Mucogingival Surgery

Abstract

1. The term “mucogingival surgery” refers to surgical procedures employed to handle problems of treatment involving the interrelationship between gingiva and alveolar mucosa. 2. The objectives and the problems of mucogingival surgery center around the production of a functionally adequate zone of attached gingiva, when one encounters such presurgical situations as (a) pockets that traverse the mucogingival junction; ( b ) a frenum positioned in such a manner as to retract the marginal gingiva or interdental papilla; ( c ) a shallow vestibule coexistent with a functionally inadequate amount of gingiva. 3. A “functionally adequate” amount of attached gingiva is not a matter of a measurement in millimeters, but rather an amount sufficient to dissipate the pull that causes retraction of the marginal tissues. 4. Four operations are used to accomplish the objectives of mucogingival surgery. One, the apically repositioned flap, has wide application and can be used to handle most mucogingival problems. The other three—the frenotomy, the laterally repositioned flap and the double flap—have less frequent application. 5. A scalloped incision with an internal bevel is described as an integral component of the apically repositioned flap operation. This incision removes the pocket epithelium, thins the gingiva in order to compensate for fibrosis that may be present, and permits maximum coverage of bone and wound closure. 6. Vestibular extension achieved by the apically repositioned flap does not lessen materially in healing as it does with most other operations. The need for such extension is not as frequent as had been advocated previously. 7. A frenotomy operation is preferred to the frenectomy. It consists of severing the frenum in order to eliminate retraction of the marginal tissue. 8. The laterally repositioned flap is described as a gingival graft to repair the defect of root denudation resulting from gingival recession. 9. The “double flap” operation is used when very little gingiva is present and the vestibule is so shallow as to require deepening in the mandibular posterior region. Since the need for such vestibular extension does not occur frequently, the operation has limited application. 10. Observations made from preliminary studies of experimental periodontal surgery on human beings indicate that the apically repositioned flap, with or without osseous surgery, results in either no bone loss or a negligible amount of bone loss.