While non-surgical endodontics is the mainstay of the endodontic specialist, surgical procedures are often necessary to save teeth. Most patients are aware of their aesthetic smile and are not willing to compromise their appearance to save a tooth. Predictable aesthetic results may be achieved by a skilled hand and thorough knowledge of surgical flap design and maintenance. The purpose of this review is to present a thorough appraisal of the accepted and predictable flap designs as well as review guidelines for tissue handling and closure. It may be concluded that endodontic surgery offers a significant contribution to endodontic practice; that treatment is performed using sound surgical principles with appropriate case selection; and that flap design can offer successful outcomes without compromising aesthetics. Keywords: endodontics, flap, management, microsurgery, surgery