title: Fundamental principles in periodontal plastic surgery and mucosal augmentation--a narrative review.
abstract: OBJECTIVE
  To provide a narrative review of the current literature elaborating on fundamental principles of periodontal plastic surgical procedures.
  
  
  METHODS
  Based on a presumptive outline of the narrative review, MESH terms have been used to search the relevant literature electronically in the PubMed and Cochrane Collaboration databases. If possible, systematic reviews were included. The review is divided into three phases associated with periodontal plastic surgery: a) pre-operative phase, b) surgical procedures and c) post-surgical care. The surgical procedures were discussed in the light of a) flap design and preparation, b) flap mobilization and c) flap adaptation and stabilization.
  
  
  RESULTS
  Pre-operative paradigms include the optimal plaque control and smoking counselling. Fundamental principles in surgical procedures address basic knowledge in anatomy and vascularity, leading to novel appropriate flap designs with papilla preservation. Flap mobilization based on releasing incisions can be performed up to 5 mm. Flap adaptation and stabilization depend on appropriate wound bed characteristics, undisturbed blood clot formation, revascularization and wound stability through adequate suturing.
  
  
  CONCLUSIONS
  Delicate tissue handling and tension free wound closure represent prerequisites for optimal healing outcomes.
authors.affiliation: The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR and University of Zurich, Zurich, Switzerland.
authors.forename: Rino
authors.initials: R
authors.lastname: Burkhardt
authors.forename: Niklaus P
authors.initials: NP
authors.lastname: Lang
mesh_terms: D003773:Dental Plaque / Q000517:prevention & control; D006801:Humans; D010347:Patient Care Planning; D010510:Periodontal Diseases / Q000601:surgery*; D011182:Postoperative Care; D011300:Preoperative Care; D019651:Plastic Surgery Procedures / Q000379:methods*; D016540:Smoking Cessation; D013524:Surgical Flaps / Q000601:surgery; D013536:Suture Techniques; D014945:Wound Healing / Q000502:physiology
keywords: Periodontal plastic surgery; clot formation; suturing; vascularity; wound closure; wound healing; wound stability