Increasing the Amount of Attached Gingiva Using a Modified Apically Repositioned Flap

Carnio, João; Miller, Preston D.

doi:10.1902/jop.1999.70.9.1110

Cited by 27 publications

(46 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Carnio et al 60 treated a total of 37 areas in 33 systemically healthy patients. Evidence supporting the procedure is supported by two case series reported by the same group 59,60 . In these two case series, the amount of KT increased from a baseline mean of 2.14 ± 0.78 and 2.20 ± 0.38 mm to approximately double (4.25 ± 1.03 and 4.28 ± 0.87 mm).…”

Section: What Are the Alternatives To Autogenous Gingival Grafting Tomentioning

confidence: 84%

“…In neither report was there a significant change in probing depth. In the first report, the authors noted no change in recession, and in the second report, they noted a statistically significant, but not clinically significant, reduction in recession from 0.82 to 0.75 mm 59,60 …”

Section: What Are the Alternatives To Autogenous Gingival Grafting Tomentioning

confidence: 95%

“…It is important to remember that some patients might require treatment in multiple areas and may not have adequate palatal donor areas. Table 3 summarizes these findings 58‐68 . Various surgical procedures, such as periosteal retention and denudation, have been initially suggested and used to increase the width of attached gingiva around teeth 69,70 .…”

Section: What Are the Alternatives To Autogenous Gingival Grafting Tomentioning

confidence: 99%

“…Carnio et al 59,75 described the modified apically repositioned flap (MARF) surgical technique, which consists of a single horizontal incision within KT, elevation of a split‐thickness flap, and suturing of the flap to the periosteum in an apical position. It consists of a modern and minimally traumatic reinterpretation of the periosteal retention and denudation procedures.…”

Section: What Are the Alternatives To Autogenous Gingival Grafting Tomentioning

confidence: 99%

See 3 more Smart Citations

Periodontal Soft Tissue Non–Root Coverage Procedures: A Systematic Review From the AAP Regeneration Workshop

Kim

Neiva

2015

Journal of Periodontology

180

185

View full text Add to dashboard Cite

Background: Gingival augmentation procedures around natural teeth and dental implants are performed to facilitate plaque control, to improve patient comfort, to prevent future recession, and in conjunction with restorative, orthodontic, or prosthetic dentistry. The aim of this study is to answer the most common questions related to this treatment modality based on the most relevant and current knowledge in the field. Methods: Two reviewers worked to answer the five most common and clinically relevant questions with supporting literature to understand the role of gingiva around teeth. 1) What circumstances require an increased zone of keratinized tissue (KT), or is KT important? 2) What is the ideal thickness of an autogenous gingival graft? Is a thick autogenous gingival graft more effective than a thin autogenous gingival graft? 3) What are the alternatives to autogenous gingival grafting to increase the zone of attached gingiva? 4) Does orthodontic intervention affect soft tissue health and dimensions? 5) What is the patient‐reported patient outcome for minimal KT compared with that for an enhanced zone of KT? An extensive literature search was performed using PubMed, the Cochrane Oral Health Group Specialized Trials Registry (the Cochrane Library), and the most respected journals in the field. Results: Although gingival augmentation procedures were first introduced in 1960s, there have not been in‐depth comparative studies examining the five questions that have been proposed by the authors. Lack of relevant systematic reviews and randomized clinical trials (RCTs) on this topic do not allow authors to answer those questions with a strong level of evidence. However, the following can be recommended after reviewing case reports and case series on these topics. 1) There is enough clinical evidence to support maintaining an adequate band of gingiva for intracrevicular margin restoration. 2) Thick grafts do not appear to result in better clinical outcomes than thin grafts. Thick grafts are likely to result in more primary contraction, whereas thin grafts tend to be prone to secondary contraction. 3) Viable alternative treatment modalities are currently available that are capable of providing KT augmentation without the need for palatal donor tissue. 4) Appropriately applied orthodontic forces do not cause permanent damage to a healthy periodontium. The probability of recession during tooth movement in thin biotype is high to justify gingival augmentation when the dimension of gingiva is inadequate. In addition, cases in which there will be a facial tooth movement outside of the alveolar process need to be considered for a gingival augmentation procedure. 5) Although the articles that have been published on this topic did not consider patient‐reported outcomes and esthetics as part of the overall treatment success assessment, patients who have received alternative treatment modalities that did not depend on palatal tissue harvesting appear to have reported more satisfaction and less discomfort after treatment. Conclu...

show abstract

Section: What Are the Alternatives To Autogenous Gingival Grafting Tomentioning

confidence: 84%

Section: What Are the Alternatives To Autogenous Gingival Grafting Tomentioning

confidence: 95%

Section: What Are the Alternatives To Autogenous Gingival Grafting Tomentioning

confidence: 99%

Section: What Are the Alternatives To Autogenous Gingival Grafting Tomentioning

confidence: 99%

See 2 more Smart Citations

Periodontal Soft Tissue Non–Root Coverage Procedures: A Systematic Review From the AAP Regeneration Workshop

Kim

Neiva

2015

Journal of Periodontology

180

185

View full text Add to dashboard Cite

show abstract

“…To correct these mucogingival issues, a free gingival graft (FGG), an apically positioned flap, or a connective tissue graft is required if there is a minimal width of keratinized tissue, in order to increase the width [7]. If there is a sufficient amount of keratinized tissue near the implants, apically or laterally positioned flaps can be applied using the pre-existing keratinized mucosa [89], or the combination of an apically positioned flap (APF) and FGG can be used [1011]. However, these techniques have distinct limitations, such as a limited quantity of donor tissue, common infections, morbidity of patients, bleeding from the donor area, and unpredictable failure.…”

Section: Introductionmentioning

confidence: 99%

Preservation of keratinized mucosa around implants using a prefabricated implant-retained stent: a case-control study

Kim

Duong

Park

et al. 2016

J Periodontal Implant Sci

View full text Add to dashboard Cite

PurposeThe aim of this study was to clinically assess the impact of a prefabricated implant-retained stent clipped over healing abutments on the preservation of keratinized mucosa around implants after implant surgery, and to compare it with horizontal external mattress sutures.MethodsA total of 50 patients were enrolled in this study. In the test group, a prefabricated implant-retained stent was clipped on the healing abutment after implant surgery to replace the keratinized tissue bucco-apically. In the control group, horizontal external mattress sutures were applied instead of using a stent. After the surgical procedure, the width of the buccal keratinized mucosa was measured at the mesial, middle, and distal aspects of the healing abutment. The change in the width of the buccal keratinized mucosa was assessed at 1 and 3 months.ResultsHealing was uneventful in both groups. The difference of width between baseline and 1 month was −0.26±0.85 mm in the test group, without any statistical significance (P=0.137). Meanwhile, the corresponding difference in the control group was −0.74±0.73 mm and it showed statistical significance (P<0.001). The difference of width between baseline and 3 months was −0.57±0.97 mm in the test group and −0.86±0.71 mm in the control group. These reductions were statistically significant (P<0.05); however, there was no difference between the 2 groups.ConclusionsUsing a prefabricated implant-retained stent was shown to be effective in the preservation of the keratinized mucosa around implants and it was simple and straightforward in comparison to the horizontal external mattress suture technique.

show abstract

The Modified Apically Repositioned Flap Technique and Its Potential to Regain Gingival Melanin Pigmentation

Carnio

Camargo

Chen

et al. 2018

Clin Adv Periodontics

View full text Add to dashboard Cite

IntroductionPatients that have gingival melanin pigmentation present an esthetic challenge to clinicians because it is often hard to maintain or regain this pigmentation after surgery. These cases show the Modified Apically Repositioned Flap (MARF) technique and its potential to increase the likelihood of repigmentation of the surgical site with better matching esthetic results.Case SeriesA total of six healthy, non‐smoking patients presented with the need for increased dimension of attached gingiva. All patients had pre‐existing physiologic gingival melanin pigmentation and underwent the MARF technique. Ten teeth were included in the case series and the observational follow‐up period ranged from 1 to 2 years. The surgical areas were analyzed in relation to the width of keratinized and attached gingiva, marginal tissue recession, and probing depth. The final esthetic results, were judged by 20 periodontists using standardized photographs and a grading scale from 0 to 2.ConclusionsTreatment with MARF resulted in a significant increase in the apico‐coronal dimension of the keratinized and attached gingiva (P < 0.05). The increase in keratinized tissue ranged from 1.85 to 4.65 mm, and the increase in attached gingiva ranged from 0.8 to 3.55 mm. Probing depths and recession did not change significantly compared to initial values. Experienced clinicians judged the final esthetic results to be completely matched, with pigmentation in the healed tissue blending well with pre‐existing pigmentation.The MARF technique should be considered as an alternative surgical technique when an increase in the apico‐coronal dimension of attached gingiva is required in patients with gingival melanin pigmentation.

show abstract

Increasing the Amount of Attached Gingiva Using a Modified Apically Repositioned Flap

Cited by 27 publications

References 17 publications

Periodontal Soft Tissue Non–Root Coverage Procedures: A Systematic Review From the AAP Regeneration Workshop

Periodontal Soft Tissue Non–Root Coverage Procedures: A Systematic Review From the AAP Regeneration Workshop

Preservation of keratinized mucosa around implants using a prefabricated implant-retained stent: a case-control study

The Modified Apically Repositioned Flap Technique and Its Potential to Regain Gingival Melanin Pigmentation

Contact Info

Product

Resources

About