The Modified Apically Repositioned Flap to Increase the Dimensions of Attached Gingiva: The Single Incision Technique for Multiple Adjacent Teeth

This article describes a surgical technique directed at increasing the dimensions of attached gingiva over multiple adjacent teeth. The described technique is a variation of the modified apically repositioned flap (MARF) technique previously proposed. The MARF technique uses one single horizontal incision within keratinized tissue, elevation of 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 keratinized tissue. Therefore, keratinized epithelial cells migrate over the periosteum during wound healing, resulting in the formation of keratinized attached tissue in the area of the previously exposed periosteum. The advantages associated with this surgical technique include its simplicity: It employs one single horizontal incision, generates minimal morbidity since it does not involve any palatal donor tissue, and provides predictable gingival color match.