Operator-related factors such as preoperative planning of the surgical procedure, correct flap design, and soft tissue management, as well as patient-related factors such as the gingival biotype and the periodontal condition, may influence the risk of soft tissue complications following endodontic surgery. The clinician should be aware of possible anatomical pitfalls during flap procedure, such as adjacent neurovascular bundles. In order to avoid flap dryness and possible tissue necrosis and delayed healing, it is recommended to perform a short-duration surgery with a constant irrigation of the reflected tissues with saline. Different flap designs may be predisposed to different risks of complications. Intra-sulcular flaps are prone to gingival recession, submarginal and semilunar flaps are prone to scar formation, and a controversy exists whether papilla-based incision is prone to gingival recession and if papilla preservation incision may prevent gingival recession.
