A comparison of mandibular lingual surgical flaps with and without a vertical releasing incision

The purpose of this study was to evaluate the short-term postoperative pain for surgical flaps with mandibular lingual vertical releasing incisions (ML-VRI) compared with envelope flaps and to observe the postoperative clinical healing of ML-VRI. Using a split mouth design, 12 adult periodontal patients received bilateral posterior mandibular surgery with an envelope flap on one side and a flap with an ML-VRI on the contralateral side. Surgical procedures were performed at separate appointments, varied in order, and performed an equal number of times on the right and left sides. Postoperative pain was scored by the patients, and scores for each technique were compared using an analysis of variance and covariance with repeated measures. Photographs were used to assess postoperative clinical healing of ML-VRI with various degrees of initial closure. Results indicated no significant statistical difference (P greater than 0.05) between pain levels for the two surgical techniques. There was complete clinical healing despite variations in the degree of closure of ML-VRI. The findings of this study support the use of ML-VRI. They are indicated in areas with flat contours or with slight ledges and inferior concavities. ML-VRI are contraindicated in areas with prominent ledges and inferior concavities and in areas with exostoses. Suturing the vertical incision is unnecessary and may be detrimental to the tissues. A "step down" incision that preserves attachment levels in nondiseased sites is discussed.