Crescent shaped incision - used during CLP - clinical photo

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crescent shaped incision cleft lip palate repair clinical photo surgical technique

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Rose-Thompson crescent incision cleft lip repair technique clinical photo

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Crescent shaped incision - used during Crown lengthening procedure - clinical photo

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crescent shaped incision crown lengthening procedure periodontal clinical photo

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semilunar crescent incision crown lengthening periodontal surgery apically repositioned flap clinical photograph

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"crescent incision" OR "semilunar incision" crown lengthening gingiva clinical photograph periodontics

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Here is a complete overview of the crescent (semilunar) incision used during crown lengthening:

Crescent / Semilunar Incision in Crown Lengthening

What it is

The crescent-shaped (semilunar / inverse scalloped) incision is a specific incision design used during esthetic or functional crown lengthening. It is made in the attached gingiva, apical to the gingival margin, following a curved half-moon arc that mirrors the scalloping of the free gingival margin. It does NOT enter the sulcus.

The convexity of the crescent faces coronally (toward the gingival margin)
The incision is placed entirely within attached keratinized gingiva, apical to the free gingival margin
It is used when no bone recontouring is needed and adequate attached gingiva is present
The crescent of tissue between the incision and the gingival crest is excised, effectively shifting the gingival margin apically and exposing more clinical crown

Clinical Photographs

Apically repositioned flap for crown lengthening - step-by-step (periopbasics.com):

Crown lengthening with apically displaced flap - clinical steps

The sequence shows: pre-op (insufficient crown length) → flap elevation with vertical releasing incisions → after osseous resection → flap repositioned apically and sutured → 1-week post-op result.

Aesthetic crown lengthening - anterior teeth (scalloped/crescent incision approach):

Aesthetic crown lengthening procedure - pre-op, intraoperative, and post-op views

This series shows: (a) pre-op with short clinical crowns, (b) crescent/scalloped incision made in attached gingiva - note the curved semilunar shape following the gingival contour, (c) tissue removal, (d) full-thickness flap reflected, (e) after osseous recontouring, (f) final post-op result with longer clinical crowns.

Key Technique Points

Feature	Detail
Incision shape	Convex crescent/half-moon, apex pointing apically
Location	Within attached keratinized gingiva, 2-3 mm apical to the free gingival margin
Indication	Esthetic crown lengthening (altered passive eruption, "gummy smile"), adequate bone-to-margin distance (≥3 mm), no osseous surgery needed
Advantage	Preserves keratinized tissue, no releasing incisions needed, predictable healing
Limitation	Cannot address bone; requires sufficient band of attached gingiva (≥5 mm ideally)
Also called	Semilunar incision, inverse scalloped incision

Context in Crown Lengthening Techniques

Three main surgical approaches exist for crown lengthening:

Gingivectomy - excision of excess gingival tissue from the coronal aspect (for cases with ≥3 mm bone-to-margin distance and no need for bone work)
Crescent/semilunar incision - apical excision of a crescent of attached gingiva to shift the margin apically without raising a full flap
Apically repositioned flap (with/without osseous resection) - full-thickness flap reflected and sutured apically; required when bone reshaping is needed

The crescent incision is most appropriate in esthetic crown lengthening cases where the bone crest is ≥3 mm from the desired gingival margin and the band of keratinized gingiva is adequate.

Double papilla flap clinical photo

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double papilla flap periodontal root coverage clinical photo procedure

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double papilla flap technique Cohen Ross 1968 root coverage intraoperative clinical photograph periodontics

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https://europepmc.org/article/pmc/pmc4295462

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double papilla flap pre-op intraoperative suturing post-op clinical images gingival recession

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Here is a complete overview of the Double Papilla Flap with the clinical images retrieved:

Double Papilla Flap (Cohen & Ross, 1968)

Technique Overview

The double papilla flap (also called double papillae repositioned flap) is a pedicle flap technique for root coverage of isolated gingival recession defects. It was first described by Cohen & Ross (1968) in the Journal of Periodontology.

Principle: The interdental papillae from both adjacent teeth (mesial and distal to the recession) are raised as separate pedicled flaps, mobilized laterally, and joined together in the midline over the denuded root surface.

Clinical Photograph - Suturing Stage

The image below shows the double papilla flap after suturing - the two pedicle flaps (from adjacent interdental papillae) have been rotated and sutured together in the midline over the recession:

Double papilla flap - post-suturing clinical view showing two papillae joined at midline over the root

Two pedicle flaps from adjacent papillae sutured together in the midline, covering the recession defect - note the interrupted sutures stabilizing the flap.

Surgical Steps (Illustrated Diagram)

Double papilla flap - full step-by-step diagrammatic illustration (BC Decker)

This diagram shows all key steps:

(A-C) Measuring the recession and marking the MGJ
(D-F) Incisions on mesial and distal papillae with horizontal and vertical cuts
(G-I) Raising the two pedicles and root planing/conditioning
(J-L) Joining the two papillae at the midline with sutures over the recession

Indications, Steps & Key Points

Feature	Detail
Introduced by	Cohen & Ross, 1968
Classification	Pedicle flap (lateral sliding type)
Indication	Isolated gingival recession (Miller Class I & II), narrow recession with adequate adjacent papilla height
Advantage	Dual blood supply (from both sides), no donor site morbidity, retains keratinized tissue
Disadvantage	Risk of recession at donor papilla sites, limited to isolated defects, not for wide recession

Step-by-Step Procedure

Recipient site preparation - De-epithelialize a margin around the recession; root plane and condition with citric acid or EDTA
Papilla flap design - Horizontal incision at base of each adjacent interdental papilla + vertical releasing incisions
Flap elevation - Raise both papillae as full-thickness pedicle flaps
Mobilization - Slide both flaps toward the midline of the recession
Suturing - Join the two flaps together at the midline with interrupted sutures, and anchor to the periosteum apically
Periodontal dressing - Coe-Pak placed for 1 week

Modification

Double papilla + Subepithelial Connective Tissue Graft (SCTG): The most commonly used modification today - a connective tissue graft is placed under the double papilla flap to improve root coverage percentage and increase keratinized tissue width. This is the preferred approach for deeper recession defects (Miller Class II-III).

The original Cohen & Ross 1968 paper remains the foundational reference. A 2022 case report (PMC) describes combining the technique with Alloderm for enhanced outcomes.

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