الفهرس 
Review of Literature.Only 14 pages are availabe for public view
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Abstract
The attached gingiva is a keratinized tissue that aids in the protection and maintenance of periodontal health and contributes to stabilization of the gingival margin against frictional forces and against gingival recession.
Many gingival augmentation techniques were described throughout literature to compensate for the insufficiency of keratinized gingiva. Split-thickness apically positioned is a technique used for increasing the width of attached gingiva by using a partial thickness flap elevated at the level of the mucogingival junction and secured apically exposing the periosteum in the area where gingival augmentation is needed, leaving the marginal gingival tissues intact.
The exposed periosteal bed left after the surgery may take from two to four weeks to fully heal. This open wound may cause patients to experience postoperative pain, bleeding and discomfort during the healing process which validates the search for biological materials that may enhance wound healing.
EPO is one of the various biological materials that was introduced to accelerate wound healing and to control post-operative pain and discomfort. Positive effects of EPO on wound healing have been demonstrated in several studies
which prompted us to investigate its influences on wound healing following split thickness apically positioned flap.
This study was carried out to evaluate the effect of topical application of chitosan based erythropoietin gel as an adjunct to split-thickness apically positioned flap regarding wound healing and patient satisfaction and to evaluate the clinical gain in width of attached gingiva. The study included 20 patients having insufficient width of attached gingiva
Our results showed that EPO gel accelerated wound healing in 1st and 2nd weeks of surgery and reduced postoperative pain and discomfort during the 1st week. According to our satisfaction questionnaire, patients were generally satisfied with both treatments. After 1 month , the gain in attached gingiva width was insignificant between both groups.
So we concluded that EPO may accelerate wound healing and reduce pain and inflammation in split-thickness apically positioned flap surgical site, which could be related to improved angiogenesis, epithelialization and decreased secretion of proinflammatory cytokines. However, it doesn’t affect the final outcome of keratinized tissue gain.