The purpose of this paper was to review the cellular events of wound healing that relate to the gingival attachment apparatus and to the ability of the healed tissue to withstand trauma that may occur as a sequelae to restorative treatment. Wound-healing dynamics progress in an orderly and predictable sequence but are affected by factors such as systemic health, age, oral hygiene, and smoking habits of the patient. Epithelial cells of the wound margin begin migration into the affected area within 12 hours and move at the rate of 0.5 to 1.0 mm per day. A new junctional epithelium is formed in approximately two weeks but does not possess adequate strength to resist trauma at this point. The underlying connective tissue attachment takes longer to mature.
New cementum appears on root surfaces six to eight weeks after osseous surgery.
Therefore, by eight weeks the surgical site has a mature junctional epithelium and a connective tissue attachment that is incorporated into new cementum. Additional healing occurs from eight weeks to six months and involves maturation of connective tissue attachment and change in the orientation of the collagen fiber bundles. Postsurgical stabilization of the gingival margin position is very important, especially in the anterior regions. It is important to understand that different tissue profiles will lead to different post-surgical healing. Thick tissue results in gingival movement which is coronal postsurgically.