Basic Research| Volume 47, ISSUE 10, P1625-1630, October 2021

Clinical and Histological Evaluation of Tissue Healing in Beveled or Perpendicular Vertical Releasing Incision



      The aim of this investigation was to evaluate the clinical and histological differences in wound healing between beveled and perpendicular vertical releasing incisions in dogs.

      Material and Methods

      Four male mongrel dogs were used in this investigation. In each quadrant, a vertical releasing incision was made on either the mesial or the distal aspect of the cuspid teeth of each animal all on the same day. The sites were randomly selected to either receive a beveled incision or a perpendicular incision. A sulcular muco-periosteal flap was raised, reapproximated, and then sutured using 3-0 Vicryl. The animals were evaluated daily for the first week, and then at different time intervals during this investigation. One animal was killed at each time interval of 9, 14, 21, and 28 days after surgery. One animal was killed at each time interval, and a bone block consisting of the cuspid teeth and their surrounding bone and soft tissues was harvested, formalin fixed, and paraffin embedded. Samples were sectioned serially and stained with hematoxylin-eosin. Specimens were evaluated using a microscope with magnification ranging from ×10 to ×400 by a histopathologist. Four indices were used for histologic evaluation.


      At day 9 after surgery, a visible groove was seen in the marginal tissues of both perpendicular and beveled incisions. At day 9, both of the histologic sections showed less organized connective tissue and capillary networks with no significant difference in inflammation. In the 14-day samples, a depression was still present at the perpendicular incision sites, but not in the beveled incision group, where the groove was not visualized at all.
      In the 21- and 28-day samples, irregular capillary arrangements were seen in the connective tissue of the perpendicular incision groups with completely healed epithelium. There were no statistically significant differences noted histologically between the beveled and perpendicular incision groups noted at 9, 14, 21, or 28 days (P > .05).


      Based on these findings, it appears that clinical and histologic healing of beveled or perpendicular releasing incisions are similar 28 days after surgery.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Endodontics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Tsesis I.
        • Rosen E.
        • Taschieri S.
        • et al.
        Outcomes of surgical endodontic treatment performed by a modern technique: an updated meta-analysis of the literature.
        J Endod. 2013; 39: 332-339
        • Grandi C.
        • Pacifici L.
        The ratio in choosing access flap for surgical endodontics: a review.
        Oral Implantol. 2009; 2: 37-52
        • Larjava H.
        • Wiebe C.
        • Gallant-Behm C.
        • et al.
        Exploring scarless healing of oral soft tissues.
        J Can Dent Assoc. 2011; 77: b18
        • Arx T.V.
        • Vinzens-Majaniemi T.
        • Bürgin W.
        • et al.
        Changes of periodontal parameters following apical surgery: a prospective clinical study of three incision techniques.
        Int Endod J. 2007; 40: 959-969
        • Kramper B.J.
        • Kaminski E.J.
        • Osetek E.M.
        • et al.
        A comparative study of the wound healing of three types of flap design used in periapical surgery.
        J Endod. 1984; 10: 17-25
        • Ahmed M.V.
        • Rastogi S.
        • Baad R.K.
        • et al.
        Comparative study between two flaps-trapezoidal flap (TZF) and Ocshenbein-Leubke flap (OLF) in periapical surgeries.
        J Maxillofac Oral Surg. 2013; 12: 440-446
        • Velvart P.
        • Peters C.I.
        Soft tissue management in endodontic surgery.
        J Endod. 2005; 31: 4-16
        • Allen E.P.
        Use of mucogingival surgical procedures to enhance esthetics.
        Dent Clin North Am. 1988; 32: 307-330
        • Miller P.D.
        Regenerative and reconstructive periodontal plastic surgery. Mucogingival surgery.
        Dent Clin North Am. 1988; 32: 287-306
        • Robertson P.B.
        Surgical periodontal therapy: indications, selection and limitations.
        Int Dent J. 1983; 33: 137-146
        • Burgess L.P.
        • Morin G.V.
        • Rand M.
        • et al.
        Wound healing. Relationship of wound closing tension to scar width in rats.
        Arch Otolaryngol Head Neck Surg. 1990; 116: 798-802
        • Nedelec B.
        • Ghahary A.
        • Scott P.G.
        • et al.
        Control of wound contraction. Basic and clinical features.
        Hand Clin. 2000; 16: 289-302
        • Kon S.
        • Caffesse R.G.
        • Castelli W.A.
        • et al.
        Vertical releasing incisions for flap design: clinical and histological study in monkeys.
        Int J Periodontics Restorative Dent. 1984; 4: 48-57
        • Wadhwani K.K.
        • Garg A.
        Healing of soft tissue after different types of flap designs used in periapical surgery.
        Endodontology. 2004; 16: 19-22
        • Wirthlin M.R.
        • Yeager J.E.
        • Hancock E.B.
        • et al.
        The healing of gingival wounds in miniature swine.
        J Periodontol. 1980; 51: 318-327
        • Bahat O.
        • Handelsman M.
        Periodontal reconstructive flaps--classification and surgical considerations.
        Int J Periodontics Restorative Dent. 1991; 11: 480-487
        • Kon S.
        • Caffesse R.G.
        • Castelli W.A.
        • et al.
        Revascularization following a combined gingival flap-split thickness flap procedure in monkeys.
        J Periodontol. 1984; 55: 345-351
        • Zuolo M.L.
        • Ferreira M.O.F.
        • Gutmann J.L.
        Prognosis in periradicular surgery: a clinical prospective study.
        Int Endod J. 2000; 33: 91-98
        • Harrison J.W.
        • Jurosky K.A.
        Wound healing in the tissues of the periodontium following periradicular surgery. II. The dissectional wound.
        J Endod. 1991; 17: 544-552
        • Kim S.
        Principles of endodontic microsurgery.
        Dent Clin North Am. 1997; 41: 481-497
        • Peters L.B.
        • Wesselink P.R.
        Soft tissue management in endodontic surgery.
        Dent Clin North Am. 1997; 41: 513-528
        • Mörmann W.
        • Meierand C.
        • Firestone A.
        Gingival blood circulation after experimental wounds in man.
        J Clin Periodontol. 1979; 6: 417-424