What is an apically repositioned flap?
An apically repositioned flap (ARF) is a gum operation performed by a periodontist or dental surgeon. The surgeon makes a cut along the gum, lifts a thin flap of tissue away from the tooth and bone, reshapes the bone if needed, and then stitches the flap back at a lower (apical, meaning towards the root) level than before. Because the gum is not removed but moved, the band of firm, attached gum is kept, which is the main reason to choose this method over simply cutting gum away. Dental clinics in Turkey use it to treat deep gum pockets, to expose more of a short tooth before a crown, and to widen a narrow band of attached gum. For other work you may need alongside it, see our dental treatments in Turkey.
It is surgery on the supporting tissues, not a whitening or cosmetic polish, so this guide explains when it is advised, what it costs against the UK, US and Germany, how healing goes and how to check a clinic.
When is an apically repositioned flap the right operation?
There are three usual reasons. The first is pocket reduction: deep periodontal pockets that remain after scaling and root cleaning can be opened so the roots are cleaned under direct view, and the gum is repositioned to a level that is easier to keep clean. The second is crown lengthening: when a tooth is broken at gum level or too short for a crown or filling to grip, moving the gum (and sometimes smoothing a little bone) exposes more sound tooth. The third is gaining or keeping attached gum, the firm pink band around the tooth that resists brushing wear. The dentist decides on probing depths, X-rays and the position of the gum margin; a flap is not needed for shallow pockets, which usually respond to cleaning alone.
How is the operation done, step by step?
The area is numbed with local anaesthetic, so you are awake but should feel pressure rather than pain. The surgeon makes an incision along the gum margin and, often, a short vertical release cut, then gently lifts the flap. Hardened deposits and inflamed tissue are cleaned from the roots, and if the crown is being lengthened the bone edge may be reshaped with fine instruments. The flap is moved down to the planned level and stitched in place, and some surgeons cover it with a protective dressing. Treating one to three teeth takes about 30 to 60 minutes; a whole section of the mouth takes longer. Sutures are typically removed after one to two weeks.
Does it work? What the evidence says
Periodontal flap surgery is well established. Clinical guidelines from bodies such as the European Federation of Periodontology describe surgical access as a standard option when deep pockets persist after non-surgical treatment, and pockets are generally shallower after surgery. For crown lengthening, the method reliably exposes more tooth, but the gum margin can continue to move for several months before the dentist should take final impressions. What no flap can do is cure gum disease on its own: the result depends on daily plaque control, stopping smoking, which slows healing, and regular professional cleaning. Gum that has receded can also look different afterwards, so ask the dentist to explain the expected change in the shape of your smile line.
Apically repositioned flap cost in Turkey compared with the UK, US and Germany
The ranges are approximate per treated area (a tooth or a small group of teeth in one site) and are not hospital quotes. The clinic confirms its price in writing after an examination and X-rays.
| Country | Approximate cost range |
|---|---|
| Turkey | €120 – €600 |
| United Kingdom | €450 – €1,500 |
| United States | €700 – €3,000 |
| Germany | €350 – €1,400 |
What changes the apically repositioned flap price: how many teeth or sites are treated, whether bone reshaping is needed, the type of anaesthesia (local or with sedation), whether a graft is added, and whether the quote includes X-rays, the cleaning that precedes the surgery, medication and follow-up. If you are having crowns or fillings afterwards, ask whether they are priced separately, as in our guide to tooth restoration.
Apically repositioned flap, gingivectomy or gum graft: which fits?
| Option | Best suited to | Typical limits |
|---|---|---|
| Apically repositioned flap | Pockets with a narrow band of firm gum; crown lengthening | Gum margin sits lower; some root exposure |
| Gingivectomy | Excess gum with a wide band of attached gum and no bone work | Removes tissue; can leave a raw surface; healing is open |
| Free gingival graft | Adding firm gum where there is none or where gum is receding | Second wound at the donor site, usually the palate |
A gingivectomy removes gum and leaves the area to heal on its own, so it is best where there is plenty of firm gum. The flap keeps the tissue, which is why it is preferred when firm gum is thin. If you have lost gum and need to rebuild it, a graft is the better tool. The dentist should show you the probing chart and explain which option the measurements favour.
Who is a good candidate, and who should wait?
Good candidates have gum disease that is under control after non-surgical treatment, a short tooth that needs a restoration, or a narrow band of attached gum and can keep the area clean. You may be asked to wait if there is active infection, heavy plaque, unstable diabetes, heavy smoking you are not ready to reduce, or if you take blood-thinning drugs without a plan from your doctor. Pregnancy, radiotherapy of the jaw and some bone medicines also need a discussion first. Tell the clinic about all medicines and conditions before it quotes.
Healing: what to expect week by week
For the first one to three days you may have swelling, tenderness and slight bleeding; cold compresses and simple painkillers usually help, and you eat soft, cool foods and avoid brushing the stitched area. Chlorhexidine mouthwash may be prescribed for a short period. Sutures come out at about one to two weeks, after which gentle cleaning with a soft brush resumes. The gum matures over about four to six weeks, and for crown lengthening the final crown is usually placed after about two to three months, once the margin has settled. After surgery the roots can look longer and feel sensitive to cold; this often eases with a desensitising toothpaste.
How many days in Turkey do you need?
The surgery itself is a day-case. Most patients plan three to five days: one for the examination and X-rays, one for the operation and a check the following day, and a few days of rest before travelling. If sutures are placed, your home dentist can remove them at about 10 to 14 days with a letter and X-rays from the clinic, which avoids a second trip. If a crown or implant follows, the clinic should tell you honestly how many visits that takes, because the sequence matters for the final result.
Risks and possible complications
Common effects after any gum surgery are swelling, discomfort and temporary sensitivity. Less common problems include bleeding, infection, exposed roots that look longer or lead to lasting sensitivity, gaps between teeth (sometimes called black triangles), bone loss at the surgical site and, rarely, tooth mobility. The risk of poor healing is higher in smokers and in people with poorly controlled diabetes. The NHS and the British Society of Periodontology both stress that gum treatment works only when patients keep the teeth clean afterwards. Ask what the clinic will do if there is a problem once you are home.
How to choose a dentist and clinic, and red flags
Look for a periodontist or a dentist with documented gum-surgery training, a clinic that takes X-rays and records pocket depths before quoting, and a written treatment plan with the number of teeth and the price per site. Red flags: a plan to do a flap on every tooth without measurements, promises that the gums will grow back, no named dentist and no after-care plan. Read how our process works and request a plan through the free quote page, and the clinic will reply in writing.
- Which tooth measurements and X-rays justify a flap rather than a gingivectomy?
- Will the gum margin sit lower, and how will that look when I smile?
- Is the quote per tooth, per site or per sextant, and does it include a follow-up?
- Can my own dentist remove the sutures, and what documents will you send?
- When can the crown or filling be placed afterwards?
Hospitals with Dental Treatments in Turkey
Frequently asked questions
It is a gum operation in which a flap of gum is lifted, the roots and bone are cleaned or reshaped, and the flap is stitched at a lower level. It keeps the firm attached gum while reducing pockets or exposing more tooth.
Usually for pockets that remain after cleaning, for a tooth too short to hold a crown or filling, or for a narrow band of firm gum. The dentist decides after probing the gums and taking X-rays.
Approximate ranges are €120 to €600 per treated area in Turkey, against about €450 to €1,500 in the UK. The price depends on the number of teeth, bone work and what the quote includes.
The area is numbed, so the operation itself should not hurt. Afterwards expect soreness and swelling for a few days, which simple painkillers and cold compresses usually control.
The first week brings swelling and soft food, stitches come out at one to two weeks, and the gum matures over four to six weeks. A crown, if needed, usually waits two to three months.
A gingivectomy cuts gum away and suits a wide band of firm gum. A flap repositions the gum and keeps the tissue, so it is chosen when firm gum is thin or bone must be reshaped.
Often a little, because the gum margin sits lower and roots can be more visible. The dentist should explain the expected change, especially at the front of the mouth where the smile line matters.
It helps reach and clean the roots and makes the pockets easier to maintain, but it does not cure gum disease alone. Daily cleaning, regular professional care and stopping smoking decide the long-term result.
Three to five days is common: examination, the operation, a check the next day and some rest. Stitches can usually be removed by your home dentist at ten to fourteen days.
Swelling, bleeding, sensitivity, infection, exposed roots and gaps between teeth can occur, and healing is slower in smokers. Choosing a trained dentist and keeping the area clean lowers the chance of problems.