Increasing the Apico-Coronal Dimension of Attached Gingiva by using the Modified Apically Repositioned Flap Technique: A Clinical Study

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. The treatment areas consisted of a minimum of two and a maximum of four adjacent teeth with a minimum of 0.5 mm and a maximum of 2.0 mm of attached gingiva on each tooth. Treatment with MARF resulted in a significant increase in the apico-coronal dimension of the keratinized tissue and attached gingiva. 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.