Attached gingival is defined as that gingiva that extending from the free margin of the gingiva to the mucogingival junction minus the pocket or sulcus depth measured with a thin probe in the absence of inflammation.
At the present, no specific number of millimeters of attached gingiva has been determined to be adequate.
Long term studies indicate that attached gingiva can be created or increased on a predictable basis employing grafting procedures. Coverage of roots exposed by recession through grafting or grafting plus coronal repositioning appears to be predictable. Root deminerialization may prove to be useful when combined with root coverage procedures.
Placing gingival grafts on bone is a predictably successful procedures but appears to provide no advantage over grafting to a periosteal bed and is more likely to increase the incidence of delayed healing or necrosis of the graft.
Increasing the band of attached gingiva by orthodontic means has not been demonstrated. As the legal doctrine of informed consent spreads, the need to fully discuss the pros and cons of grafting to prevent or correct recession relating to inadequate attached gingiva has become increasingly obvious.
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