The term periodontal surgery includes surgical procedures that aim to restore the normal function or appearance of the supporting tissues of the teeth that are affected by periodontitis or other non-inflammatory causes. The success of periodontal surgery depends on various factors including operator's skills, patient selection and appropriate choice of techniques when considering an individual's clinical findings. In regenerative, reconstructive periodontal surgery, the choice of flap design and appropriate suturing techniques are a precondition for a successful outcome of the surgery. Their goal is to ensure the conditions for the appropriate stability of the wound and primary closure hence primary healing of the tissue, which enables unhindered formation and maturation of the underlying tissue. In this sense, both flap design and suturing technique play the greatest role in achieving the maximum potential of reconstructive materials such as membranes, replacement materials and biological agents. From a historical perspective, the evolution of surgical techniques begins with gingivectomy techniques in the second half of the 19th century, after which the development of early surgical techniques, commonly named flap operations, began. The main problem of the classic access flaps is the inability to achieve primary wound closure, which prompted the evolution of the flap design in order to preserve the supracrestal interdental soft tissues. Surgical techniques of "preservation of the papilla" can include bilateral flap elevation with the inclusion of the entire papilla in one of the flaps (PPT, ITM, MPPT and SPPT), unilateral flap elevation without lifting interdental tissue (SFA and M-MIST), or even complete preservation of the integrity of the papilla with an intraosseous defect (EPPT). With the use of soft tissue grafts, the latest techniques enable, in addition to bone regeneration, also soft tissue reconstruction.