Increasing the apico-coronal dimension of attached gingiva using the modified apically repositioned flap technique: a case series with a 6-month follow-up.

BACKGROUND: This case series reports on the effectiveness of the modified apically repositioned flap (MARF) in increasing the apico-coronal dimension of attached gingiva over multiple adjacent teeth.

METHODS: The MARF surgical technique consists of a single horizontal incision within keratinized tissue, elevation of a split-thickness flap, and suturing of the flap to the periosteum in an apical position. The periosteum is left exposed so that the full perimeter of the wound is surrounded by keratinized tissue. The nature of this wound healing leads to the formation of new keratinized and attached tissue in the area where periosteum is left exposed. A total of 37 areas in 33 systemically healthy patients were analyzed after treatment with the MARF technique. The treatment areas consisted of a minimum of two and a maximum of five adjacent teeth with a minimum of 0.5 mm and a maximum of 2.0 mm of attached gingiva on each tooth.

RESULTS: Treatment with MARF resulted in a significant increase in the apico-coronal dimension of the keratinized tissue and attached gingiva (P <0.05). The increase in keratinized tissue ranged from 2.20 to 4.28 mm, and the increase in attached gingiva ranged from 1.0 to 3.14 mm. Gingival recession decreased significantly in the treated areas, but the difference was of little clinical significance. Probing depths in the treated areas did not change significantly compared to baseline values.

CONCLUSIONS: MARF is an effective technique in increasing the apico-coronal dimension of the keratinized tissue and attached gingiva. MARF offers considerable advantages over other mucogingival surgery techniques: simplicity, limited chair time for the patient and the operator, low morbidity because of the absence of palatal donor tissue, and a predictable tissue color match.