What is a contraindication for performing an apically positioned flap?

The reason why esthetics is considered a contraindication for performing an apically positioned flap relates to the specific outcome expectations associated with this surgical technique. An apically positioned flap typically involves repositioning the gum tissue downward, which can lead to increased visibility of the tooth roots and potentially compromise the aesthetic harmony of a patient's smile.

When an apically positioned flap is used, there is often a reduction in the amount of keratinized tissue around the teeth, which may not be desirable from a cosmetic standpoint, especially in areas visible during smiling or speaking. Therefore, if a patient has high aesthetic expectations, particularly in the anterior region of the mouth, this surgical approach might not be appropriate.

In contrast, factors such as the presence of infection, bone loss, and patient age usually do not make the technique inherently unsuitable; rather, those factors could influence the decision-making process but don't strictly preclude the performance of an apically positioned flap.