Flap advancement is required as part of certain surgical procedures (e.g., ridge augmentation) to attain tension-free primary closure along the incision line. Flap advancement may also be an integral part of other surgical procedures, such as root coverage. When coapting flaps, coronal positioning of mucogingival tissues facilitates healing by primary intention, which is superior to healing by secondary intention.1 Primary closure results in decreased discomfort and faster healing and is critically important in attaining desired objectives (e.g., bone regeneration). Failure to attain tensionless closure may result in a soft tissue dehiscence along the incision line that can cause a poor outcome and/or postoperative complications. Numerous investigators2-6 have made contributions with regard to procedures and the understanding of biologic benefits derived from coronally advanced flaps. This article builds on that information and describes several techniques to achieve predictable tension-free primary closure of surgical wounds. In addition, the following subjects are discussed: histology of incised tissues, concerns about anatomic structures in specific sections of the mouth, basic surgical principles, and complications associated with these procedures.

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