Management of Inadequate Attached Gingiva and Vestibular Depth by Combination of Free Mucosal Graft and Modified Apically Repositioned Flap Surgery: A Case Series with 3 Years Follow Up

Navneet Sheokand, Mohinder Panwar, Manab Kosala, Oliver Jacob, Sumidha Bansal, Vishvnathe Udayshankar, Lalit Janjani

Introduction: Attached gingiva plays very important role in maintaining long term periodontal health in relation to teeth. Although literature is divided on the issue of minimum requirement of attached gingiva in relation to a tooth, Lang and Loe in 1972 mentioned that 2 mm keratinized gingiva out of which 1 mm is attached is considered adequate. There are various surgical modalities to increase amount of keratinized gingiva with MARF being the latest addition.

Objectives: To evaluate the combined effect of Free Mucosal Graft (FMG) and Modified Apically Repositioned Flap (MARF) Surgery in cases with inadequate keratinized gingiva, gingival recession and shallow vestibule.

Methodology: 10 Patients with Millers Class III and IV recession, inadequate width of keratinized gingiva and shallow vestibule were included in the study. 4 parameters were recorded at baseline and 6 months i.e. Width of keratinized gingiva, Width of attached gingiva, Vestibular depth and gingival recession.

Summary of results: Result showed significant difference in width of keratinized gingiva, vestibular depth and coverage of gingival recession. Study showed mean change of 3.0 ± 0.57 mm (p<0.01) in Width of Attached Gingiva, 3.5 ± 0.67 mm (p<0.01) in Vestibular Depth.

Conclusions: Present study demonstrated successful management of inadequate attached gingiva and shallow vestibule by combining two surgical modalities i.e. FMG and MARF