• Journal of Periodontal and Implant Science
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• v.33 no.2
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• pp.289-299
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• 2003

The autogenous free gingival graft is the most predictable procedure currently used to increase the width of　the attached gingiva in periodontics. But the major disadvantage of the procedure is to create the multiple surgical wounds at both a donor site and a recipient site. The other problem is the limited amount of available　graft material in oral cavity. Therefore, recent researches have been focused to develop the biomaterial to substitute the autogenous gingival tissue. The purpose of this study was to evaluate the histologic healing after　grafting of bilayer artificial dermis, compared to the free gingival graft. Four non-smoking subjects (mean age, 32.5 years) in systemically healthy state and good oral hygiene were selected according to their particular needs for correction of mucogingival problems as suggested by Nabers(1966). The recipient sites were prepared through the procedure for the free gingival graft and were grouped according to the graft materials: Experimental group(n=5) - bilayer artifcia1 dermis ($Terudermis^{(R)}$; Terumo Co. Japan) and Control group(n=6) - free gingival graft with autogenous palatal mucosa. Biopsies were harvested at 1,2,3 and 6 weeks postsurgery to evaluate histologically. At the third week in the experimental group and at the second week of in the control group, the grafts has been clinically stabilized on the recipient bed and the graft border has been blended into the surrounding tissue. In the experimental group after 1 week of grafting, the epithelial migration from the adjacent tissue to graft material was seen and after 3 weeks of grafting, the : nflmmation decreased, collagen layer of the artificial dermis was lost and the basement membrane of epithelium was formed. After 6 weeks of grafting, both groups demonstrated orthokeratinized epithelium and increased thickness of epithelial tissue and the rete peg formation, similar to the adjacent tissue, Histologic evaluation revealed a biologic acceptance and incorporation of the collagen layers of the graft tissue to the host tissue, without foreign body reaction. In conclusion, a bilayer artificial dermis is essentially similar to autogeneous free gingival graft in the correction of mucogingival problems, and has the advantages of decreased patient morbidity (no donor site) and availability of abundant amounts of graft material when needed.

• Journal of the korean academy of Pediatric Dentistry
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• v.27 no.1
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• pp.122-134
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• 2000

The aim of this study is (1) to establish the baseline information concerning the width of keratinized gingiva, depth of gingival sulcus and width of attached gingiva on the buccal surface of the teeth: and (2) to determine the relationship between the above values and tooth eruption: and (3) to estimate the frequency of mucogingival problems. The results were as follows; 1. The mean width of attached gingiva of the children aged $6\sim12$ proved to be wider in the maxilla than in the mandible. Of the primary teeth, the widest width was found in the areas of maxillary primary lateral incisors and maxillary primary canines(3.50mm and 3.55mm). The narrowest was noted in the area of mandibular first primary molars(1.34mm) In the permanent dentition, the greatest width was found in the areas of maxillary permanent lateral incisors (3.00mm). The narrowest was noted in the area of mandibular first premolars(0.55mm). 2. In the primary dentition, the width of attached gingiva of primary canines and first and second primary molars became wider from the age of six as the age increased. In the permanent dentition of the boys, only mandibular central incisors and maxillary first molars showed the tendency towards increase in the width of attached gingiva with increasing age. In the permanent dentition of girls, central and lateral incisors of both jaws and maxillary first molars showed statistically significant increase in the width of attached gingiva with increasing age(p<0.05). 3. At the age of tooth change, the attached gingiva of primary teeth were almost wider than those of successive permanent teeth (p<0.05). 4. During the period of 6 to 12 years of age, the width of keratinized gingiva and the depth of gingival sulcus of permanent tooth at the age of twelve were larger than those of primary tooth at the age of six (p<0.05). 5. The maximum in the frequency of mucogingival problems was found in the areas of upper and lower first primary molars of primary dentition, and in the upper and lower first premolars of permanent dentition regardless of sex. The frequency was higher in primary teeth than in the corresponding successive permanent teeth These teeth showed tendency towards increase in mucogingival problems with age.

• 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.

• 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.