All treatments for periodontal diseases are centered, at least in part, on the thorough debridement of the root surfaces. Without the removal of plaque, biofilm, and calculus from the root surfaces, most authorities agree that periodontal treatment whether aimed at ameliorating the disease process or the regeneration of lost periodontal tissue is doomed to failure. Bearing this goal in mind, all periodontal surgical approaches are aimed at allowing the surgeon improved access and visualization to debride root surfaces and the periodontal lesion.

Most authorities credit Widman and Neumann with the first descriptions of periodontal surgery [1,2]. The surgery described involved large incisions to expose the bone beyond the apex of the teeth, allowing for the debridement of root surfaces and osseous defects. Often, it was recommended that the interproximal bone be left exposed to allow for the formation of new interproximal tissue. This surgical technique was aimed at pocket elimination. Everett credits Kirkland with describing the first periodontal surgical procedures that were aimed at regeneration and reattachment to the root surface [3]. Most traditional periodontal surgical procedures are modifications of these early techniques.

Schluger was the first to described periodontal osseous surgery [4]. Osseous surgery had many similarities to the original procedure described by Widman but altered the treatment of the bone by reshaping the alveolar bone to include the removal of existing osseous defects. Ramfjord described what he termed the modified Widman procedure [5]. This procedure also had many of the elements of the original Widman procedure but utilized a much more conservative flap design and did not include the complete surgical removal of osseous defects.

Despite many strongly held opinions at the time these surgeries were current, traditional periodontal flap surgery techniques whether aimed at pocket elimination or amelioration had many similarities. Most used large incisions that allowed for the reflection of the tissue from around many teeth. Typically, the flap reflection included all or most of the teeth in a quadrant to gain access to the underlying defects. In addition, a frequent end point was some amount of apical positioning of the gingival tissue.

The advent of surgery aimed at the regeneration of periodontal supporting tissue began a change in periodontal surgical techniques that resulted in a move toward minimally invasive periodontal surgery. Most credit Hyatt and Schallhorn with the introduction of bone grafting techniques for periodontal regeneration [6]. The original surgical techniques for periodontal regeneration were very simil/>