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INTRODUCTION
Mucogingival
surgical
techniques
are
designed
to provide a functionally adequate zone of keratinized
attached gingiva.(Friedman, 1962).
Pocket elimination or creation of proper physiologic form
Complex capable of withstanding the stresses of
mastication
Tooth brushing
Trauma from foreign objects
Tooth preparation associated with a crown and bridge
Subgingival restorations, orthodontics, inflammation,
and
frenulum pull.
DEFINITION
The definition proposed by Friedman included surgery
designed to preserve attached gingiva, to remove frena or
muscle attachment and to increase the depth of the
vestibule , correct or eliminate anatomic, developmental or
traumatic deformities of the gingiva or alveolar mucosa
INDICATIONS
These procedures, therefore, should be used only where
specifically indicated or where inflammation cannot be
controlled.
Wennstrm (1985) stated: A thin marginal tissue, in
particular in the absence of underlying alveolar bone, will be
at greater risk of recession since the plaque-induced
inflammatory lesion may occupy
and cause destruction of the entire connective tissue portion
of the gingiva.
General Considerations
Principles
1. Existing keratinized gingiva should always be
maintained.
2. Exposing bone to increase the zone of keratinized
gingiva is contraindicated (Wilderman, 1964).
3. When an adequate zone of attached keratinized
gingiva exists, vestibular depth is not
a factor (Bohannan, 1963a).
Objectives
To create an adequate zone of attached keratinized gingiva
To eliminate pockets that extend beyond the mucogingival
line
To eliminate muscle and frenulum pull
To deepen the vestibule
To cover denuded root surfaces for esthetics
or hypersensitivity
To overcome the anatomic factors of tooth
position, thin alveolar housing, and large
prominent roots, which promote dehiscence
and/or fenestration formation with gingival
accession
Classification of Procedures
The surgical methods available for correction of mucogingival
problems are as follows:
1. Periodontal flapspositioned and repositioned
a. Full thickness (mucoperiosteal; modified, apically positioned)
b. Flap curettage
c. Partial thickness (apically positioned)
d. Curtain procedure
2. Free soft tissue autografts
a. Grafting for root coverage
b. Connective tissue pedicle graft
c. Ridge augmentation for esthetics