Mucogingival Surgery

Mucogingival Surgery

What are indications for mucogingival surgery? Describe apically displaced flap surgery.
Answer. Mucogingival surgery refers to periodontal surgical procedures designed to correct defect in morphology, position and/or amount of gingiva surrounding the teeth.

Mucogingival Surgery Indications

• Augmentation of edentulous ridge.
• Prevention of ridge collapse associated with tooth extraction.
• Crown lengthening.
• Loss of interdental papilla which presents as esthetic/phonetic defect.

Apically Displaced Flap Surgery

Used for both pocket irradiation and widening of zone of attached gingiva:

• Step 1: Internal bevel incision is made 1 mm from the crest of the gingiva and directed towards the crest of the bone.
• Step 2: Crevicular incision is made followed by initial elevation of flap and than interdental incision is performed, the wedge of the tissue containing the pocket wall is removed.
• Step 3: Vertical releasing incisions are made extending beyond the mucogingival junction. If objective is full thickness flap, then it is elevated by blunt dissection with periosteal elevator. If split thickness flap is required, then it is elevated by sharp dissection using bard parker knife to split it.
• Step 4: Remove all the granulation tissue, root planing is done and flap is displaced apically at the tooth bone junction.
• Step 5: If a full thickness flap was performed, then a sling suture around the tooth prevents the flap from sliding to a position more apical than that desired, and the periodontal dressing can avoid its movement in a coronal direction. A partial thickness flap is sutured to the periosteum using a direct loop suture or a combination of loop and anchor sutures. Place a dry foil over the flap before covering it with dressing to prevent the introduction of pack under the flap.