reduces post-operative recession.
5 Post-operative healing
Patient instructions: chlorhexidine rinse 0.12–0.2% twice daily for 2 weeks. Soft diet. No toothbrushing at the site for 7 days. Suture removal at 7–10 days.
