Modified Apically Repositioned Flap: A Novel Technique for Increasing the Width of Attached Gingiva: A Case Series

This case series describes a modified technique for increasing the width of the attached gingiva (AG). The described technique is a variation of the apically repositioned flap technique previously proposed by Freidman in 1962. The modified apically repositioned flap (MARF) technique uses a single horizontal incision within the keratinized tissue (KT), elevating a split-thickness flap, and suturing of the flap to the periosteum in an apical position. Periosteum is left exposed in the area between the initial horizontal incision and the coronal margin of the flap. The full perimeter of the exposed periosteal area is completely surrounded by KT. Therefore, keratinized epithelial cells migrate over the periosteum during the wound healing, resulting in the formation of keratinized attached tissue in the area of the previously exposed periosteum. Four patients were selected and analyzed for the efficacy of MARF. Treatment area consisted of minimum two and maximum five adjacent teeth with minimum 0.5 mm of AG on each tooth. Treatment with MARF resulted in a significantly increased in AG in all four cases. Increase in the AG ranged from 1 to 2.5 mm. The increase in KT ranged from 1 to 1.5 mm. There was no significant change in probing pocket depth. The advantages of this technique include: Minimal surgical trauma; it does not require a second surgical site; it is less time-consuming; and it results in a perfect gingival color match.