Aesthetic effect evaluation of the xenogeneic collagen matrix in keratinized mucosa augmentation around dental implants / 口腔疾病防治

Objective@#To evaluate the stability and aesthetic effect of a xenogeneic collagen matrix (mucograft) on achieving an adequate keratinized mucosa width (KMW) around implants and to provide a reference basis for the clinical application of xenogeneic collagen matrix materials.@*Methods@#The hospital ethics committee approved the study protocol, and the patients provided informed consent. Twenty patients with a KMW<2 mm at the buccal implant site who were treated in Binzhou Medical University Affiliated Yantai Stomatological Hospital from July 2020 to September 2022 were included, and a total of 36 implants were included. The mean age of the patients was (52.0±10.4) years, of which 18 were females and 2 were males. They were divided into a free gingival graft group (FGG, control group) and a xenogeneic collagen matrix group (test group) according to different graft materials. The incremental effect of the KMW on the buccal side of the implant and the mucosal shrinkage rate was measured at 1 month and 3 months after the operation. The mucosal scar index (MSI) was evaluated after the operation.@*Results@#At 3 months postoperatively, the KMW was (3.67 ± 1.06) mm in the control group and (2.96 ± 0.98) mm in the test group, and the difference was statistically significant (t = 2.076, P<0.05). The KMW shrinkage rate was (33.34 ± 16.30) % in the test group and (22.05 ± 15.47) % in the control group at 1 month postoperatively and (51.95 ± 12.60) % in the test group and (37.44 ± 16.30) % in the control group at 3 months postoperatively, with statistically significant differences between the two groups at the same time points (P<0.05). Three months after surgery, the test group showed significantly better outcomes than the control group in terms of the five scar indicators (scar width, scar convexity, scar color, scar trace, and overall appearance), and the difference was statistically significant (P<0.05).@*Conclusion@#Xenogeneic collagen matrix can increase the peri-implant KMW and achieve a more natural and coordinated soft tissue aesthetic effect but with a higher shrinkage rate.

Is there an effective way to control pain perception after free gingival graft removal? A systematic review and meta-analysis

Abstract The literature describes multiple ways to stimulate wound healing to reduce the patient's perception of pain. This systematic review aimed to evaluate if methods that enhance wound healing can reduce the patient's perception of pain after free gingival graft removal from the palate region compared to natural healing. A systematic review protocol was written following the PRISMA checklist. Electronic searches of five databases were performed to identify randomized clinical trials (RCTs) that assessed the patient's perception of pain after the removal of a free gingival graft from the palate. The primary outcome was the visual analog scale (VAS) score assessing the patient's perception of pain 7 days after the free gingival graft removal from the palate region. Of the 1,622 potentially relevant articles retrieved from the electronic databases, 16 RCTs were selected for qualitative analysis, and of these, 6 RCTs were included in the meta-analysis. RCTs showed a significant VAS reduction associated with the use of methods to enhance wound healing. The pooled estimates revealed a significant overall VAS reduction of 2.20 (95% CI 2.32, 2.07) 7 days after surgery. The methods that presented the greatest reduction in the perception of pain were platelet-rich fibrin, hyaluronic acid, and autologous fibrin glue. Methods that enhance wound healing, including platelet-rich fibrin, hyaluronic acid, and autologous fibrin glue, can reduce pain perception after free gingival graft removal in the palate region. However, only 1 RCT investigated each approach, which hinders the conclusion regarding the best procedure to reduce the perception of pain.

Resumo A literatura descreve diferentes formas de estimular a cicatrização para reduzir a percepção de dor do paciente. Esta revisão sistemática teve como objetivo avaliar se métodos que melhoram o reparo de feridas podem reduzir a percepção de dor do paciente após a remoção de enxerto gengival livre da região do palato quando comparado a cicatrização natural. Um protocolo de revisão sistemática foi escrito seguindo a lista de verificação PRISMA. Pesquisas eletrônicas em cinco bancos de dados foram realizadas para identificar ensaios clínicos aleatorizados (ECA) que avaliaram a percepção de dor do paciente após a remoção do enxerto gengival livre do palato. O desfecho primário foi o escore da escala visual analógica (VAS) avaliando a percepção de dor do paciente 7 dias após a remoção do enxerto gengival livre da região do palato. Dos 1.622 artigos potencialmente relevantes recuperados das bases de dados eletrônicas, 16 ECAs foram selecionados para análise qualitativa, e destes, seis ECAs foram incluídos na meta-análise. Os estudos analisados demonstraram uma redução significativa de VAS associada ao uso de métodos para melhorar a cicatrização de feridas. As estimativas agrupadas revelaram uma redução global significativa do VAS de 2,20 (95% CI 2,32, 2,07) 7 dias após a cirurgia. Os métodos que apresentaram maior redução na percepção de dor foram fibrina rica em plaquetas, ácido hialurônico e cola de fibrina autóloga. Métodos que melhoram a cicatrização de feridas podem reduzir a percepção de dor após a remoção do enxerto gengival livre na região do palato, especialmente fibrina rica em plaquetas, ácido hialurônico e cola de fibrina autóloga. No entanto, apenas um ECA avaliou cada abordagem, o que impossibilita a conclusão sobre qual é o melhor procedimento para reduzir a percepção de dor.

Application of soft tissue augmentation in labial contour aesthetics of anterior dental implants / 口腔疾病防治

@#After tooth extraction, labial contour collapses due to inevitable physiologic bone remodeling. To achieve optimal outcomes for pink esthetic treatment at anterior implant sites, bone or soft tissue augmentation has been advocated to maintain or reconstruct the labial tissue contour. When choosing soft tissue augmentation for esthetic restoration, it is necessary to strictly grasp the indications for surgery. Soft tissue augmentation to maintain or reconstruct the labial tissue contour could be considered in patients with healthy soft tissue and no bone defects or only mild horizontal bone defects. In immediate, early and late implant placement, the timing of soft tissue augmentation may vary. In immediate implantation, the labial bone plate is intact, so it is highly recommended to simultaneously manage soft tissue during implant placement. However, patients may have large bone defects with early or late implant placement. The risk of augmenting bone and soft tissue simultaneously is likely too high, and bone augmentation surgery is often performed at the first stage while soft tissue augmentation surgery is performed at the second stage. Therefore, soft tissue surgery is often carried out simultaneously with abutment connection. Currently, soft tissue augmentation is achieved mostly with adjacent autologous soft tissue grafts, such as free gingival grafts, subepithelial connective tissue grafts or pedicle palatal flaps, which are often accompanied by a second surgical area. The replacement of autogenous soft tissue grafting with new biological materials will become an inevitable trend. In this article, we analyze and summarize the indications, timing and different methods of soft tissue augmentation to maintain and reconstruct the labial contour.

Tratamento de mucosite periimplantar pela técnica de enxerto gengival livre: relato de caso / Treatment of peri-implant mucositis through free gingival graft technique: case report

A Mucosite peri-implantar é considerada a precursora da peri-implantite, ela é uma lesão inflamatória da mucosa peri-implantar na ausência de perda óssea marginal contínua. O objetivo desse relato de caso, foi descrever o tratamento da mucosite periimplantar através da cirurgia de enxerto gengival livre. Foi proposto, portanto, um tratamento reabilitador envolvendo uma abordagem multidisciplinar de forma a resgatar e restabelecer estética, função e bem-estar através do enxerto gengival livre para melhorar as características de mucosa e viabilizar uma previsibilidade de uma prótese definitiva implantosuportada em condições teciduais mais estáveis. O uso do EGL para aumento da gengiva queratinizada na cirurgia de implantes em paciente idosos é uma solução prática e segura para a manutenção da saúde periodontal ao redor do implante... (AU)

Peri-implant mucositis is considered the precursor of peri-implantitis, it is an inflammatory lesion of the peri-implant mucosa in the absence of continuous marginal bone loss. The purpose of this case report was to describe the treatment of peri-implant mucositis through free gingival graft surgery. Therefore, a rehabilitation treatment involving a multidisciplinary approach was proposed in order to rescue and reestablish aesthetics, function and well-being through the free gingival graft to improve the characteristics of the mucosa and enable a predictability of a permanent implant prosthesis under more stable tissue conditions. The use of EGL to increase keratinized gingiva in implant surgery in elderly patients is a practical and safe solution for maintaining periodontal health around the implant... (AU)

Short-term clinical efficacy of a collagen matrix and free gingival graft in augmenting keratinized mucosa around dental implants / 中华口腔医学杂志

Objective@#To compare the short-term outcomes of a collagen matrix (CM) and free gingival graft (FGG) in augmenting keratinized mucosa around dental implants.@*Methods@#Nineteen partially edentulous patients who had undergone implant surgery or implant review from June 2017 to June 2018 at Department of Periodontology, Peking University School and Hospital of Stomatology with lack of keratinized mucosa at buccal aspect of implants (<2 mm) were recruited in this study. According to the width of keratinized mucosa (KW) pre-operation, 9 patients including 5 males and 4 females were assigned into control group (KW<0.5 mm) which performed free gingival graft (17 implants) and 10 patients including 3 males and 7 females were assigned into experimental group (KW≥0.5 mm) which used collagen matrix as the grafts (15 implants). The KW at buccal aspect of each implant were measured pre-operation and 2 weeks, 1 month, 2 months, 3 months after surgery respectively. Each of the patients was required to fill out a questionnaire using a visual analogue scale to assess the postoperative morbidity.@*Results@#The KWs around implants were increased significantly during the 3 months follow-up period in both groups (P<0.01). At 3 months after surgery, KW gain in control group was (3.44±1.64) mm, in experimental group was (2.30±0.82) mm, the difference between two groups was statistically significant (P<0.05). Meantime, the total shrinkage of KW in control group [(34±25)%] and experimental group [(51±11)%] also showed a statistically significant difference (P<0.01). However, by using collagen matrix as the grafts, augmented tissues had a much more comparable appearance with adjacent tissues than that in control group. And the patients of experimental group experienced much less postoperative bleeding than those of control group.@*Conclusions@#Both collagen matrix and free gingival graft can significantly increase the KW around implants within the 3 months post-surgery follow-up period. There were more KW gain and less shrinkage in group FGG than that in group CM. However, surgery time were reduced and the postoperative bleeding were less in group CM than in group FGG as no harvesting procedure was needed.

Free gingival graft: An effective technique to create healthy keratinised gingiva

The high labial frenal attachment in mandibular anterior segment is most commonly associated with inadequate width of attached gingiva. Insufficient attached gingiva contributed to the difficulty in oral hygiene maintenance and ultimately poor gingival health. Frenectomy, vestibular extension and gingival augmentation procedures either alone or in combination are often required to maintain adequate health of the gingiva. Clinical relevance Inadequate width of keratinised gingiva contributed to the difficulty in oral hygiene maintenance and ultimately poor gingival health. Frenotomy with free gingival graft (FGG) technique is most predictable in these situations. Objective To highlight the importance of keratinised gingiva and overview of the FGG technique.

Enxerto gengival livre para ganho de tecido queratinizado prévio à instalação de implante na região posterior de mandíbula: relato de caso com três anos de acompanhamento / Free gingival graft for keratinized tissue gain prior to implant installation in posterior mandible region: case report with three years of follow-up

O objetivo deste trabalho foi apresentar o relato de um caso clínico no qual uma paciente de 52 anos, com ausência de tecido queratinizado na região de rebordo do elemento 46, previamente extraído, foi submetida à cirurgia de enxerto gengival livre para criar uma faixa de tecido queratinizado, antes da instalação do implante osseointegrado. Após três meses de cicatrização, foi constatado signifi cativo ganho de tecido queratinizado na região, tornando o sítio mais favorável à reabilitação com implante dentário. Dessa forma, foi seguido o planejamento inicial e instalado um implante na região, que foi reabilitado posteriormente. Diversos trabalhos têm mostrado que o selamento biológico proporcionado por uma adequada faixa de tecido queratinizado ao redor de implantes seria um pré-requisito para a saúde e o sucesso desses implantes no longo prazo. A revisão clínica e radiográfi ca com três anos de acompanhamento mostrou estabilidade do tecido peri-implantar e, consequentemente, o sucesso do tratamento proposto.

The aim of this study was to present a clinical case report where a 52-year-old patient, with absence of keratinized tissue in the ridge region of the previously extracted element 46, received a free gingival graft surgery to create a tissue band before the osseointegrated implant installation. After 3 months of healing, a signifi cant gain of keratinized tissue was observed in the region, making the site more amenable to rehabilitation with a dental implant. In this way, the initial planning was followed and an implant was installed in the region and the restoration delivered afterwards. Several studies have shown that biological sealing provided by a suitable range of keratinized tissue around implants would be a prerequisite for the health and success of these implants in the long run. The clinical and radiographic review with 3 years of follow-up showed stability of the peri-implant tissue and, consequently, the success of the proposed treatment.

Aparición de exostosis 7 años después de aumento del reborde alveolar con técnica de bolsillo / Exostosis 7 years after alveolar ridge augmentation with pocket technique

Antecedentes: Las técnicas de manejo de tejidos blandos para aumentar rebordes alveolares atrofiados incluyen el uso de injertos de tejido conectivo, con o sin collar de epitelio, y técnicas en rollo. Algunas veces generan complicaciones posoperatorias. Objetivo: Describir el caso de una paciente a la que se le realizó aumento de reborde alveolar y se produjo una exostosis. Caso clínico: A una paciente de 35 años se le realizó un aumento del reborde alveolar con la técnica de bolsillo en el área del diente incisivo central superior derecho. Se tomó un injerto de tejido conectivo sin collar epitelial del paladar que se trasplantó y cubrió con el colgajo. La paciente regresó siete años después y clínicamente presentaba una aparente exostosis en la zona vestibular del diente tratado que la afectaba estéticamente. Se realizó osteoplastia para mejorar el contorno y se tomó una biopsia del hueso cuya histopatología mostró un tejido compatible con hueso alveolar. Conclusiones: La exostosis es una complicación posoperatoria inusual en casos de reborde alveolar que puede ser tratado con éxito. Se requiere más investigación sobre dichos efectos.

Background: Soft-tissue treatment techniques for alveolar ridge augmentation include connective tissue grafts, with or without epithelial collar, and roll techniques. Sometimes, there are postoperative complications. Purpose: To describe a case for a female patient who underwent an alveolar ridge augmentation and developed an exostosis. Case description: A 35-year-old female patient underwent an alveolar ridge augmentation procedure through a pocket technique in the upper right central incisor. A connective tissue graft without epithelial collar from the palate was transplanted and covered with the flap. Seven years later the patient returned with an exostosis in the buccal area of the treated tooth that affected her aesthetically. An osteoplasty was performed and a bone biopsy was taken, whose histopathological analysis showed a bone-compatible tissue. Conclusion: Exostosis is an unusual postoperative complication in cases of alveolar ridge augmentation that can be successfully treated. More research is necessary about such complications.

Application of periodontal microsurgery in the augmentation of attached gingiva around an implant / 华西口腔医学杂志

OBJECTIVE@#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.@*METHODS@#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.@*RESULTS@#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%.@*CONCLUSIONS@#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.

Técnica de enxerto gengival livre para aumento de tecido queratinizado em recessão gengival classe III de Miller / Free gingival graft technique for keratinized tissue increase in Miller III gingival recession ­ a case report

A presença ou ausência de gengiva inserida pode interferir na manutenção da saúde gengival, uma vez que sua deficiência leva à exposição radicular dificultando o processo de higienização, o que resulta na presença de biofilme e inflamação gengival com perda de inserção. Foi realizada terapia periodontal cirúrgica com enxerto gengival livre em paciente com recessão gengival classe III de Miller para aumento de faixa de tecido queratinizado. Após período de pós-operatório e acompanhamento de um ano e 12 meses, foi observado ganho e manutenção de volume e altura do tecido queratinizado enxertado, com saúde gengival e ganho de inserção. Nos casos onde há necessidade de reforçar áreas fragilizadas pela diminuição ou falta de gengiva inserida, a técnica de enxerto gengival livre apresenta boa previsibilidade e manutenção da faixa de tecido queratinizado, favorecendo o controle de biofilme e saúde gengival.

The presence or absence of attached gingiva may interfere with the maintenance of gingival health, since its defi ciency in some cases complicates the process of cleaning, resulting in the presence of biofilm and gingival inflammation with insertion loss. This case report describes a surgical technique based on free gingival graft in a patient with gingival recession Miller class III to increase keratinized tissue band. After the postoperative period of 12 months tissue improvement was observed, as well as, volume maintenance and height of keratinized grafted tissue along with gum health and insertion gain. In cases where there is need to strengthen weakened areas by reducing or lack of attached gingiva, the free gingival graft technique has good predictability and maintenance of keratinized tissue range, favoring the control of biofilm and gingival health.

Enxerto gengival livre para aumento da faixa de gengiva queratinizada em região com recessões múltiplas / Free gingival graft to increase the band of keratinized tissue in cases of multiple gingival recessions

Defeitos de recessões gengivais podem contribuir para a ocorrência de hipersensibilidade dentinária, cáries radiculares, desenvolvimento de abrasões cervicais e deficiência estética. O objetivo do presente trabalho foi relatar o tratamento de recessões gengivais múltiplas classe III de Miller, em região inferior anterior de mandíbula, utilizando a técnica de enxerto gengival livre. As recessões gengivais classe III de Miller nos dentes 31, 41 e 42 foram, provavelmente, causadas pela associação de um biotipo periodontal delgado e presença de inserções musculares na região anterior da mandíbula. Após a remoção de inserções musculares presentes e frênulos, um enxerto de epitélio conjuntivo foi cuidadosamente preparado para ser acomodado no leito receptor das recessões. Após 24 meses de proservação clínica, foi possível observar: recobrimento parcial das recessões, aumento da faixa de tecido ceratinizado e um excelente controle do biofilme. Diante da resolução do caso clínico apresentado, a técnica do enxerto gengival livre demonstrou um recobrimento parcial das raízes envolvidas e o aumento da faixa de gengiva inserida, corroborando com um menor acúmulo de biofi lme e facilidade de higienização pelo paciente.

Gingival recession defects may contribute to the occurrence of tooth sensitivity, root caries, development of cervical abrasions and aesthetic deficiency. The aim of this study was to report the treatment of multiple Miller class III gingival recessions in lower anterior mandibular region using the free gingival graft technique. The gingival recessions on teeth 31, 41, 42 were probably caused by the combination of a thin periodontal biotype and the presence of muscle insertions. After their removal, an epithelium-connective graft was carefully prepared to be accommodated at the recipient site. After twenty-four months of clinical proservation it was possible to observe partial coverage of these recessions, an increased keratinized tissue and excellent control of the biofilm by the patient. Given the resolution of the case presented, the free gingival graft technique showed partial root coverage and increase the attached gingiva, contributing to less biofi lm build-up and still facilitating patient hygiene procedures.

Reposição do volume tecidual na área dos incisivos laterais superiores, apenas com enxerto de tecido mole, previamente à Implantoterapia / Volumetric tisue reposition at the maxillary lateral incisor area only with soft tissue graft before implant therapy

O objetivo deste caso clínico foi mostrar que nem sempre alvéolos cicatrizados apresentam perda óssea na zona estética. Um paciente apresentou-se para tratamento queixando-se das proporções dentárias no sítio do incisivo lateral superior direito, há muito tempo. Curiosamente, os exames radiográfico e tomográfico não revelaram perda óssea suficiente para um enxerto de tecido duro. Desta forma, a abordagem consistiu apenas em realizar a coleta de enxerto gengival livre usando um bisturi circular no momento da instalação do implante dentário. Após a cicatrização, a configuração dos tecidos moles foi obtida pelos contornos da coroa provisória e reposicionamento da linha do término do pilar metálico. Na fase restauradora, o paciente recebeu uma coroa definitiva metalocerâmica. O acompanhamento clínico mostrou estabilidade dos níveis ósseos e gengivais. Embora casos como este sejam raros, principalmente em uma área onde a tábua óssea vestibular é muito fina e delicada, o diagnóstico imageológico preciso e os procedimentos subsequentes contribuíram para uma condução adequada, evitando que o paciente passasse por um número maior de cirurgias até que um resultado aceitável fosse obtido.

The purpose of this case report was to demonstrate that not always healed sockets have bone loss in the esthetic zone. One patient presented for treatment with a long-term complaint regarding the dental proportions at the site of the upper right lateral incisor. Surprisingly, the periapical and tomographic exams revealed no large bone loss indicative of hard tissue grafting. Thus, the approach was to collect only a free gingival graft using a circular scalpel at the time of dental implant placement. After healing, the new soft tissue confi guration was obtained by the temporary crown contours and repositioning of the metallic abutment prosthetic margins. In the restorative phase, the patient received a defi nitive metalloceramic crown. In the clinical follow-up, bone and gingival level stability was verifi ed. Although such cases are uncommon, particularly in the area where the buccal bone plate is very thin and delicate, precise diagnostic images and subsequent procedures contributed for appropriate treatment sequence, avoiding excessive surgical steps until an acceptable result be obtained.

Enxerto gengival livre em retração gengival classe II ­ relato de caso com um ano de controle / Free gingival graft in the treatment of class II gingival recession ­ case report with 1-year of follow-up

O objetivo desse trabalho foi apresentar o relato de uma paciente de 25 anos de idade, com queixa principal de desconforto à escovação e retração gengival classe II na região de canino inferior direito (43), e percepção de aumento progressivo da coroa dentária. Os elementos 42, 32 e 33 apresentavam retração classe I, mas sem mobilidade dentária. A falta de gengiva inserida no caso levou à necessidade de intervenção, optando-se pela técnica do enxerto gengival livre (EGL), por causa do desnudamento parcial da superfície radicular devido à migração apical da gengiva marginal. Na área receptora, um retalho misto foi realizado; na área doadora, o enxerto foi removido do palato contralateral (regiões 25-27), desepitelizado e suturado com fio reabsorvível. O retalho foi fechado com fio seda 4-0. O ganho de tecido queratinizado foi avaliado após seis meses e um ano. A estabilidade marginal gengival foi considerada excelente. O EGL favoreceu o controle do biofilme na região e, eventualmente, pode propiciar recobrimento radicular, devendo-se levar em conta as limitações estéticas desta técnica.

The objective of this study was to report a 25 years-old patient complaining of discomfort on tooth brushing having a class II gingival retraction at the mandibular right canine (43), with perception of progressive dental crown lengthening. The elements 42, 32, and 33 had class I retraction, but no tooth mobility. The lack of attached gingiva in this case led to the need for intervention using the free gingival graft technique (FGG), because of partial root surface denudation and apical migration of the gingival margin. At the recipient area, a mixed flap was developed, and at the donor area, the graft was removed from the contralateral palate (regions 25-27), de-epithelized, and stabilized with resorbable sutures. The mixed flap was closed with 4-0 silk sutures. The keratinized tissue gain was evaluated after six months and one year. The stability at gingival margins was considered excellent. The FGG favored biofilm control and may eventually provide root coverage taking into account the esthetic limitations of this technique.

Free gingival graft to increase gingival dimensions in Down syndrome patients: clinical case report

Introduction:Down Syndrome (DS) patients have increased susceptibility to the development of periodontal diseases by the occurrence of several factors, such as inadequate hygiene, mouth breathing, dental morphology, leukocyte reduction and increased inflammatory mediators. Objective:This study aimed to review the literature on the main aspects of DS and present a clinical case of a DS patient treated with basic periodontal therapy and free gingival graft surgery. Case report: DS patient, leucoderma, aged 26 years showed gingival recession and little amount of keratinized tissue in the area of teeth #31 and #41. After surgery, there was an increase in the keratinized tissue band. Conclusion: The free gingival graft surgery performed in DS patients was effective, as the increase of keratinized tissue band occurred.

Simultaneous placement of an interpositional free gingival graft with nonsubmerged implant placement

PURPOSE: Various surgical techniques target achieving adequate keratinized tissue around dental implants; however, these techniques are usually performed before implant placement or upon the exposure of submerged implants. The aim of this case report is to describe a simultaneous placement of an interpositional free gingival graft (iFGG) with that of nonsubmerged implants in a patient lacking keratinized tissue and to assess the long-term outcome of this grafted gingiva. METHODS: A wedge-shaped free gingnival graft (FGG), including an epithelium-connective tissue (E-C) portion and a connective-tissue-only (CT) portion, was harvested from the palate. The CT portion was inserted under the buccal flap, and the E-C portion was secured tightly around the implants and to the lingual flap. RESULTS: At the 8-year follow-up, the gingival graft remained firmly attached and was well maintained, with no conspicuous shrinkage or reported discomfort during oral hygiene procedures. The use of an iFGG at a nonsubmerged implant placement minimizes the required number of surgical steps and patient discomfort while providing adequate buccal keratinized tissue. CONCLUSIONS: Therefore, the technique could be considered an alternative method in increasing the keratinized tissue for cases that have a minimal amount of keratinized tissue.

Free Gingival Graft In The Treatment of Isolated Gingival Recessions : A Case Report.

Gingival recession is an intriguing and complex phenomenon. Recession frequently disturbs patients because of sensitivity and esthetics. Many surgical techniques have been introduced to treat gingival recession, including those involving connective tissue grafting, various flap designs, orthodontics, and guided tissue regeneration. This article describes a different clinical approach to treat gingival recession with emphasis on techniques that show promising results and root coverage.

Two-step procedure for root coverage using a free gingival graft and a subepthelial connective tissue graft.

Gingival recession is a multifaceted problem, for which several treatment options are available. Both epithelized and subepithelial connective tissue grafts offer predictable solutions for the treatment of gingival recession.The case report involved a 30-year-old man with gingival recession of 8 mm on 41 (Miller's class II recession). Before surgery, full mouth scaling and polishing were performed. Recession height, width, probing depth, clinical attachment level (CAL), and width of the attached gingiva (WAG) were measured at the baseline, two months postoperatively, and six months postoperatively. Four weeks after scaling, the first step of increasing the width of the attached gingiva was carried out, using a free gingival graft. Two months after this step, the subepithelial connective tissue was harvested from the palate and placed in relation to 41, to cover the residual defect.Two months postoperatively, there was a 3 mm gain in WAG and 35% root coverage. Six months postoperatively there was a significant increase in WAG, CAL; and reduction in height and width of recession (root coverage achieved was 75%). These results suggested that this two-stage surgical procedure could be successful for root coverage in case of deep recession and lack of attached gingiva in the mandibular anterior region.

Avaliação clínica comparativa da sintomatologia após a realização de enxertos gengivais livres autógenos e alógenos para a criação e manutenção de uma faixa de mucosa ceratinizada / Comparative clinical evaluation of postoperative morbidity after autogenous free gingival graft and dermal matrix allograft to gain and maintain keratinized tissue

Avaliou-se comparativamente os sinais e sintomas pós-operatórios de enxertos gengivais livres (EGL) e de matriz dérmica acelular (MDA) em 22 pacientes que possuíam duas áreas com quantidade inadequada de mucosa ceratinizada na região de pré-molares inferiores de arcos homólogos, sendo que cada paciente foi submetido aos dois tipos de enxertos. A análise foi realizada por meio de respostas a um questionário de sinais e sintomas no pós-operatório imediato de 10 dias. Os resultados foram analisados estatisticamente pelo teste de McNemar, p < 0,05, para comparar as frequências relativas de cada ocorrência (dor, edema e sangramento) e também para analisar o sítio de escolha do paciente de maior sensibilidade dolorosa, demonstrando similaridade de sintomatologia nos sítios enxertados e eleição da área doadora de enxerto autógeno como a mais sensível. Com base nesses resultados pode-se concluir que a MDA quando utilizada como substituta dos EGL apresenta menor desconforto no pós-operatório por não necessitar de uma área cirúrgica adicional para remoção de tecido.

This clinical study compared the postoperative morbidity resulting of free gingival graft and acellular dermal matrix allografts. Twenty two patients with contralateral insufficient keratinized tissue were submitted to both grafts and answered a signals and symptoms questionnaire in the 10th immediate postoperative day. McNemar test, p < 0,05, was used to compare the relative frequency of pain, swelling, bleeding and to analyze the most sensible area in accordance with the patients. The postoperative sensibility of the receptor area was comparable in both groups and the donor area of free gingival graft was the most sensible. The results of this study suggest that acellular dermal matrix allografts can be used as free gingival graft substitute with less postoperative discomfort and it’s not necessary any additional site to remove autogenous tissue.

Free gingival graft for the increase of peri-implant attached keratinized mucosa decreased after guided bone regeneration / 대한치주과학회지

PURPOSE: During guided bone regeneration procedures for the augmentation of deficient alveolar ridge, primary closure of flap is necessary. For primary flap closure, flap is repositioned coronally and the zone of attached keratinized mucosa may decreased. The need for attached keratinized mucosa around dental implants is still controversial, but sufficient peri-implant attached keratinized mucosa would be beneficial for functional and esthetic aspects. This case report presents three cases that demonstrated free gingival graft for increasing the zone of peri-implant attached keratinized mucosa which was decreased after guided bone regeneration. MATERIALS AND METHODS: In first case, maxillary incisors were extracted and guided bone regeneration was performed simultaneously. Because the membrane was exposed at 3 weeks after operation, the membrane was removed and free gingival graft was performed for primary flap closure. Free gingival graft was performed again at implant placement for the increase of attached keratinized mucosa. In second case, guided bone regeneration was performed on lower right first molar area, and implant was placed with free gingival graft. In third case, lower right molar area showed insufficient attached keratinized mucosa after implant placement with guided bone regeneration. When abutments were connected, free gingival graft with apically positioned flap was performed. RESULT: In these three cases, the zone of attached keratinized mucosa around dental implants was decreased after guided bone regeneration. And the increase of peri-implant attached keratinized mucosa could be obtained effectively by free gingival graft. CONCLUSION: Free gingival graft could be a effective treatment method increasing the zone of attached keratinized mucosa which was decreased after guided bone regeneration procedures.

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

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 2x4 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.