Modified Apically Repositioned Flap Technique: A Surgical Approach to Enhance Donor Sites Prior to Employing a Laterally Positioned Flap

The goal of this study was to evaluate the ability of the modified apically repositioned flap (MARF) technique to increase keratinized tissue at the donor site and to analyze if this procedure would enhance the indication for and predictability of the laterally positioned flap (LPF) without any consequences to the donor area. Thirty isolated defects with recession and/or lack of attached gingiva were treated in 30 healthy patients. All donor areas adjacent to these defects lacked ideal gingival conditions both in height and width. The MARF technique was used to increase these areas 8 weeks before the LPF was performed. Clinical evaluation was done at the donor and receptor areas after 18 months. The results showed that the donor area increased from 2.78 to 5.01 mm at 8 weeks and remained at 3.28 mm after the use of the LPF. The marginal tissue recession and probing depth remained clinically unchanged. In the receptor area, the recession decreased from 1.86 to 0.57 mm, and the keratinized and attached tissue increased from 0.71 to 3.57 mm and from 0.05 to 2.49 mm, respectively. The use of the MARF technique to enhance keratinized tissue at the donor area proved to be an efficient and predicable technique that also augmented LPF use without any consequences to the donor site.