Modified Widman Flap Surgery with Osseous Recontouring for the Management of Residual Periodontal Pockets in Stage II...

Periodontal pockets persisting after non-surgical periodontal therapy may require surgical intervention to facilitate adequate access for root debridement and elimination of inflamed pocket tissues. Modified Widman flap surgery remains a predictable periodontal surgical procedure that allows thorough debridement while preserving soft tissue architecture. A 45-year-old female patient presented with pain in the gums during mastication in the maxillary right quadrant. Clinical examination revealed residual periodontal pockets measuring 5 mm extending from the maxillary right central incisor to the first molar following completion of Phase I periodontal therapy. Bleeding on probing was present, and the clinical attachment level measured 4 mm. The patient was systemically healthy and had no history of smoking. A diagnosis of Stage II periodontitis was established. Modified Widman flap surgery with osseous recontouring was performed under local anesthesia. Following internal bevel and crevicular incisions, a full-thickness mucoperiosteal flap was reflected. Inflamed pocket epithelium and granulation tissue were removed, root surfaces were thoroughly debrided, and osseous recontouring was performed to establish physiologic architecture. The flap was stabilized using 3-0 polyglycolic acid/polylactic acid (PGA/PLA) sutures. Healing was uneventful throughout the postoperative period. At three months, probing pocket depth was reduced, and gain in clinical attachment level was observed; also, bleeding on probing was absent. Minimal postoperative gingival recession, mobility, or furcation involvement was observed. Modified Widman flap surgery combined with osseous recontouring provided favorable clinical outcomes in the management of residual periodontal pockets, resulting in reduced probing depths, attachment gain, and maintenance of soft tissue architecture after three months.