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Volume 4 Number 1 December 1999

Mucogingival Deformities
Giovan Paolo Pini Prato*

* University of Florence, Florence, Italy.

The presence of mucogingival deformities often have an impact

on patients in terms of esthetics and function. The variety of
the conditions makes it difficult to place gingival and alveolar
mucosa deformities under a single definition. Mucogingival defor-
mities, as defined in this paper, may be congenital, develop-
mental, or acquired defects. These may occur around natural

D
eformities of the gingiva and alve-
teeth or implants and in edentulous ridges. They may be local- olar mucosa, which are usually
ized to soft tissues or be associated with defects in the under- referred to as mucogingival prob-
lying bone. They may show different degrees of severity and lems, are associated with a large variety
extension. A classification of mucogingival deformities should of conditions that affect a large number
provide a method for identifying the different conditions in order of patients. Epidemiological data are
to improve diagnosis, etiologic identification, research, treat- available only for some conditions. Gin-
ment, and insurance evaluation. Ann Periodontol 1999;4:98-100. gival recession occurs in populations with
both high or low oral hygiene levels. It
KEY WORDS
was observed in 60% to 90% of Norwe-
Gingiva, abnormalities; mouth mucosa/abnormalities; gians, depending on age, and in 30% to
gingiva/anatomy and histology; mouth mucosa/anatomy and 100% in parallel cohorts of Sri Lankans.1
histology; mucogingival deformities. Drug-influenced gingival enlargement is
associated with administration of cyclo-
sporin (13% to 85%) and calcium chan-
nel blocking agents (20% to 44%).2 Pull
syndrome (a detaching movement of the
marginal gingiva transferred from the lip
by the frenum) is associated in 100% of
papillary types of frenum.3
CLASSIFICATION CRITERIA
Evaluation of Current Definitions
Several definitions have been offered to
describe mucogingival deformities and
their treatment. The main problem with
these terms is that they have essentially
been used to describe therapy, without
having previously established conclusive
definitions of the conditions to be treated.
The term mucogingival is currently
defined4 as a generic term used to
describe the mucogingival junction and
its relationship to the gingiva, alveolar
mucosa, frenula, muscle attachments,
vestibular fornices and floor of the
mouth. In this definition, the adjective
mucogingival has a generic connota-
tion, referring to a heterogeneous group

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Ann Periodontol
of anatomic structures and their possible relationship
to the mucogingival junction.
An early definition of mucogingival surgery was sur-
gical procedures designed to preserve gingiva, remove
aberrant frenulum or muscle attachment and increase
the depth of the vestibule.5 This definition simply
groups together various surgical procedures for soft
tissues under a collective name without precisely defin-
ing the adjective mucogingival. The rationale for
mucogingival surgery rapidly evolved into a primary
goal of gingival augmentation.
The Glossary of Periodontal Terms 4 defines mucogin-
gival surgery as periodontal surgical procedures
designed to correct defects in the morphology, posi-
tion and/or amount of gingiva. Mucogingival surgery
(periodontal plastic surgery) has also been defined as
surgical procedures performed to correct or eliminate
anatomic, developmental, or traumatic deformities of
the gingiva or alveolar mucosa.6 This is a broader
term and includes a larger number of surgical proce-
dures. Terms such as developmental and traumatic Mucogingival deformities can be divided into 3 main
are used to categorize the deformities according to an
etiologic criterion.
The Consensus Report on Mucogingival Therapy
from the 1996 World Workshop in Periodontics7 defines
mucogingival therapy as non-surgical and surgical
correction of defects in morphology, position, and/or
amount of soft tissue and underlying bone and peri-
odontal plastic surgery as surgical procedures per-
formed to prevent or correct anatomical, develop-
mental, traumatical, or plaque disease-induced defects
of the gingiva, alveolar mucosa, or bone.
This replaces the term mucogingival surgery with
mucogingival therapy, enlarging the scope to include
non-surgical modalities and to include management
of both soft tissues and bone. Bone has been included
because of its influence on the morphology of soft tis-
sue defects. In this broader context, surgical mucogin-
gival therapy is again referred to as periodontal plas-
tic surgery. The idea of plaque-induced defects is
included. Soft tissues are described as gingiva and
alveolar mucosa.
In conclusion, a critique of the definitions from the
current periodontal literature reveals an inconsistent
use of the same terms and different uses of the clas-
sification criteria (anatomy, etiology, surgical tech-
nique, etc.). The more recent trend seems toward the
inclusion of anatomical abnormalities of gingiva and
alveolar mucosa, associated or not with abnormalities
in the underlying bone.
RATIONALE FOR CLASSIFICATION
The classification of mucogingival deformities may be
based on clinical, chronological, etiological, and/or
morphological criteria. The chronological criterion
(congenital versus acquired) is not appropriate, since
Pini Prato
it is difficult to determine if some deformities have
been present since birth. An etiologic criterion is usu-
ally preferred for clinical classifications, but may not
be adequate as the primary criterion for mucogingival
deformities. In fact, the same etiologic factor (for
instance, trauma) may cause several different mucogin-
gival deformities in soft tissues and/or bone, around
teeth or implants, or even in an edentulous area. There-
fore it is recommended that mucogingival deformities
be divided according to clinical and morphologic cri-
teria. This way, more homogeneous groups of clinical
conditions can be defined before an etiologic criterion
is applied.
Clinical Criterion
The first proposed criterion is clinical and is based on
the presence or absence of teeth or implants. This
seems useful as an initial step for classification, since
clinical features, therapeutic approaches, and treat-
ment outcomes may differ among the 3 groups.
categories:
1. Soft tissue deformities associated with teeth;
2. Soft tissue deformities associated with implants
(implants are not the focus of the following classifica-
tion system);
3. Soft tissue deformities associated with edentu-
lous ridges.
Morphological Criterion
The second criterion is morphological, describing the
deformity.
Severity Criterion
The third criterion is the severity of the deformity and
implies a quantitative or semiquantitative assessment.
A simple measurement of the size of a deformity
(quantitative assessment) may be adequate in many
instances. The clinician may evaluate the severity of
any mucogingival deformity taking into account the
shape and size, as well as presence or absence of ker-
atinized tissue, the location of the mucogingival junc-
tion, and the localized or generalized nature of the
deformity. It is often convenient to assign a deformity
to one of several categories (scores) to classify its
severity (semiquantitative assessment). For example,
Millers classification8 of gingival recessions is useful
in evaluating their severity and in predicting treatment
outcomes.
Etiologic Criterion
Etiologic factors that may contribute to the above clas-
sified mucogingival defects include some develop-
mental, traumatic, infectious, and neoplastic factors.
In addition, certain mucocutaneous diseases and some
medications can result in the formation of mucogingi-
val deformities.
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Mucogingival Deformities Volume 4 Number 1 December 1999

For example, developmental factors that may play 13. Andreasen JO, Andreasen FM. Textbook and Color Atlas
an etiologic role in the formation of mucogingival of Traumatic Injuries to the Teeth, 3rd ed. Copenhagen:
Munksgaard; 1994;219-311.
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Maxillofac Surg 1993;51:828-835.
23. Pernu HE, Pernu LMH, Huttunen KRH, Nieminen PA,
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