The free gingival graft fgg is predictable surgical techniques often employed to increase the zone of attached gingiva. The width of the attached gingiva can be accurately measured if scaling has not been done gingival inflammation in the area has been eliminated the pocket depth is not beyond 3mm. Although the need for a socalled adequate amount of keratinized tissue for maintenance of periodontal health is questionable, the mucogingival junction serves as. Wiley online library, proceedings from the state of the art workshop on surgical therapy for periodontitis, journal of periodontology, 53, 8, 475501, 1982. Pdf width of keratinized gingiva and the health status. Vestibuloplasty is a preprosthetic surgical technique that has been developed to rebuild a sufficient vestibular depth by reducing the high muscle tensions that are streching to the maxillary or mandibular sides 3,4. Ughabharathy r, balu p, muthu j, saravanakumar r, vineela k, karthikeyan i. Pdf free gingival graft for increasing the width of. Students ttest for paired samples was used to compare the means of the clinical measurements at all experimental periods.
A free gingival graft 12, was obtained from the right and left side portions of the palate, approximately 2 mm below the gingival margin. None introduction the width of the attached gingiva ag is an important clinical parameter. Width of attached gingiva on attached gingiva is the largest in the incisors and indigenous areas ranging from 3. The assessment of width of attached gingiva in different age groups by vm revealed that the width of gingiva increases with age wherein the mean width in maxillary teeth in width of attached gingiva using. This technique is important for maintaining an adequate zone of keratinized tissue, as opposed to the gingivectomy technique, where soft tissue is resected. On attached gingiva does not include any part of the desna river, which is separated from tooth to the crevice, grooves or periodontal pocket. The mean width of the attached gingiva did not show an increase from the deciduous to the permanent dentition. Adam bear discusses the advantages this procedure has for surgical crownlengthening procedures. Assessment of the width of attached gingiva using different. Significance of the width of keratinized mucosa on the. Width of attached gingiva is not measured to taste, because it is impossible to determine where attached gingiva ends and the soft palate mucosa begins. The objective of this in vivo study was to evaluate sulcus depth width and thickness of facial attached gingiva in primary, mixed, and permanent dentition.
Assessment of the width of attached gingiva using different methods in various age groups. Free gingival graft to increase the width of attached. Clinical evaluation of increase in the width of attached gingiva using modified apically repositioned flap. The width of attached gingiva can vary dramatically between patients and within an individuals mouth, from as little as 1 mm to over 10 mm. Upon intra oral examination the sound tooth structure was deep below the gum tissue and not accessible, very narrow zone of attached gingiva was also noticed. It is the distance between the mucogingival junction mgj and the projection on the external surface of the. Measurement of the width of attached gingiva in an indian. This procedure is done when there is no adequate width of attached gingiva, and there is a biologic width of more than 3 mm on multiple teeth. The opinions or assertions contained in this article are the private ones of the writer and are not to be construed as official or reflecting the views of the department of the navy or the navy dental corps.
No significant correlation was shown between width of attached gingiva or vestibular depth and gingival inflammation and oral hygiene maintenance. Aug 21, 2012 the most coronal part towards the tooth reforms as attached gingiva keratinized tissue from the gingiva surrounding the adjacent teeth. May 02, 2014 the assessment of width of attached gingiva in different age groups by vm revealed that the width of gingiva increases with age wherein the mean width in maxillary teeth in width of attached gingiva and the prevalence of gingival recessions, journal of clinical periodontology, 9, 1, 8692, 2011. The relationship between the width of keratinized gingiva prosites. However, in the present study the widths varied from 0 to 5 mm. The treatment procedure led to significant improvements in width of gingiva. P of keratinized attached gingiva and nonkeratinized alveolar mucosa shows that attached gingiva is keratinized with thin, prominent epithelial ridges, and is firmly attached to the underlying bone and tooth allowing it be more protective and making it better able to withstand mechanical irritation bouri, 2008.
In case 2, the width of the attached gingiva increased from 3 mm to 6 mm on tooth 2431 and from 1 mm to 6. Pdf correlation of width of attached gingiva, depth of the. The width of attached gingiva varies from tooth to tooth and also among individuals with mixed opinions regarding an adequate or sufficient dimension of the gingiva. An adequate width of attached gingiva is essential to maintain oral hygiene. Attached gingiva definition of attached gingiva by. The width of the attached gingiva during orthodontic. The width of attached gingiva varies in different areas of the mouth and have been given a range of 19 mm, 14 mm, 0g5 mm. The width of keratinized gingiva was measured in midfacial area for six anterior teeth in the maxillary and mandibular regions from the gingival margin to the.
Measurement of attached gingiva width the width of keratinized gingiva was measured in midfacial area for six anterior teeth in the maxillary and mandibular regions from the gingival margin to the mucogingival junction using unc15 periodontal probe. Double lateral sliding bridge flap for the coverage of. Similar to the variations seen in bowers study, the widest zone of attached gingiva was found in the incisors and the least in the premolar region irrespective of the. Attached gingiva then and now cods journal of dentistry.
The mucogingival junction was determined using a jiggle method because of movable the alveolar mucosa and firmly attached gingiva. The relationship between the width of keratinized gingiva. A study of the width of attached gingiva bowers 1963. However, the present findings failed to demonstrate the hypothesis that the width of the attached gingiva at the manditable 1. This question of assigning a value to the width has been explored from a different perspective. Subsequent studies38 demonstrated that it is possible to maintain the periodontal attachment level through the control of gingival in. According to abrahamsson in 1996, a certain width of keratinized gingiva is required to promote an adequate epithelial and connective tissue attachment. A study of the width of attached gingiva by g e r a l d m. The width of the attached gingivamuch ado about nothing. Attached gingiva 4 555 3 4,5 gain of attached gingiva 2,5 5 5 4 3 2,5 fig. The width of attached gingiva in the labial or buccal surface at edentulous area was measured before surgical procedures and after the completion of superstructures. The aim of this study was to determine normal values of the width of attached gingiva in an indian subpopulation.
Pdf correlation of width of attached gingiva, depth of. There was a significant association p gingival recession and width of attached gingiva, tooth malposition, type of frenal attachments, simplified oral hygiene index, type of brush. Feb 01, 2017 width of attached gingiva maxilla incisor region. The width of the attached gingiva was measured 60 and 90 days after surgery. The smallest width was usually seen in the area of the anterior teeth, and the widest gingiva was found. Clinical evaluation of a dermic allograft in procedures to. Increasing the width of periodontal attached gingiva using an. The importance of keratinized gingiva surrounding dental.
Pdf width of attached gingiva in an indian population. The width of attached gingiva increases with age and in supraerupted teeth 7,15. Hall 1982 said that the width of attached gingiva is determined by subtracting the sulcus or pocket depth from total width of gingiva. Bouri and nabil bissada and mohammad alzahrani and fady fouad faddoul and imad e nouneh, journalthe international. The free gingival margin covers the cementoenamel junction cej and the gingival papillae fill the embrasures. Soft tissue sealing around dental implants based on. On attached gingiva lies between the free gum and mucous alveolar ridge fig. There are various periodontal plastic surgical techniques available till date to treat these defects in order to increase the width of the attached gingiva and to improve the aesthetics. The width of the attached gingiva can be accurately. Attached gingiva and its significance linkedin slideshare. View the article pdf and any associated supplements and figures for a period of 48 hours. Pdf width of keratinized gingiva and the health status of. Therefore, the current consensus9 is that, provided with adequate oral hygiene, periodontal stability.
The apical part towards the vestibule would be expected to be movable, but frequently i find it to be a scar kind of tissue, pretty stable. Each measurement was made from the gingival margin to the mucogingival junction. Width of keratinized gingiva and the health status of the. Biologic width and its importance in periodontal and. Width of attached gingiva wag is an important marker for diagnosis of periodontal disease. Assessment of gingival sulcus depth, width of attached. The attached gingiva increased on all experimental teeth. The orthopantomographic width of the attached gingiva was measured to the nearest millimeter by determination of the distance between the mucogingival and cementoenamel junctions along the long axis of each tooth. However, thin gingival tissues around teeth with restorations or undergoing labial orthodontic tooth movement may be more susceptible to recession. Attached gingiva is an important factor affecting periodontal health which enhances the plaque removal around the gingival. Singlestage surgical procedure for increasing depth of.
In patients with inadequate width of attached gingiva mucogingival surgeries like connective tissue grafts, free gingival grafts, apically displaced flap etc. They concluded that 2mm of keratinized gingiva, with less than 1mm of attached gingiva. However, the width of the attached gingiva in the case of newly erupted permanent teeth was narrower than in the corresponding primary teeth. The anatomy and physiology of the healthy periodontium. In case 1, the width of the attached gingiva increased from 3 mm to 7 mm on teeth 2431 and 2541 and from 2 mm to 6 mm on teeth 2332 and 2642. The width of attached gingiva varies in different areas of the mouth and have been given a range of 19 mm, 14 mm, 05 mm.
The study included 40 subjects 22 males and 18 females with 480 sites of an age range 425 years. The width of the attached gingiva during orthodontic treatment. Similar to the variations seen in bowers study, the widest zone of attached gingiva was found in the incisors and the least. A free gingival graft with strip technique was chosen to obtain augmentation of the gingiva and increase of the vestibule depth on the whole frontal area. Orthopantomographic assessment of the width of attached.
The width of attached gingiva on the facial aspect varies in differ ent areas of the mouth. Width of keratinized gingiva and the health status of the supporting tissues around dental implants. Gingiva, gingival recession, periodontal attachment loss. In the present study, the range of the mean width of attached gingiva varied from 1 mm to 4 mm. Henri tenenbaum, a clinical study comparing the width of attached gingiva and the prevalence of gingival recessions, journal of clinical periodontology, 9, 1, 8692, 2011. The significance of keratinized mucosa on implant health. The 20 patients were pleased with this new technique using the nd.
It may be concluded that the new procedure provides significant increase of keratinized gingiva with the advantage of minimal morbidity and pleasing cosmetic results. Living cellular construct for increasing the width of. The apically positioned flap is a commonly used surgical approach to achieve pocket elimination. The procedure involves adjusting the levels if the gum tissue and bone around the tooth in question, to. A clinical study article pdf available in journal of indian society of periodontology 192. The intracrevicular restorative margin,the biologic width, and the maintenance of gingival margin. Clinical dental advantages of the apically positioned flap. Bayesian hierarchical model of width of keratinized gingiva. The anatomy and physiology of the healthy periodontium 7 when a periodontal probe is placed into this space, a measure may be recorded which is very useful for diagnosis. Shallow vestibule along with the inadequate width of attached gingiva is a common cause of the gingival recession.
Attached gingiva and dental implants perioimplant advisory. Dorfman determined the changes in the width of keratinized gingiva of fully treated orthodontic patients. Longitudinal changes in the width of attached gingiva in. Brownstein, recognition of periodontal disease in children, pediatric clinics of north america, 29, 3, 457. Free gingival graft to increase keratinized mucosa after. On attached gingiva in the narrow premolar regions 1. Pdf assessment of the width of attached gingiva using. Lang and loe 5 reported a study on the relationship between the gingival width and inflammation, in an effort to determine the adequate amount. Proper mucogingival therapy should lead to gingival augmentation and create a vestibule with adequate depth in the regions with insufficient attached gingival tissues 1, 14, 18. The gingiva regenerated with the lcc matched the color and texture of the adjacent gingiva. The relationship between the width of keratinized gingiva and gingival health.
The width of keratinized gingiva the distance between gingival margin and mucogingival line was measured to. The width of attached tissue is critical, because the more there is available provides a greater sense of protection against the aforementioned insults to the tissue. Broadening of the attached gingiva indication matrix. The free gingival grafts have been used in periodontics to primarily augment the width of attached gingiva and to a lesser extent cover denuded root surfaces. The mucogingival junction was identified by the rolling technique, wherein the mucosa was rolled until the nonmovable portion of the attached. Clinical evaluation of increase in the width of attached. A total of 240 subjects were selected with healthy gingival tissue. In man the keratinized gingiva includes the free and the attached gingiva and extends from the gingival mar gin to the mucogingival. The widest zone of attached gingiva was found over the central and lateral incisors. Henri tenenbaum and monique tenenbaum, a clinical study of the width of the attached gingiva in the deciduous, transitional and permanent dentitions, journal of clinical periodontology, , 4, 270275. Longitudinal changes in the width of attached gingiva in children.
Apical repositioned flap with osseous reduction this technique is used when there is no adequate zone of attached gingiva and the biologic width is less than 3 mm. The width of the attached gingiva can be accurately measured if scaling has not been done. A clinical study of the width of the attached gingiva in the. Using the mucogingival junction as the boundary demarcating the apical border of the attached gingiva, a periodontal probe in inserted into the gingival sulcus to measure how much. The relationship between the width of keratinized gingiva and. The width of the attached gingiva can be accurately measured if a pontic replacing a mandibular first molar should be designed so that itits 1.
Attached gingiva, esthetics, inadequate width, modified apically repositioned flap, mucogingival surgery how to cite this article. The width of the attached gingiva can be accurately measured. The loss of the attached gingiva affects the oral health as well as the aesthetics and in addition compromises the natural support of the teeth or the dentures 1,2. Assessment of the width of attached gingiva using different methods. The recipient area was prepared with a split thickness flap which was fixed apical with periosteal. Pdf a study of the width of attached gingiva giovanna saldana.
174 415 180 1500 1262 169 1208 1221 207 58 57 7 1409 543 881 241 711 310 178 983 208 793 136 554 410 942 452 459 974 677 35 1068