Free Gingival Graft Research Articles

PR320: Does previous surgical experiments of patients affect quality of life after free gingival graft surgery? A pilot study

PR320: Does previous surgical experiments of patients affect quality of life after free gingival graft surgery? A pilot study

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

PR321: Does smoking and hyaluronic acid impact on the wound healing of free gingival graft and donor sites?

PR321: Does smoking and hyaluronic acid impact on the wound healing of free gingival graft and donor sites?

PC463: Free gingival grafts for implants with lack of keratinized mucosa: a retrospective long‐term case series

PC463: Free gingival grafts for implants with lack of keratinized mucosa: a retrospective long‐term case series

PR680: Dimensional changes of recipient and donor sites following free gingival graft surgery around dental implants in smokers and non‐smokers: a preliminary study

PR680: Dimensional changes of recipient and donor sites following free gingival graft surgery around dental implants in smokers and non‐smokers: a preliminary study

PC093: Free gingival graft harvested from flabby ridge to improve the attached gingiva around the dental implants: a case report

PC093: Free gingival graft harvested from flabby ridge to improve the attached gingiva around the dental implants: a case report

Flap Management in Alveolar Ridge Preservation: A Systematic Review and Meta-Analysis.

This systematic review aimed to identify the effects of certain flap management procedures on ridge preservation on the basis of existing literature. Electronic (MEDLINE, EMBASE, and Cochrane Central Register of controlled trials) and manual searches of the literature were conducted until February 2017. Randomized controlled trials (RCTs), controlled clinical trials (CCTs), and prospective cohort studies that involved at least 10 subjects were eligible for this systematic review. To evaluate the beneficial effects of flap management on ridge preservation, changes in the bone width, bone height, and keratinized gingiva width were calculated using a random effects model. Eleven studies (nine RCTs and two CCTs) were included in this review. No statistically significant differences in bone width and height changes were identified between the flapped and flapless ridge preservation techniques and between the free gingival graft and flapless ridge preservation techniques. A statistically significant shrinkage in keratinized gingiva width was noted with flapped ridge preservation compared with flapless ridge preservation (weighted mean differences, -3.21 mm; 95% confidence interval, -4.10 to -2.33; P < .00001; heterogeneity, 51%; χ2, 0.15). Within the limitations, this review reveals that flapless ridge preservation was more effective in preserving bone width, bone height, and keratinized gingiva width. To present pertinent evidence regarding which flap management should be recommended for ridge preservation, more controlled and high-quality studies are warranted.

Evaluation of the effect of EDTA on root coverage at free gingival graft procedure

Background: The present study has been designed to compare the effect of root surface biomodification with EDTA for the treatment of buccal gingival recession with free gingival graft.&#x0D; Materials and methods: This randomized controlled parallel clinical trial, 34 patients of 40 existing tooth Miller Class I and Class II gingival recession were treated with free gingival graft (FGG). Forty teeth with recession were assigned randomly to receive the free gingival graft with or without the application of an EDTA gel. Pre-treatment (Day 0) and post-treatment 3. and 6. months gingival recession height(GRH), gingival recession width(GRW), probing depth (PD), clinical attachment level(CAL) and width of keratinized tissue WKT were measured.&#x0D; Results: In FGG+EDTA group statistically significant changes from baseline were found GRH decreased from 4.7±1.5 mm to 1.3±1.2 and WKT increased from 0.9 ± 0.9 mm to 5.5±1.8 mm. Also in FGG group, GRH decreased from 4.6±1.3 mm to 1.3±1.2 mm and WKT increased from 0.9 ± 0.7 mm to 5.4±1.5 mm. For FGG and FGG+EDTA, the average root coverage 74.14% and 69.26% was found.&#x0D; Conclusion: In the light of these data obtained with the root surface biomodification agent EDTA have no beneficial effect for root coverage. In the light of these data obtained with the root surface biomodification agent EDTA have no beneficial effect for root coverage.&#x0D; Keywords: Gingival recession, free gingival graft, EDTA, root coverage

Acellular dermal matrix allograft versus free gingival graft: a histological evaluation and split-mouth randomized clinical trial.

This split-mouth controlled randomized clinical trial evaluated clinical and histological results of acellular dermal matrix allograft (ADM) compared to autogenous free gingival graft (FGG) for keratinized tissue augmentation. Twenty-five patients with the absence or deficiency of keratinized tissue (50 sites) were treated with FGG (control group) and ADM (test group). Clinical parameters included keratinized tissue width (KTW) (primary outcome), soft tissue thickness (TT), recession depth (RD), probing depth (PD), and clinical attachment level (CAL). Esthetic perception was evaluated by patients and by a calibrated periodontist using visual analog scale (VAS). Histological analysis included biopsies of five different patients from both test and control sites for each evaluation period (n = 25). The analysis included percentage of connective tissue components, epithelial luminal to basal surface ratio, tissue maturation, and presence of elastic fibers. Data were evaluated by ANOVA complemented by Tukey's tests (p < 0.05). After 6months, PD and CAL demonstrated no differences between groups. ADM presented higher RD compared to FGG in all periods. Mean tissue shrinkage for control and test groups was 12.41 versus 55.7%. TT was inferior for ADM group compared to FGG. Esthetics perception by professional evaluation showed superior results for ADM. Histomorphometric analysis demonstrated higher percentage of cellularity, blood vessels, and epithelial luminal to basal surface ratio for FGG group. ADM group presented higher percentage of collagen fibers and inflammatory infiltrate. Both treatments resulted in improvement of clinical parameters, except for RD. ADM group presented more tissue shrinkage and delayed healing, confirmed histologically, but superior professional esthetic perception. This study added important clinical and histological data to contribute in the decision-making process between indication of FGG or ADM.

EVALUATION OF THE EFFECT OF PLATELET‑RICH FIBRIN ON PALATAL DONOR AREA PAIN AFTER HARVESTING A FREE GINGIVAL GRAFT.

02Mar 2018 EVALUATION OF THE EFFECT OF PLATELET‑RICH FIBRIN ON PALATAL DONOR AREA PAIN AFTER HARVESTING A FREE GINGIVAL GRAFT. Devrim Deniz Uner and Bozan Serhat Izol. Harran University Faculty of Dentistry Department of Periodontology. Dicle University Faculty of Dentistry Department of Periodontology.

Free Gingival Graft versus Mucograft: Histological Evaluation.

INTRODUCTION:The correction of the gingival recession is of esthetical and functional significance, but the tissue regeneration can only be confirmed by a histological examination.AIM:This study aims to make a comparison between the free gingival graft and the autograft.MATERIAL AND METHODS:This study included 24 patients with single and multiple gingival recessions. Twelve patients were treated with a free gingival graft and the other twelve with a micrograft. Six months after the surgical procedure, a micro-punch biopsy of the transplantation area was performed. The tissue was histologically evaluated, graded in 4 categories: immature, mature, fragmented and edematous collagen tissue. The elastic fibres were also examined and graded in three categories: with a normal structure, fragmented rare and fragmented multiplied.RESULTS:Regarding the type of collagen tissue that was present, there was a significant difference between the two groups of patients, with a larger number of patients treated with a micrograft showing a presence of mature tissue, compared to the patients treated with a free gingival graft. A larger number of patients in both of the groups displayed elastic fibres with a rare fragmented structure; 33.3% of the patients showed a normal structure; 50% demonstrated a normal structure.CONCLUSION:The patients treated with a free gingival graft showed a larger presence of fragmented collagen tissue and fragmented elastic fibres, whereas a mature tissue was predominantly present in the surgical area where a Geistlich Mucograft was placed.

Effect of platelet-rich fibrin palatal bandage on pain scores and wound healing after free gingival graft: a randomized controlled clinical trial.

This prospective randomized clinical trial was conducted to determine whether the application of a platelet-rich fibrin (PRF) palatal bandage after harvesting free gingival grafts (FGG) would improve healing of donor sites and decrease pain scores and patient discomfort. Twenty-four patients received FGG to augment keratinized tissue dimensions. The application of a PRF bandage was decided randomly (n = 12 in each group). Patients reported their pain levels for the first 7days of healing using the visual analog scale (VAS), 101-point numerical rating scale (NRS-101), and 4-point verbal rating scale (VRS-4). The patients' pre-operative anxiety levels were measured using three anxiety scales. The healing of the donor sites was evaluated and compared to preoperative records. Data were assessed and recorded before surgery and at 1, 2, 3, 4, and 8weeks postoperatively. Dental anxiety and state-trait anxiety were evaluated at baseline and correlated to the postoperative pain scores. There were no significant differences in anxiety levels between the two groups; yet, they could potentially influence the outcome of any surgery and were included as covariates. The patients in the PRF group reported significantly lower pain scores and their pain levels returned to baseline levels earlier, compared to the control group. PRF palatal bandages significantly reduced postoperative pain and discomfort and facilitated wound healing after harvesting FGG. The study provided evaluation of patient-centered outcomes, which is timely, significant, and could benefit both periodontists and patients.

Application of periodontal microsurgery in the augmentation of attached gingiva around an implant

This study aimed to evaluate the clinical effect of periodontal microscopic surgery on the augmentation of attached gingiva and determined the clinical principle on how to use minimally invasive surgery to improve the surgery success rate. Twenty patients with insufficient attached gingiva around implants were selected. Periodontal microscopic surgery for free gingival graft was performed to increase the width of the attached gingiva around the implants. The survival state of the free gingiva was observed after surgery, and the width of the attached gingiva around the implants was recorded before and after surgery and 1 year after surgery. The shrinkage rate of the free gingival flap 1 year after surgery was analyzed to evaluate the stability of the flap. The flaps of the 20 cases all survived. One year after the operation, the width of the attached gingiva was (3.05±0.44) mm, which increased compared with that of preoperation (2.56±0.31) mm and decreased compared with that of postoperative day (2.13±0.28) mm. The shrinkage rate of the attached gingiva was 41.22%±5.04%. The application of microscopic surgery on the augmentation surgery of attached gingiva can increase the success rate and improve the quality and quantity of attached gingiva around implants.

Effect of Platelet-rich Fibrin and Free Gingival Graft in the Treatment of Soft Tissue Defect preceding Implant Placement

Free gingival graft is a procedure that is used to increase keratinized tissue around teeth and edentulous sites for future dental implants. Keratinized tissue is critical for maintainability of surgical site and flap management. Platelet-rich fibrin consists of bioactive and biological components, mainly composed of growth factors. Growth factors attract stem cells to the site of release and stimulate cell proliferation. Moreover, growth factors promote angiogenesis, which accelerates wound healing. Site preparation is critical in implant dentistry, including soft tissue and hard tissue augmentation. To improve free gingival graft (FGG) healing by using platelet-rich fibrin (PRF) at the soft tissue defect area of extracted upper right first molar in order to restore keratinized tissue and prepare the site for bone grafting followed by dental implant placement. A healthy female patient, 59 years old, presented to the dental clinic at the University at Buffalo, School of Dental Medicine, seeking dental implants to restore missing teeth. The patient had an extraction for upper right first molar 4 months ago. The surgical extraction left severe soft and hard tissue defects at the site. Free gingival graft was placed at the site to increase keratinized tissue band followed by PRF to improve healing. Cyanoacrylate adhesive was used to stabilize PRF Two months later, a full-thickness flap was reflected, and tenting screws placed with bone grafting at the site. Titanium-reenforced membrane was placed over the bone graft. Three months later, tenting screws were removed and two dental implants were placed at the site. The use of PRF accelerates the healing of FGG. More tissue handling could be achieved by increasing the kera-tinized tissue during surgical procedures. The combination of PRF and FGG could help in the healing process during soft tissue procedures.

The use of paquette blade handle in harvesting free gingival graft from the palate – a report of three cases with its method of use, advantages and disadvantages.

Free gingival grafting is a well-known periodontal plastic surgical procedure used for gingival augmentation, for root coverage procedures and in some cases of pre-prosthetic ridge augmentation. Several instruments have been used to harvest the graft from hard palate, ranging from scalpel to mucotome, each of which has its own advantages and disadvantages. One such instrument is Paquette blade handle, which incorporates a regular razor blade for graft harvesting. This article intends to describe in detail the handling of this instrument, its usefulness as well as limitations, as explained in the following three cases.

Two Cases of Clinical Application of a Chitosan-derived Hemostatic Agent for Hemostasis after Tooth Extraction and Periodontal Plastic Surgery

There are several types of hemostatic dressings available for use in the oral surgery field, one of which is derived from chitosan: the HemCon Dental DressingⓇ （HDD）. Case 1 was an 85-year-old female whose chief complaint was dental pain. The patient was taking warfarin tablets because of a history of cerebral infarction. The right upper maxillary of the first premolar teeth and second premolar teeth were indicated for tooth extraction due to severe chronic periodontitis. Tooth extraction was performed while warfarin tablets were orally administered. Persistent bleeding was seen from the extracted tooth cavity after tooth extraction. The HDD was inserted into the extracted tooth cavity, and compression hemostasis was performed for 10 minutes. Case 2 was a 70-year-old male whose chief complaint was an ill-fitting right mandibular partial denture, with mandibular right alveolar ridge constriction and lacking keratinized gingiva. The right mandibular buccal frenum was excised, and a free gingival graft （FGG） and an expansion of the anterior ridge were performed. While performing the FGG, an HDD was applied to the donor side palate for 10 minutes. We conclude that the HDD is a fast-acting hemostatic agent with both wound healing and antimicrobial properties.

Fabrication of Conventional Complete Denture in Resorbed Mandibular Ridge with Deficient Keratinized Mucosa Using Free Gingival Graft

Fabrication of Conventional Complete Denture in Resorbed Mandibular Ridge with Deficient Keratinized Mucosa Using Free Gingival Graft

Connective tissue graft to improve aesthetic peri-implant area: modified clinical technique.

This article reports a clinical case with a 4-years follow-up in which sub epithelial connective tissue graft harvested by two different technique was used to recuperate the aesthetic conditions of the two-previous implanted anterior areas which presented soft tissue fenestration and osseous dehiscence promoted by dental extraction. The highly compromised areas were treated using sub epithelial connective tissue grafts which due the necessity of the quantity and quality were harvested by using two different surgical techniques: dental wedge and free gingival graft. After 4-years of follow-up the goal of treatment was fully reached. The gingival soft tissue around perimplantar area is stable and seems to be normal. The two techniques applied to harvest sub epithelial connective tissue in this case were essential to obtain a large amount of tissue to be grafted. Quality and quantity of the sub epithelial graft are critical conditions to maintain stability during the early phase of healing process, allowing and improving initial revascularization.

Effect of topically applied hyaluronic acid on pain and palatal epithelial wound healing: An examiner-masked, randomized, controlled clinical trial.

This study aims to evaluate the effects of two different concentrations of topical hyaluronic acid (HA) on postoperative patient discomfort and wound healing of palatal donor sites after free gingival graft (FGG) surgery. Thirty-six patients requiring FGG were randomly assigned into three groups in an examiner-masked, randomized, controlled clinical trial. After harvesting palatal grafts, 0.2% and 0.8% HA gels were used in test groups 1 and 2, respectively. Gels were applied on donor sites and protected with periodontal dressing in the test groups, whereas the wound was covered only with periodontal dressing in the control group. On days 3, 7, 14, and 21, pain and burning sensation were recorded using a visual analog scale (VAS) as well as other parameters such as complete epithelization (CE) and color match on days 3, 7, 14, 21, and 42. Test groups experienced less pain than the control group on days 3 and 7 (P <0.001 and P <0.001, respectively). Mean VAS score for burning sensation was higher in the control group on day 3 compared with test groups 1 and 2 (P = 0.03 and P = 0.02, respectively). CE in all patients was achieved on day 21 in both test groups, whereas it was achieved on day 42 in the control group. The test groups showed higher color match scores than the control group on days 21 (P <0.001 and P <0.001, respectively) and 42 (P = 0.004 and P = 0.002, respectively). Topical application of HA exhibits positive impact on postoperative pain and burning sensation, and accelerates palatal wound healing in terms of epithelization and color match.

Complete Root Coverage in Millers Class III Isolated Gingival Recession using Free Gingival Graft &amp;ndash; A 12 Month Follow Up Report

Gingival recession is most commonly encountered periodontal problem. It is often complicated by inadequate attached gingiva and decreased vestibular depth. Free gingival autograft is the technique of choice in such complicated situations. This case report presents a Millers Class III recession with inadequate attached gingiva treated with free gingival graft and achievement of complete root coverage