Mucogingival surgery. The subperiosteal vestibule extension. Clinical results 2 years after surgery.

A surgical technique to establish wide zones of attached mucosa was performed in 28 patients presenting with inadequate amounts of attached gingiva. The clinical results of the procedure were monitored over a period of 2 years. Biometric assessment of 112 mucogingival units immediately before and at 1, 3, 6, and 24 months after surgery revealed that the mean width of attached gingiva changed from 1.1 mm to 5.3 mm of attached tissue (gingiva plus vestibular mucosa). A surgically produced increase of 4.9 mm in width (P less than 0.001) and subsequent shrinkage of 0.7 mm or 14% (P less than 0.001) resulted in a total average gain of 4.2 mm of attached mucosa 2 years after surgery (P less than 0.001). A begin/end analysis of the coronal level of clinical periodontal attachment and the extent of gingival recession showed no clinically significant changes. The mean width of keratinized gingiva increased 0.8 mm during the 2-year postoperative period. The subperiosteal vestibule extension is recommended as an alternative to the free autogenous mucosa graft for establishing wide bands of attached mucosa in areas where loss of attached gingiva is associated with mechanical or microbial irritation of the marginal periodontium.