The Modified Apically Repositioned Flap Technique And Its Potential To Regain Gingival Melanin Pigmentation

IntroductionPatients that have gingival melanin pigmentation present an esthetic challenge to clinicians because it is often hard to maintain or regain this pigmentation after surgery. These cases show the Modified Apically Repositioned Flap (MARF) technique and its potential to increase the likelihood of repigmentation of the surgical site with better matching esthetic results.Case SeriesA total of six healthy, non-smoking patients presented with the need for increased dimension of attached gingiva. All patients had pre-existing physiologic gingival melanin pigmentation and underwent the MARF technique. Ten teeth were included in the case series and the observational follow-up period ranged from 1 to 2 years. The surgical areas were analyzed in relation to the width of keratinized and attached gingiva, marginal tissue recession, and probing depth. The final esthetic results, were judged by 20 periodontists using standardized photographs and a grading scale from 0 to 2.ConclusionsTreatment with MARF resulted in a significant increase in the apico-coronal dimension of the keratinized and attached gingiva (P < 0.05). The increase in keratinized tissue ranged from 1.85 to 4.65 mm, and the increase in attached gingiva ranged from 0.8 to 3.55 mm. Probing depths and recession did not change significantly compared to initial values. Experienced clinicians judged the final esthetic results to be completely matched, with pigmentation in the healed tissue blending well with pre-existing pigmentation. The MARF technique should be considered as an alternative surgical technique when an increase in the apico-coronal dimension of attached gingiva is required in patients with gingival melanin pigmentation.