Modified fenestration operation procedure for the treatment of inadequate width of attached gingiva- A clincial case

As we know that Attached gingiva is continuous with the marginal gingiva and is firm resilient and tightly bound to the underlying periosteum of alveolar bone. It can be determined as distance between the mucogingival junction and the projection on the external surface of the bottom of the gingival sulcus or periodontal pocket.

Inadequate width of attached gingiva impedes proper oral hygiene measures, damage by masticatory forces, sub gingival plaque formation, favors attachment loss and soft tissue recession, accumulation of food particles during mastication.

There various techniques which are employed for the management of inadequate width of attached gingiva namely free gingival graft, connective tissue graft, conventional fenestration operation. But limitation includes good patient compliance while graft procedures are technique sensitive which requires expertise. While fenestration operation or periosteal separation¹ procedure is less technique sensitive and easy to master. Again conventional fenestration operation has limitation of being less predictable as wound created is secured using periodontal pack which is unpredictable in case pack is lost in initial days of healing. While in present case modified fenestration operation provides sufficient healing and increases attached gingiva.

In present case, non-surgical periodontal therapy is performed, followed by advice of vigorous oral hygiene care is been advised to the participant. Width of attached gingiva was in adequate from left mandibular canine region to right mandibular canine region. Modified vestibuloplasty procedure is performed.

Results of modified fenestration operation technique are more predictable as compared to conventional technique making it more useful as a routine procedure by clinician to increase the width of attached gingiva.