• Journal of the korean academy of Pediatric Dentistry
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• v.28 no.3
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• pp.383-390
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• 2001

It is a relatively common clinical experience to see a impacted maxillary central incisor Most often, the central incisor is impacted labially. The labial impaction has been indicated as the most difficult to manage. The labial impactions have been found to be associated with mucogingival recession, reduced attached gingiva and periodontal pockets. For the successful treatment, clinicians should avoid loss of attached gingiva in surgical exposure. The most common methods of uncovering labially impacted maxillary anterior teeth are gingivectomy, apically positioned flap and closed eruption technique. If gingivectomy will not leave enough attached gingiva, then an apically positioned flap may be the treatment of choice. If the tooth is impacted in the middle of the alveolus or high in the vestibule near the nasal spine, the closed eruption technique may be the treatment of choice. Closed eruption technique was used in one case, apically positioned flap was used in two case. As the result in two cases of impacted maxillary central incisor, apically positioned flap provide the adequate width of attached gingiva. In case of impacted maxillary central incisor, through the clinical and radiologic examination to select correct surgical operation for reduce the complications.

• The Journal of the Korean dental association
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• v.55 no.3
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• pp.240-248
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• 2017

A keratinized gingiva is important to the natural teeth and it is more essential to the health of the peri-implant mucosa of the implants. There are various surgical methods to restore a keratinized gingiva. First, a clinician could utilize apically positioned flap operation. This flap operation technique could be used as a full or partial thickness. If there is little keratinized gingival tissue available for the apically positioned flap operation, free gingival grafting should be used. Its technique sensitivity is relatively high, but using various surgical techniques and disciplines makes it simple and have the good predictability. There have been many considerations for those surgical techniques. Clinicians who treat for periodontitis or operate implant surgeries have to know the considerations and surgical methods.

• Journal of the korean academy of Pediatric Dentistry
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• v.26 no.1
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• pp.69-76
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• 1999

The mandibular buccal frenum is defined as a fold of mucous membrane at the posterior labial vestibule and attaches the lips and the cheeks to the alveolar mucosa, gingiva, and underlying periosteum. The buccal frenum becomes a problem when its attachment is too close to the marginal gingiva. It may then pull on healthy gingiva, encourage plaque formation and interfere with tooth brushing. Especially, heavy buccal frenum mucogingivally results in insufficent attached gingiva, inadequate vestibular depth and high frenum attachment and also difficulty in eruption of mandibular premolar. Frenotomy, frenectomy and mucogingival surgery are used in treating heavy buccal frenum. Frenotomy with autogenous free gingival graft has been used popularly because of its stable result. But, it is difficult in younger children because of inadequate donor site, difficulty in making recipient site and behavior management. Frenotomy with apically positioned flap is considered as more efficient way for a very young child with heavy buccal frenum. Additionally, modified deep sedation with $N_2O-O_2$ can be used as an adjunct for the effective treatment outcome. Decrease in muscle pull, adequate width of attached gingiva and increased vestibular depth can be expected from this treatment approach.

• 대한치과교정학회:학술대회논문집
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• 1998.10a
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• pp.90.3-90.3
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• 1998

• Journal of the Korean Academy of Esthetic Dentistry
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• v.6 no.1
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• pp.32-38
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• 1997

• 대한치주과학회:학술대회논문집
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• 2000.11a
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• pp.114-114
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• 2000

• Journal of Dental Rehabilitation and Applied Science
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• v.29 no.4
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• pp.407-417
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• 2013

The one of peri-implant soft tissue problems seen during the maintenance phase of implant therapy is an inadequate zone of keratinized tissue. Keratinized tissue plays a major role around teeth and dental implants, helping in maintaining and facilitating oral hygiene. A free gingival graft (FGG) is chosen to correct the soft tissue defects and provide optimal peri-implant health in order to increase the long-term prognosis of the implant reconstruction. However, the patient treated with FGG has pain and discomfort on donor site such as palate. It is also technically demanding, time consuming, and the color match of the tissue is often less than ideal. An apically positioned flap (APF) is selected for increasing the keratinized tissue simply while or after the second stage implant surgery. This case report shows successfully increasing the width of peri-implant kenratinized tissue through APF procedure on small site of dental implant instead of FGG.

• Journal of the korean academy of Pediatric Dentistry
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• v.31 no.4
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• pp.665-670
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• 2004

The mandibular buccal frenum becomes a problem when its attachment is too close to the marginal gingival. Heavy buccal frenum mucogingivally results in insufficient attached gingiva, inadequate vestibular depth and also difficulty in eruption of mandibular premolar. The aim of this study is to demonstrate the effectiveness of apically positioned partial-thickness flap as adequate method in order to remove heavy buccal frenum and expose impacted teeth. The author presents the case of a 12-year-old boy. He had problems that was prolonged eruption of #34, #35 due to high pull buccal frenum. After space regaining for normal eruption of #34, #35, we performed apically positioned partial-thickness flap on #34, 35 area. As a results, we confirmed that eruption of #34, #35 has been processed normally And vestibular depth, position of buccal frenum and width of attached gingival was within a normal range. Decrease in muscle pull, adequate width of attached gingiva and increased vestibular depth can be expected from this treatment.

• The Journal of the Korean dental association
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• v.50 no.8
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• pp.474-481
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• 2012

The periodontal flap surgery is the most widely utilized surgical procedure to reduce the pocket depth and to access the subgingival root surfaces for scaling and root planing. The diagnosis of the periodontal lesion and the objective of the surgery will dictate the type of flap procedure which will be utilized to obtain the best result. The incisions, type of flap and the selection of suturing design must be planned and executed to fit the problem. Periodontal flaps are designed to preserve gingival integrity and to gain access to root surfaces for residual calculus removal and to thoroughly remove granulation tissue so bone defects can be visualized and treated. Gentle and efficient procedures result in optimum healing and minimal postoperative pain. When flaps need to be repositioned apically or less often, coronally, then the flaps must sit passively at the appropriate level before suturing. To ensure this, buccal and lingual flaps need to be elevated beyond the mucogingival junction so the elasticity of the mucosa allows for flap mobility. Sometimes it may be necessary to extend the flap elevation apically with a split incision approach to minimize the effect of the less elastic periosteum. Vertical incisions can aid in flap positioning by allow ing the clinician to suture the flap at a different level to the adjacent untreated gingiva. In osseous periodontal surgery, flaps are apically positioned to minimize postoperative pocket depth. In regenerative periodontal surgery including implant surgery, soft tissue cove rage of bony defects, graft materials, membranes, and bio logic agents is important so sulcular incisions and light suturing techniques are crucial.

• Journal of Periodontal and Implant Science
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• v.29 no.3
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• pp.635-645
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• 1999

The present study examines the effects of orthodontic treatment of surgically exposed impacted upper canines or ectopically erupted upper canines to periodontal condition and whether various opening procedures have significant difference in postoperative periodontal status. The subjects included 23 orthodontic patients(7 men, 16 women) with unilateral upper canine impaction treated either with closed eruption technique(group I), with apically positioned flap procedure (group II), and those with canines ectopically erupted through keratinized gingiva (group III). In each subject, the ectopic canine was orthodontically aligned, and changes in periodontal tissue were assessed by measuring keratinized gingival width, attached gingival width, probing depth and bone probing depth. In all three groups, the width of keratinized gingiva was preserved while showed no signs of detrimental periodontal condition such as gingival recession. In all three groups, no significant difference in periodontal pocket depth from control was observed. The width of attached gingiva was significantly greater in patients treated with apically positioned flap procedure(group II) than in patients on other groups.