Mucogingival repairs in periodontal surgery

The utilization of partial thickness apically repositioned flaps, laterally repositioned flaps, and free mucosal autografts enable the clinician to repair most mucogingival problems. These techniques may be used separately or in combination to increase the zone of attached gingiva, deepen the vestibular fold, and eliminate muscle and frenum pulls. If basic surgical principles are adhered to, the possibilities of repair of mucogingival problems utilizing these procedures are unlimited. The most important step in mucogingival surgery is planning the surgical procedure prior to beginning surgery. In this way different techniques may be combined to achieve the desired result and minimize the number of surgical episodes that may be required. It is important to conserve tissue. For example, tissues from gingivectomy or flap surgery in one area may be utilized for a free gingival graft in another area (Fig. 21). There is one last but most important requirement for mucogingival surgery: there should be some evidence of periodontal pathology. The lack of a wide zone of attached gingiva, the lack of a deep vestibule or a frenum pull is not in itself an indication for surgical intervention ulness some periodontal pathology is evident. In some cases it may be determined by the clinician's judgment that it would be best to perform a mucogingival surgical procedure to prevent one of these areas from developing into a periodontal problem. This decision is often dictated by the patient's age. In older patients, areas of minimal attached gingiva and shallow vestibular depth that show no periodontal breakdown should be regarded as areas of health and no surgical intervention is indicated. On the other hand, if these areas are evident in a child, particularly when orthodontic therapy is anticipated, then surgical intervention may be advisable to prevent serious damage to the gingival tissues.