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99]

Original Article

Evaluation of gingival fiber retention

technique on the treatment of
patients with chronic periodontitis:
A comparative study
Pooja Palwankar, Jagjit Dhaliwal1, Vivek Mehta2

Department of Abstract:
Periodontics, and The destructive action of the chronic periodontitis on the periodontal tissues has provided a continuous challenge to
2
Paedodontics, Manav the dental profession to develop better methods to achieve repair of the recession regions and even regeneration
Rachna Dental College, of post periodontal tissues. Aims: To assess the effect of periodontal muco‑periostal flap surgery with gingival fiber
Faridabad, 1Department retention technique on minimizing the post surgical recession. Materials and Methods: The sample for the study
of Periodontics, comprised of 20 patients. The criteria for selection included patients with moderate periodontitis, with minimum
recession in the anterior teeth, with adequate width of the attached gingiva, and with no traumatic occlusion.
National Dental College,
Periodontal muco‑periosteal flap surgery with gingival fiber retention technique was done in the experimental site
Derabassi, India with internal bevel incision, and in control site, muco periosteal flap surgery with crevicular incision was done.
Thereafter, observation period was of one week, four weeks, and eight weeks were done for both the sites.
Statistical Analysis Used: The results were subjected to statistical analysis using student’s t`‑test. Results:
The result of this study suggests that the periodontal flap surgery with gingival fiber retention technique has a
beneficial effect on the anterior teeth, as it maintains the esthetics, recontours the gingiva with minimal recession.
The area of recession was more on the control site as compared to experimental site at 4 weeks, 8 weeks and
12 weeks. Conclusions: Gingival fiber retention technique showed less post‑surgical recession and also there
was fall in values of plaque index, gingival index, and periodontal index scores, throughout the study.
Access this article online Key words:
Website: Connective tissues, gingival fibers, the attachment apparatus
www.jisponline.com
DOI:
10.4103/0972-124X.92574
INTRODUCTION insights into the etiological factors, subsequent
Quick Response Code:
tissue damage, and the potential for tissue

I nter proximal areas up to the cemento‑enamel

junction and contact areas of the teeth. Many
authors have demonstrated that by retaining the
repair.[9]

Dentistry traditionally has been concerned

gingival fiber apparatus and its cemental insertion
on the root surface, the collagen fibers from the
healing margin of the flap will unite or fuse with
the retained gingival fiber unit; thus giving rise to
minimal post‑surgical recession.[1-5] Periodontitis
is the most common type of periodontal disease
and it usually results from the extension of
inflammatory process initiated in the gingival
spreading to deeper supporting periodontal
structures.[6] The goals of periodontal therapy
Address for are to eliminate the pathology, and to change
correspondence: the environment, so that the healing restores the
Dr. Pooja Palwankar, tissues to a state of health identical to that present
Department of prior to the disease.[7]
Periodontics, Manav
Rachna Dental These objectives of periodontal therapy can be
College, Faridabad, attained by preserving further destruction of
Haryana ‑ 122 001, India.
attachment apparatus, and if possible, promoting
E‑mail: drpooja.p@
rediffmail.com the reconstruction of the lost attachment.[8,5]
Submission: 10-01-2011 To treat periodontal disease, one must know
Accepted: 30-11-2011 its mechanism part by part; one must provide
with the physical health of the oral cavity, but
contemporary thinking on oral health means
not only freedom from pathological conditions
but a concern for the esthetic appearance of the
dentition as well.[10]
Conflicting points of view concerning the
etiology of gingival recession are evident in the
literature, when the gingival recession violates,
the cosmetic consciousness of individual, it is no
less of a problem than sensitivity.[11] The detection
and correct causative agent is important, so as to
minimize the gingival recession.[11]
As all types of surgical periodontal therapy
gave rise to the post‑surgical recession, there
was, therefore, a need for a surgical procedure
which will produce minimum or no post
surgical gingival recession. Hiatt[12] introduced
muco‑periosteal flap surgery with full gingival
fiber retention technique. He stated that when
flap is re‑adapted on root surfaces with full

376 Journal of Indian Society of Periodontology - Vol 15, Issue 4, Oct-Dec 2011
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Palwankar, et al.: Gingival fiber retention in periodontitis
gingival fiber retention, the proliferation and down growth
of the epithelial attachment does not occur, thus giving rise to
minimal post‑surgical recession.
The gingival fiber retention technique is used to establish the
healthy gingival unit in the most coronal position possible on
the root of the teeth.[12]
In the present clinical study, therefore keeping all the pertinent
points in mind, an attempt has been planned with the aim
to evaluate clinically the efficacy of this new technique
introduced by Leslie Levine (1972) as periodontal flap surgery
with gingival fiber retention technique in treating suprabony
periodontal pockets and minimizing postsurgical recession in
anterior teeth.[2]
Therefore, the present clinical study is aimed at evaluating
clinically the efficacy of periodontal flap surgery with gingival
fiber retention technique with respect to:
i. its efficacy in elimination of periodontal pocket
ii. its efficacy in reducing post‑surgical gingival recession
iii. its effect on the maintenance of oral hygiene of the affected
areas
MATERIALS AND METHODS
Sample for the present study comprised of 20 patients from
both sexes, 16 male and 4 female in the age‑group of 20‑40 years,
were selected from outpatient department of periodontics. All
the selected patients were physically healthy and presented
no detectable clinical signs and symptoms of any systemic
diseases.
Following are the criteria used for the selection of the patients:
i. Patients with moderate periodontitis without observable
radiographic evidence of vertical or angular bone loss
ii. Each segment selected for treatment had minimum
recession and had adequate width of attached gingiva
iii. Patients showing severe malocclusion leading to traumatic
bite, but that could not be corrected by occlusal adjustment
procedures were rejected
iv. In each patient, at least six teeth were included in the
surgery
v. Enthusiastic, well motivated, and co‑operative patients,
who could visit the hospital for frequent check‑ups for
evaluation of study for a period of at least three months,
were selected.
Each of 20 patients selected according to the above criteria
were explained about the entire procedure to be carried out as
well as the purpose of the study. All the pertaining questions
raised by the patients were answered to their satisfaction and
a written consent was obtained from them. Patients visits were
divided into four phases and following indices were repeated
at every phase of treatment.
Phase ‑ I
Pre‑operative preparation of patient to get the tissues to a
surgically manageable condition and following observations
were repeated at every phase of treatment:
1. Plaque index (Turesky’s Modification of Quigley and Hein,
plaque index),[6]
Journal of Indian Society of Periodontology - Vol 15, Issue 4, Oct-Dec 2011 377
2. Gingival index (Loe and silness)[6]
3. Periodontal disease index (Ramfjord)[6]
4. Clinical probing attachment level (in mm)
5. Length of recession (in mm)
6. Width of recession (in mm)
7. Area of recession (in mm)
(Evaluated at pre‑operative, 1‑week, 4‑weeks, 8‑weeks, and
12‑weeks).
Above mentioned subjective and objective criteria were
evaluated at 24‑ hrs and 1‑week post surgically. The patients
were called after a week for the surgical phase and were
prescribed antibiotics and anti‑inflammatory drugs to be taken
one day prior to surgery.
Phase ‑ II
After about a week of completion of phase‑I therapy [Figure 1],
phase‑II was carried out. The surgical site was divided into
two halves.
I. Distal of right canine to the mesial of right central incisor
II. Distal of left canine to the mesial of left central incisor.
Either in maxilla or mandible of permanent dentition. Both the
surgical procedures were carried out in the same patient and
at the same sitting to avoid biological variability. They were
done under local anesthesia of 2% lignocaine hydrochloride
with 1:80,000 adrenaline.
On the experimental site
An internally bevelled labial incision was made approximately
2 mm apical to the free gingival margin. If required, vertical or
oblique releasing incisions were made. A muco‑periosteal flap
is then reflected with blunt periosteal elevator [Figure 2]. Excision
of detached gingiva coronal to attached epithelial cuff was done
with delicacy and precision. With the surgical blade No.11, held
parallel to gingival surface, the free gingival epithelium was
gently dissected out. If osseous surgical recontouring procedure
was necessary, it was done by conventional method using
burs without causing damage to the collagen fibers present in
the connective tissue left on the tooth surface [Figure 3]. The
unhealthy granulation tissue from the inner mucosal surface of
the flap and interproximal surface was curetted out gently. The
specks of calculus present on the root surface were also removed.
Then the area was irrigated with normal saline. The flap was
co‑opted as close as possible to the retained connective tissue
on the teeth, without creating any tension on the flap by means
of interrupted sutures [Figure 4].
A periodontal dressing was placed over the operated area
and was left in place for seven days. Patients were given
necessary instructions and were advised to continue with
the medication.
On the control site
A full thickness micro‑periosted flap was reflected with the
crevicular incision [Figure  2]. The muco‑periosteal flap was
reflected with blunt periosteal elevator. The root surface was
then thoroughly scaled and planed. The unhealthy granulation
tissue from the interproximal as well as from the inner mucosal
surface of the flap was curetted [Figure 3]. Bone recontouring,
if required, was carried out by conventional method using
burs. Then, the surgical site was irrigated with normal saline.
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Palwankar, et al.: Gingival fiber retention in periodontitis
Figure 1: Preoperative photograph of the upper anterior region
Figure 3: Photograph of the experimental site after retaining
gingival fibers
The flap was then sutured to its original position by means of
interrupted sutures [Figure 4].
A periodontal dressing was placed over the operated area and
was left in place for seven days. Patients were given necessary
instructions and were advised to continue with the medication.
Phase ‑ III
Patients were asked to report the next day after 24‑hours and
subjective and objective observations were recorded.
Phase ‑ IV
The patients were recalled after one week, after performing
the surgical procedure. Periodontal dressing and sutures were
removed and also the evaluation of subjective and objection
symptoms were carried out once again [Figure 5]. Patients
were called for follow‑up visits at the intervals of the 1, 4, 8,
and 12 weeks [Figures 6‑10]. Subsequently, all the values of the
data were subject to statistical analysis for comparative evaluation.
Statistical analysis
Means and standard deviation were estimated from the
samples for each study group. Mean values were compared
378 Journal of Indian Society of Periodontology - Vol 15, Issue 4, Oct-Dec 2011
Figure 2: Photograph of experimental and control site taken after
reflection of mucoperiosteal flap
Figure 4: Photograph of the experimental and control site after suturing
the flap with interrupted sutures
by the student’s t‑test for both experimental and control sites
for all the factors. In the present study, P=0.05 was considered
as the level of significance.
RESULTS
All the result of this study was obtained on a statistical note
by comparing and contrasting certain parameters at various
designated phases for experimental over control groups.
Table 1 shows continuous decline in plaque index, gingival
index, and periodontal disease index score for the entire duration
of the study. The difference in the fall of plaque levels, gingival
index scores, and periodontal disease index scores for the both
groups is not statistically significant [Figures 11‑13]. There was
significant gain in the clinical probing attachment level on the
experimental as well as control sites during entire duration of
the clinical study [Figure 14].
Table 2 shows that there was increase in average width, length,
and area of recession in experimental as well as control sites.
There is significant increase in width, length, and the area of
recession at four weeks post–surgically on the experimental and
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Palwankar, et al.: Gingival fiber retention in periodontitis

Figure 5: Postoperative photograph of the experimental and control site taken after Figure 6: Postoperative photograph of the experimental and control site
removal of periodontal dressing and interrupted sutures i.e., one week after surgery taken four weeks after surgery

Figure 7: Postoperative photograph of the experimental and control site Figure 8: Postoperative photograph of the experimental and control site taken
taken eight weeks after surgery eight weeks after surgery, periodontal probe comparing the amount of
recession on both the sites

Figure 9: Postoperative photograph of the experimental and control site taken Figure 10: Postoperative photograph of the experimental and control site taken
twelve weeks after surgery, periodontal probe comparing the amount of recession twelve weeks after surgery, William’s graduated probe measuring the length of
on both the sites recession on the control site

control sites as compared to their to their pre‑operative level. increase in area of recession on the control site as compared to
There is also an increase in the average area of recession on their pre‑operative levels. There is also an increase in the average
experimental and control site at 4‑weeks, but at 8 and 12‑weeks, area of recession on the experimental site, but it is not statistically
it remained steady [Figures 15-17]. There is statically significant significant to their pre‑operative levels.

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Palwankar, et al.: Gingival fiber retention in periodontitis

Series 1 Series 2 Series 1 Series 2

3.00 2.00 1.79 1.77

2.56 2.61 1.80
2.50 2.30 2.35 1.60

Mean Index
1.35
Mean Index

1.81 1.80 1.40 1.33

2.00 1.20 0.97
1.50 1.21 1.20 1.00 0.91
0.95 0.80
1.00 0.94
0.60
0.40 0.37 0.42 0.26
0.50 0.22
0.20
0.00 0.00
1 2 3 4 5 1 2 3 4 5
Weeks Weeks

Figure 11: Plaque index (Tureskey’s modification of Quigley and Hein) average value Figure 12: Gingival index (Loe and Silness) average value at different time
at different time intervals. Series 1 – Experimental values. Series 2 – Control values intervals. Series 1 – Experimental values. Series 2 – Control values

Series 1 Series 2 Series 1 Series 2

6
6 5.09 5.09 4.78 5.11
5

Mean Index
5 4.20 4.27 4.12 4.16 3.7 3.97
4.00 4.02 3.5 3.83 3.5 3.83
Mean Index

4 4
3 3
2 2
1 1
0 0
Pre 4 8 12 Pre 4 8 12
Weeks Weeks

Figure 13: Periodontitis index (Ramfjord) average value at different time Figure 14: Clinical probing attachment level (in mm) average value at different
intervals. Series 1 – Experimental values. Series 2 – Control values time intervals. Series 1 – Experimental values. Series 2 – Control values

Series 1 Series 2 Series 1 Series 2

4.80 4.77 4.77

4.70
4.70 3.00
recesssion values

4.60
Mean Index

4.60 4.60 2.41 2.41 2.41

Mean lengh of

4.60 2.50 2.09 2.06 2.17 2.20

4.50 2.00
4.50 4.44
1.50
4.40
1.00
4.30 0.50 0.00
4.20 0.00
1 2 3 4 Pre 4 8 12
Weeks Weeks

Figure 15: Width of recession (in mm) average value at different time intervals. Figure 16: Length of recession (in mm) average value at different time intervals.
Series 1 – Experimental values. Series 2 – Control values Series 1 – Experimental values. Series 2 – Control values

DISCUSSION
Series 1 Series 2
The goals of any therapy is to eliminate the pathology and to
7.00 change the environment, so that healing response restores the
6.00 5.77 5.71 5.71
5.03 5.06 5.06 tissues to a state of health, identical to that present prior to
Mean Index

5.00 4.76 4.60

4.00 the disease.[7] This objective is obtained by preventing further
3.00 destruction of the attachment apparatus, and if possible,
2.00
1.00 promoting the reconstruction of the lost attachment.[5]
0.00
4.76 5.03 5.06 5.06
With the development of various techniques of periodontal
Weeks therapy, it has naturally become important to look after proper
healing and regeneration of the tissues.[13] This post‑operative
Figure 17: Area of recession (in mm) average value at different time phase is as important as the surgical phase planned after
intervals.  Series 1 – Experimental values. Series 2 – Control values suitable diagnostic and pre‑operative considerations.[14]

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Palwankar, et al.: Gingival fiber retention in periodontitis

Table 1: Average plaque, gingival, periodontal index and Table 2: Average width, length, and area of recession
clinical probing attachment level (mm) (in mm)
Details Plaque Gingival Peridontal Clinical Details Width Length Area
index probing E C E C E C
attachment
Pre operative 4.50 4.44 2.09 2.06 4.76 4.6
level
SD 1.93 1.33 0.93 0.78 3.19 2.87
E C E C E C E C 1 week after surgery 4.60 4.70 2.17 2.41 5.03 5.77
Preoperative 2.56 2.61 1.79 1.77 5.09 5.09 4.78 5.11 SD 1.18 1.09 0.95 0.84 3.28 2.75
SD 0.70 0.66 0.27 0.22 0.54 0.33 2.24 2.06 8 weeks after surgery 4.60 4.77 2.20 2.41 5.06 5.71
1‑week 2.30 2.35 1.33 1.35 ‑ ‑ ‑ ‑ SD 1.22 1.07 0.87 0.90 3.11 2.85
SD 0.87 0.88 0.45 0.39 12 weeks after surgery 4.60 4.77 2.20 2.41 5.06 5.71
4‑weeks 1.81 1.80 0.91 0.97 4.20 4.27 3.70 3.97 SD 1.24 1.00 0.96 0.87 3.07 2.69
SD 0.57 0.63 0.43 0.42 0.26 0.36 1.38 1.24 E – Experimental, C – Control, SD – Standard deviation
8‑weeks 1.21 1.20 0.37 0.42 4.12 4.16 3.50 3.83
SD 0.40 0.45 0.31 0.33 0.14 0.22 1.17 1.21
12‑weeks 0.94 0.95 0.22 0.26 4.00 4.02 3.50 3.83 From the results, it was observed that there was an increase in
SD 0.12 0.20 0.21 0.24 0.00 0.05 1.12 1.24 the area of recession on experimental as well as on the control
E – Experimental, C – Control, SD – Standard deviation sites. The increase in the area of recession on the experimental
site was not statistically significant to their preoperative
levels, whereas on the control site, the area of recession was
The periodontists used to frequently avoid periodontal
statistically significant to their pre‑operative level.
surgery in the anterior region for fear of post‑surgical gingival
recession, even if periodontal surgery was undertaken, the
There was an increase in the average width, length, and area
plastic masks colored like gingival tissue was fabricated and
of recession at 4 weeks, on both the control and experimental
were inserted over the labial aspect of the remaining gingiva,
sites, but at 8 weeks and 12 weeks, the average width, length
filling in the wide contact areas of the teeth.[14]
and area of recession remained steady. These findings were
Gingival fiber retention technique in the treatment of chronic similar to those reported by Levine and Stahl[1,18-20] reported
periodontitis was introduced as early as in 1960 by Kohler and minimum post‑surgical recession after three months at the site,
Ramfjord.[15] Ever since, there have been regular reports on the where muco‑periosteal flap surgery was done with retention
successful role of this technique in minimizing the post‑surgical of gingival fibers.
recession.[16,17]
Another study conducted by Russo[21] showed that the same
However, inspite of the scientific contributions in this regard, results, in addition, he reported the gingival contour to be
a critical appraisal is required by standardizing certain factors esthetically pleasing after 12 weeks post surgically.
and projecting a predictable and an efficient technique in
periodontal therapy. Hiatt and his associates,[12,22,23] reported 1‑3 mm post surgical
recession in the region where gingival fibers were not retained.
In the present study, the clinical evaluation was carried out
during the designed phases spread over a period of three months, Extrapolating the results of previous workers and combining
and the results obtained were then evaluated statistically. the findings of the present study, it may be hypothesized that
gingival fiber retention technique is successful in treating
Healing was uneventful and the period of healing was identical anterior teeth with chronic periodontitis with minimum
for all surgical sites and the gingiva looked pink throughout recession.
with a normal appearance three to four weeks, post‑surgery.
CONCLUSION
The soft tissue changes were same in both experimental and
control sites. It was observed from the results that there was From the analysis of the data, it was concluded that there
decline in plaque index, gingival index, and periodontal disease was fall in values of plaque index, gingival index, and
index scores, which could be attributed to the preparatory periodontal index scores throughout the study, thus indicating
phase carried out before surgery and motivation of patient at improvement in the oral hygiene status of the patients. The
every recall visit. experimental site showed less post‑surgical recession indicating
clinical superiority of treatment over control site as far as
There was significant gain in the clinical probing attachment recession is concerned.
level on the experimental as well as control sites during entire
duration of study. But, at four weeks, there was slightly more Gingival fiber retention technique does not involve any
gain in attachment level on the experimental site as compared to additional surgical trauma to the patient and also does not
control site. At 8 and 12 weeks, there was no statistical significant require any special additional post‑operative care. The esthetic
difference in the attachment level between experimental and results the gingival fiber retention technique offered was
control sites. The findings were similar to Kohler and Ramfjord[15] excellent as compared to control site.
reported that the surgical mucoperiosteal flaps separating the
gingiva from the teeth with retention of gingival fibers healed The gingival fiber retention technique is simple, requires less
without any significant loss of periodontal attachment in all of working time if performed skilfully, thus offering excellent
the 20 cases examined. results.

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Palwankar, et al.: Gingival fiber retention in periodontitis

REFERENCES 14. Beube F. Surgery in periodontal therapy, Disadvantages of

1. Levine HL, Stahl SS. Repair following periodontal flap surgery
with the retention of gingival fibers. J Periodontol 1972;43:99‑103.
2. Levine L, Stahl S. Periodontal flapsurgery with gingival fibre
retention. J Periodontol 1972;43:91.
3. Stahl SS, Slavkin HC, Yamada L, Levine S. Speculation about
gingival repair. J Periodontol 1972;43:395‑402.
4. Stahl SS. Gingival repair potential. J Oral Med 1976;31:104.
5. Stahl SS. Repair or regeneration following periodontal therapy.
J Clin Periodontol 1979;6:389.
6. Carranza F. Glickman’s Clinical Periodontology, 7th ed.
Philadelphia: WB Saunders Company; 1990. p. 27,212.
7. Card S, Caffesse R, Smith B. A historical perspective of current
new attachment Procedures – a review of literature. J West Soc
Periodontal Periodontal Abstr 1987;35:93.
8. Abdullah F, Kon S, Ruben M. Biochemical approach to periodontal
regeneration A review of literature. J West Soc Periodontal
Periodontal Abstr 1988;36:53‑61.
9. Aleo JJ, Vandersall DC. Cementum – recent concepts related to
periodontal disease therapy. J Dent Clin North Am 1980;10:627‑50.
10. Nash D. Professional ethics and esthetic dentistry. J Am Dent
Assoc 1988;9:10.
11. Gartell JR, Mathews DP. Gingival recession – The condition
process and treatment Gingival recession – The condition process
and treatment. J Dent Clin North Am 1976;20:199‑213.
12. Hiatt W, Stallard R, Butler Repair following mucoperiosteal flap
surgery with full Gingival retention. J Periodontol 1968;38:11.
13. Zander H. Goals of periodontal therapy. J Periodontol 1976;47:261.
surgical techniques. J Dent Clin North Am 1960;11:677.
15. Kohler C, Ramfjord S. Healing of mucoperiosteal flaps. J Oral
Surgery 1960;13:89.
16. Nyman S, Karring T. The healing following implantation of
periodontitis affected roots into gingival connective tissue. J Clin
Periodontol 1980;7:394.
17. Sharpio M. A reattachment operation. J Dent Clin North Am
1960;3:15.
18. Stahl S. Healing following simulated fiber retention procedures
in Rats. J Periodontal 1977;48:67.
19. Stahl SS. The nature of healthy and diseased root surfaces. J
Periodontol 1981;52:156.
20. Stahl SS. Speculations on periodontal attachment loss. J Clin
Periodontol 1962;13:56.
21. Russo N. Use of fibre retention procedure in treating the maxillary
anterior region. J Periodontol 1981;52:208.
22. Linghorne W, O`Connel D. Studies in regeneration and
reattachment of supporting structures of the teeth. II‑ Regeneration
of alveolar process. J Dent Res 1951;30:604.
23. Melcher A. On the repair potential of periodontal tissues. J
Periodontol 1976;47:256‑60.
How to cite this article: Palwankar P, Dhaliwal J, Mehta V.
Evaluation of gingival fiber retention technique on the treatment of
patients with chronic periodontitis: A comparative study. J Indian
Soc Periodontol 2011;15:376-82.
Source of Support: Nil, Conflict of Interest: None declared.

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