Free Gingival Graft Technique Research Articles

Peri-implant mucosal recession: Restore the aesthetics- Case report

Dental implants are believed to be the best treatment option for patients looking for replacement of missing teeth, particularly in the esthetic zone. Peri-implant mucosal recessions can be the main esthetic problem in anterior areas, while in the functional zone the coverage of exposed implants is not main concern, because the cleaning methods of these structures are much more important. Free gingival graft (FGG) is considered as a common treatment modality for increasing soft tissue thickness and keratinized mucosa at natural teeth and implant sites. In this case report 54 year old male patient presented with chief complaint of unaesthetic dental implant exposure in lower front region of the jaw since 6 years. Free gingival graft technique was used to cover the exposed implant. In 6 months follow up 80% of the coverage was seen.

Modified coronally advanced tunnel versus epithelialized free gingival graft technique in gingival phenotype modification: a comparative randomized controlled clinical trial.

The gingival thickness (GT) and keratinized tissue (KT) height are defined as the gingival phenotype. Both the modified coronally advanced tunnel technique (MCAT) and free gingival grafts (FGG) are used in modifying the gingival phenotype. This study aims to compare MCAT and FGG in gingival phenotype modification. One hundred and forty recessions in 50 patients with thin and insufficient keratinized tissue at the anterior mandible were treated with either MCAT or FGG. GT, KT height, recession depth, recession width, probing depth, and clinical attachment level were evaluated at baseline and 6weeks, 6months, and 12months. GT change, KT change, root coverage (RC), clinical attachment gain, and complete root coverage (CRC) were calculated. The wound healing index, tissue appearance, patient expectations, aesthetic, and dentin hypersensitivity were assessed at baseline and 6months. All periodontal variables showed significant change from baseline to 12months in both groups (p < 0.05). While FGG resulted in more KT change (p < 0.001), all MCAT sites showed at least 2mm KT change in 12months. MCAT resulted in greater GT change (p < 0.05) and RC (p < 0.003). In contrast, there was no significant inter-group CRC difference (p = 0.523). All patient-based variables were favorable to MCAT (p < 0.05), except dentin hypersensitivity (p = 0.225). Both techniques were successful in terms of gingival phenotype modification in the anterior mandible. Additional GT increase, RC, and patient-based outcomes favored MCAT, though KT change proved greater with FGG. Clinicians may choose MCAT for higher GT increase whereas FGG for more KTC. NCT04690140 and date: 12/26/2020.

A Case Report of a Free Gingival Graft Done to Rectify Gingival Recession

Gingival recession is associated with functional problems such as dentinal hypersensitivity and root caries. This case report describestreatment of gingival recession with free gingival graft technique. Free gingival grafting was done in relation to 31. Split-thickness flap was elevated in the region of 31. The area to be taken for grafting was selected between first and second premolar. The graft was placed on the recipient bed and suturing was done. Complete recession coverage was observed. Results of free gingival grafting show fairly acceptable results in terms of tissue gain suggesting free gingival graft as a viable option.

Use of the Free Gingival Grafting Technique for soft tissue reconstruction after excision of a Peripheral Ossifying Fibroma

The Peripheral Ossifying Fibroma is a benign tumor that develops from a hyperplastic tissue reaction, usually related to traumatic stimulus that are responsible for triggering inflammatory reactions of the connective tissue. Histologically, it is a nodular mass characterized by a dense connective tissue, surrounded by stratified squamous epithelium. Surgical removal in these cases is indicated, and for reconstruction of soft tissue in the region, some periodontal surgical techniques are recommended, such as free gingival grafting. Thus, the present study aims to report a clinical case submitted to the free gingival graft technique for tissue reconstruction after the surgical removal of a fibroma. A total excision of the lesion was performed, later sent to a histopathological report where it was diagnosed as Peripheral Ossifying Fibroma, after the removal of the lesion the region was left with the periosteum exposed and then the free gingival graft was performed to cover the region and promote keratinized gum augmentation. This technique proved to be efficient for reconstruction of soft tissue in the region after surgical removal of the Peripheral Ossifying Fibroma, returning aesthetics, function and periodontal health.

Evaluation of Color and Width of Attached Gingiva Gain in Two Surgical Techniques: Free Gingival Graft and Connective Tissue Graft Covered By Thin Mucosal Flap, a Clinical Trial.

Statement of the Problem:The periodontal health and marginal stability of gingiva can be negatively affected by a number of dental conditions in association with deficiency of attached gingiva. Purpose:This study aimed to compare the color and width of tissue grafted by two surgical techniques of keratinized gingival augmentation, namely free gingival graft(FGG) and connective tissue graft (CTG) covered by thin mucosal flap . Materials and Method: This clinical trial was performed on 15 adult individuals. The patients showed less than 2mm keratinized gingiva on two different recipient sides. One side was to be treated with CTG as the test group and the other side to be treated with FGG as the control group. The amount of keratinized gingiva before the surgery, size of grafted tissue during the surgery and 6 month after the surgery was documented. Six months after healing, the test and control sides were compared in terms of the width of generated gingiva on both sides, and the color match of the grafted areas with the surrounding gingiva or mucosa. The color of the grafted areas was determined and compared by using both professional evaluation and digital evaluation. Results: In digital evaluation, ∆E (which shows color mismatch) was higher in FGG. In professional evaluation, visual analogue scale (VAS) was used by two blinded periodontists. The mean VAS in FGG was less than CTG. The mean increase of gingival width was higher in CTG. The increased width in CTG technique was more than that in FGG technique. This difference was statistically, but not clinically, significant. Conclusion:Higher ∆E in control side and higher mean VAS CTG both showed better color adaptation of CTG side. FGG can be used in case of increasing keratinized gingiva, vestibular depth, and in patients with low smile line without esthetic concerns. However, using connective tissue in the underlying thin mucosal layer is preferred for gingival augmentation if there are adequate vestibule depth and esthetic concerns, like in maxillary canine.

A modified free gingival graft technique for gaining vertical and horizontal soft tissue augmentation

The aim of this case report was to describe a modified free gingival graft technique for gaining vertical and horizontal soft-tissue growth in the posterior region of the mandible before installation of dental implants. Patient A.A., a 38-year-old female, received a modified free gingival graft in the posterior region of the mandible. After 90 days, an increase, both horizontally and vertically, of the gingival tissue was observed, and the patient was satisfied with the result. The dental implant was installed, and a 3-mm of the vertical gain of keratinized gingiva was observed. Further research is needed to evaluate the effectiveness of this technique before prosthetic dental implantation.

PR322: Effect of two free gingival graft techniques on pain and quality of life – a randomized controlled clinical trial

PR322: Effect of two free gingival graft techniques on pain and quality of life – a randomized controlled clinical trial

Modified approach for keratinized tissue augmentation in multiple teeth

This case report demonstrated a modified technique of free gingival graft (FGG) aiming to increase keratinized attached tissue in large recipient areas. A FGG to increase the amount of attached gingival tissue, facilitate oral hygiene, and prevent further clinical attachment loss was realized in two patients. Because the extensive recipient area, a modified technique was performed to obtain a smaller graft of the donor area. A template of the graft was made about 25%–30% smaller than the total recipient area. After graft removal, interspersed incisions were made in the upper and lower edges of it. After 9–24 months of follow-up, the final width of the keratinized tissue was 4.0–4.4 times larger in comparison to initial clinical condition. In conclusion, this FGG technique can be considered an alternative to gain sufficient amount of keratinized gingival tissue using a smaller graft.

Soft Tissue Reconstruction with Free Gingival Graft Technique following Excision of a Fibroma.

Background. Oral fibromas are benign, asymptomatic, smooth surfaced, firm structured tumoral lesions that originate from gingival connective tissue or periodontal ligament. Histologically, they are nodular masses characterized by a dense connective tissue, surrounded by stratified squamous epithelium. Case Report. This case report includes the clinical, radiographical, and histological findings and periodontal treatment of a 38-year-old female patient having painless swelling on the gingiva. Intraoral examination revealed a fibrotic, sessile, smooth surfaced gingival overgrowth interdentally between the teeth #13 and #14. Radiographical findings were normal. Initial periodontal treatment (IPT) was applied including oral hygiene instructions, scaling, and root planing. Following IPT, the lesion (0.7 × 0.6 × 0.4 cm) was excised and examined histopathologically. Subsequently, flap operation was performed to have an access to alveolar bone. Surgical site was reconstructed with free gingival graft obtained from hard palate. Hematoxylin-eosin stained sections revealed a nodular mass composed by dense collagen fibers in lamina propria covered by a stratified squamous epithelium, which were consistent with fibroma. Gingival healing was uneventful and without any recurrence during the 12-month follow-up. Conclusions. In order to achieve optimal functional and aesthetical outcomes, free gingival graft can be used for the reconstruction of the wound site after the excision of the fibroma.

Aumento de gengiva queratinizada em mucosa peri-implantar

INTRODUÇÃO: Estudos recentes são direcionados a explorar a relação da faixa da mucosa queratinizada com a saúde dos tecidos peri-implantares. Quando esta faixa não é suficiente, uma cirurgia para o aumento de mucosa queratinizada pode ser indicada, pois tem sido relatado que a presença ou a reconstrução de tecido queratinizado ao redor de implantes pode facilitar os procedimentos restauradores, promover a estética e ainda permitir a manutenção de uma higienização oral rotineira sem irritação ou desconforto ao paciente. Dentre os procedimentos cirúrgicos disponíveis, a técnica do enxerto gengival livre é consagrada na literatura periodontal para aumento da faixa de mucosa queratinizada. OBJETIVO: Este estudo relata um caso clínico em que foi realizada cirurgia de enxerto gengival livre com objetivo de aumentar a faixa da mucosa queratinizada na região de implantes previamente instalados na maxila, para suporte de prótese tipo protocolo. RELATO DO CASO: Foi realizada a cirurgia de enxerto gengival livre na região anterior da maxila, obtido do palato, na qual haviam sido instalados implantes osseointegrados para suporte de prótese tipo protocolo e a mucosa peri-implantar apresentava-se sem tecido queratinizado e inflamada. Após dois meses de reparação da cirurgia mucogengival, foi possível observar que o enxerto gengival livre favoreceu a saúde peri-implantar e os procedimentos protéticos de moldagem. CONCLUSÃO: Diante dos resultados clínicos, pode-se concluir que o enxerto gengival livre é uma técnica previsível e de fácil realização para aumento da faixa de mucosa queratinizada em mucosa peri-implantar de prótese protocolo.

Free gingival autograft for augmentation of keratinized tissue in apical to gingival recession – A case report

BackgroundThe treatment of the mucogingival problem is one of the main objectives of the periodontal therapy. The insufficient or absent attached gingiva increases the risk of development of gingival recessions. MethodOne patient with Miller class II gingival recession and small vestibule depth in the frontal mandibular region was selected for treatment. Autogenous free gingival grafts harvested from the palatal mucosa were used to gain the attached gingiva. ResultThe initial healing completed in 2 weeks without complication. The augmentation of the attached gingival tissue using the free gingival graft technique led to gain of attached gingiva in the treated regions. ConclusionThe limitations of the apical mucosal flap displacement for preparation of recipient site in situations with inadequate vestibule depth and small alveolar bone height require a graft with small width. The result from the presented case report with application of the free gingival graft indicates that it could be applied when augmentation of the attached gingiva tissue.

Gingival augmentation procedure prior to fixed orthodontic treatment

Patients seek orthodontic treatment for correction of malocclusion and aesthetic improvement. A strong correlation between labially placed teeth and gingival recession has been found. If such cases are left untreated with or without orthodontic therapy, it may lead to an increase in the severity of the disease. A similar case of a 21-year-old male patient with gingival recession in the mandibular anterior region is reported. The patient was successfully treated using a free gingival graft technique. This technique not only improves the aesthetic aspect but also avoids future attachment loss and thus makes the patient more stable for further orthodontic treatment. The aim behind the treatment of gingival recession is not only to cover the exposed root surface, but also to improve aesthetics and reduce dentinal hypersensitivity. Different soft tissue-grafting procedures have been proposed for the treatment of gingival recession, of which free gingival graft is the most reliable one. The purpose of this case report is to illustrate the importance of root coverage prior to orthodontic treatment and to describe the planning for successful treatment which will improve the overall periodontal status of the patient.

A modified free gingival graft technique for the treatment of oro-antral sinus track: A case report

Purpose: Surgical intervention into the maxillary posterior area can lead to inadvertent communication with the maxillary sinus. Spontaneous healing of 1 to 2 mm openings can occur. However, in patients with larger oro-antral communications and those with a history of sinus disease, surgical closure is often indicated. Materials and Methods: In this case, a modified free gingival graft technique was used. The oro-antral sinus track after extraction was about 2×4 mm. But the patient had a history of Caldwell-Luc operation. Immediately after extraction, a modified free gingival graft was used for the closure of oro-antral sinus track. Result: A modified free gingival graft technique was successfully used for the closure of oro-antral sinus track. With this technique, esthetic results including similar colors, textures were achieved. Conclusion: It is thought that this technique is very useful in the closure of oro-antral sinus track. (J Korean Acad Periodontol 2008;38:109-114)

A clinical comparison of two gingival extension procedures

In recent years the free gingival autograft and the periosteal separation procedure have emerged as the periodontal treatment techniques most favoured for gingival extension without marginal correction. Previous investigators reporting separately on both techniques have demonstrated varying relapse rates, and while the periosteal separation procedure is regarded as more traumatic, the free gingival graft technique has the disadvantage of leaving a granulating wound in the palate as a possible source of postoperative pain. The present study was undertaken to compare the two procedures by assessing postoperative relapse at 2, 4, 12 and 24 weeks and evaluating pain experience during the first week after surgery. With the free gingival graft a mean shrinkage of 17·4 per cent occurred over 24 weeks, although this was offset by creeping reattachment coronal to the wound margin. The periesteal separation procedure produced a mean loss of 47·5 per cent of the original extension and a tendency towards gingival recession. With the latter technique pain was significantly greater at the 4- and 8-hour postoperative intervals.