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Mucogingival surgery has been gaining importance in recent years. Although these interventions are secondary to the preservation of periodontal health, the aesthetic requirements of the patients and the morphological peculiarities make the dentist carry out these treatments more frequently.

The main objectives and mucogingival surgery are: stopping the recession, widening the inserted gum, deepening the vestibule and covering the existing recession. In order to prevent or correct anatomical, evolutionary, traumatic and pathological defects of the gum, alveolar mucosa or bone tissue.

By means of mucogingival surgery, the thickness or length of the gingival tissues is increased to treat or stop the existence of a recession, as a consequence reducing or eliminating hypersensitivity. Also, plate control is facilitated. In this way the patient’s aesthetics improve a lot. In addition, it is used as a complement to rehabilitation procedures.

When Is it Necessary to Perform Mucogingival Surgery?

The appearance of mucogingival problems is usually due to morphological particularities, genetically determined. Among them are:

  • A thin or absent vestibular bone sheet completely.
  • Widths and thickness of the fine inserted gum phenotype.
  • Braces that are inserted too close to the gingival margin, so there is an absence of gum inserted.
  • Lobby Depth
Why Might Oral Pathology Be Needed

Mucogingival surgery is necessary when it is impossible to solve these mucogingival problems by adopting conservative procedures such as oral hygiene and thorough polishing of the teeth, the elimination of obvious functional disorders, and a controlled correction of the hygiene technique and the performance of frequent revision controls.

The interventions to be performed in the face of these mucogingival problems are frenectomy and gingival free grafting. In addition to stopping the recession, the coating of recessions is increasingly promoted, especially for aesthetic reasons. For this, methods and means of treatment are used such as pedicle flaps, the coating by means of a free gingival graft or a guided tissue regeneration.

It is of great importance to emphasize that mucogingival surgery can only be performed after an improvement in oral hygiene, a control and stability if there is a periodontal pathology, the eradication of harmful habits and sometimes after eliminating the occlusal traumas causing said mucogingival alteration.

Mucogingival operations require experience and skill on the part of the professional and also the collaboration on the part of the patient. It is up to the patient not only to observe the postoperative instructions, especially regarding oral hygiene, but also the elimination of risk factors, such as smoking.

Oral Surgery 1

All surgical intervention begins with the incision of the lining tissues, in the oral cavity the intervention begins with the removal of soft tissues or the completion of a flap to address the jaws.

The incision consists in opening the most superficial tissues to see the deepest ones, by means of mechanical procedures (such as the scalpel or scissors) or thermal procedures (such as the electrosurgery or the laser).

A flap is a portion of tissue, with its own vascular contribution, that the surgeon has designed to be able to comfortably access the operative field and because, once at rest, heal without difficulty. In the oral cavity, the most frequently used flaps are those of total thickness, that is, mucoperiosstics.

The incisions must be made with discharges, that is, with other vertical incisions, side and side, and distally to achieve a good flap irrigation and so that it does not tear.

The incisions to be made are conditioned by the anatomical characteristics, the type of pathology present and the approach.

What Types of Incisions Exist in Oral Surgery?

Depending on the layout of the incisions, the following flaps are distinguished:

  • Sulcular incision
  • Gingival or enveloping incision
  • Triangular incision (partial Neumann)
  • Trapezoidal Incision (Neumann)
  • Adhered gum incision
  • Modified Semilunar Incision
  • Semilunar incision
  • Linear incision
Why Might Oral Pathology Be Needed

The sulcular ares incisions consist of making the incision in the area of ​​the dental groove. This can be of three different types. The first, the gingival incision, consists in making the incision following the scalloped path of the gingival groove and the dental necks, without any discharge. The second, the triangular incision is also known as a partial Neumann incision, consists of making only one discharge per vestibular. Finally, the third type of incision, the trapezoidal incision or also called the Neumann incision , being the same as the previous one but in the trapezoidal incision two discharges are made by vestibular, one to mesial and another distal to the main incision.

The incisions in the gum attached are made in such a way that the incision is 2 millimeters above the gingival ridge, in the gum attached. A modified semilunar incision can be made which consists of a wavy horizontal incision in the gum attached or in the border area with the oral mucosa (2-4 millimeters from the gingival flange). The semilunar incision is made concavely towards the apical area. This can be done at any level of the mucosa, depending on the existing pathology. Finally, the linear incision, as the name implies, the incision is horizontal along the path of a straight line.