Advances in Periodontal Plastic Surgery: The Past, Present and Future Perspectives

ABSTRACT This review aims to explore the historical developments, current practices, and future perspectives in soft tissue procedures within periodontal surgery. Mucogingival surgery, introduced by Friedman in 1957, focused on addressing soft tissue deficiencies around teeth. Early techniques, such as the laterally positioned flap, free gingival grafts, and vestibular extension procedures aimed to increase the width of attached gingiva and manage gingival recessions. These methods served as the basis for what later became known as periodontal plastic surgery, a term introduced by Miller in 1993 to include treatments for both functional and aesthetic concerns. Recent advancements, such as coronally advanced flaps, subepithelial connective tissue grafts and tunneling techniques, have significantly improved treatment outcomes for gum recessions. However, challenges like discomfort at donor sites and limitations in complex cases remain. New approaches, including soft tissue substitutes and cell-based therapies, are being developed to overcome these issues and provide better results for patients. This review highlights the progress made in this field and the promising future of periodontal surgery. Keywords: Cell and tissue based therapy, connective tissue, gingival recessions, graft, periodontal, soft tissue.