Since the review of the status of soft tissue grafting appeared in 1977, considerable knowledge has been gained which has aided in determining what should be called attached gingiva, how much is needed around a tooth which is simply being maintained and how much is needed around one which is about to undergo various forms of dental therapy. Some information has been gained about nonsurgical modes of increasing the amount of gingiva. A number of studies have documented the stability of surgically increased bands of gingiva. Some investigations have indicated that exposed roots can be covered with stable gingiva over extended periods of time. The legal implications of informed consent in relationship to mucogingival problems are much clearer today.These studies will be reviewed critically in an attempt to define more clearly the means of determining amounts of attached gingiva and of deciding when the surgical creation of more attached gingiva is indicated at the present state of knowledge.What is Attached Gingiva? Orban1 defined attached gingiva in terms of its being stippled or keratinized gingiva. The parameters he used were the mucogingival junction and the free gingival groove. Since that time, much has been learned which has made the definition untenable. Orban believed that the free gingival groove coincided with the position of the most coronal aspect of the epithelial attachment. Also, he beheved that a probe placed in a healthy sulcus stopped when it reached the most coronal aspect of the epithelial attachment. Ainamo and Löe2 found that the free gingival groove was present only one-third of the time. A number of investigators3"5 have shown that a modern, thin probe reaches to the connective tissue near the most apical aspect of the epithelial attachment. When the tissue is inflamed, the probe actually extends into the disorganized connective tissue subjacent to the most apical aspect of the epithelial attachment. 6 Stippling is not a useful means of evaluating amounts of attached gingiva. It may not be present even when the gingiva is free of inflammation. When the gingiva be-

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Collagen biosynthesis, as measured by conversion of 3–4 3H‐proline to 3H‐hydroxyproline, was studied in excised gingival samples utilizing an in vitro tissue slice incubation technique. Samples of clinically normal gingiva and gingiva affected by periodontitis were studied in ten mongoloid patients and eleven non‐mongoloid mentally normal patients. High 3H‐proline uptakes were found in all samples of mongoloid gingiva indicating a high level of collagen synthesis. A possible metabolic block in collagen maturation is suggested as an etiologic factor in the severe form of periodontitis observed.

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