The comparison of the efficacy of gingival unit graft with connective tissue graft in recession defect coverage: a randomized split-mouth clinical trial

Comparison of conventional and modified sling suture techniques in free gingival graft operations-a randomized controlled clinical trial

BACKGROUND

The aim of this study was to investigate the effects of conventional suture (CS) and modified sling suture (MSS) techniques, applied in free gingival graft (FGG) surgery using gingival unit graft (GUT) and conventional graft (CG) techniques, on clinical parameters and graft dimensions.

METHODS

52 individuals having Cairo Type 2 (RT2) and Type 3 (RT3) gingival recessions in mandibular anterior were divided into four groups as (a) GUT + MSS (n = 13), (b) GUT + CS (n = 13), (c) CG + MSS (n = 13) and (d) CG + CS (n = 13). Keratinized tissue width (KTW), relative gingival recession height (rGRH), and relative vestibule depth (rVD) measurements were recorded using a digital caliper and UNC 15 periodontal probe. Dimensional changes (Δ) of the graft surface area (GSA) was determined by ImageJ software. All measurements were done at baseline, 1st and 3rd months.

RESULTS

It was determined that the increase in KTW in the 1st and 3rd months in GUT + CS group was significantly higher than GUT + MSS group (p < 0.05). There was no statistically significant difference in Δ rVD and Δ rGRH values between the groups. When ΔGSA (mm2) values were compared between the groups, the decrease in the 1st and 3rd months in the CG + MSS group was found to be significantly higher than the GUT + MSS and GUT + CS groups (p < 0.05).

CONCLUSION

Within the limits of this study, it can be concluded that keratinized tissue can be obtained successfully with both GUT or CG techniques in FGG surgery, on the other hand, regardless of the suture technique, GUT showed less graft shrinkage than CG.

TRIAL REGISTRATION

The study was retrospectively registered at ClinicalTrials (Registration number: NCT06197893; Date of registration: 11 January 2024).

Volumetric changes in free gingival graft and gingival unit graft treatments evaluated using an indirect digital method

BACKGROUND

The aim of this study was to evaluate clinical one-dimensional changes such as root surface coverage, decrease seen in the amount of gingival recession and keratinised gingival width (KGW) obtained throughout a 6-month follow-up period following the treatment of Cairo class II gingival recession with free gingival graft (FGG) and gingival unit graft (GUG). Three-dimensional changes in gingival volume and thickness were also compared digitally using an indirect method.

METHODS

A total of 20 patients with localised Cairo class II gingival recession were randomly separated into two groups; 10 patients were treated with FGG and 10 patients treated with GUG. Preoperatively and at 6 months postoperatively, the initial position of the gingiva and KGW were recorded for all the patients and plaster models were formed from the obtained impressions with the traditional method. The plaster models were transferred to a digital environment by scanning with a model scanner. Using a software program, changes in gingival papillary height and gingival volume and thickness were compared between the groups and according to the baseline values from The Standard Tessellation Language (STL) files obtained.

RESULTS

Compared to the baseline values, a significant increase was determined in the KGW, and a significant decrease in pocket depth, clinical attachment level, and gingiva recession depth in all the groups (p<0.05). No statistically significant difference was determined between the groups in respect of the changes in mean gingiva thickness, gingiva volume, and mean vertical papillary height (p>0.05).

CONCLUSION

The study results showed that GUG treatment for Cairo class II localised gingival recession is an effective method in respect of increasing gingiva volume and thickness, increasing KGW, coverage of the root surface, and forming tissue contours that allow the patient to easily maintain oral hygiene. However, there was not seen to be any adventage of GUG and FGG over each other.

A Modification of Fenestration Technique (MOFT) to Increase Vestibular Depth: A Case Series

ABSTRACT

The most prevalent mucogingival issues include insufficient gingival width, decreased vestibular depth, abnormal frenal attachment, gingival recession, pockets that reach the mucogingival junction, excess gingival, inconsistent gingival margin, excessive gingival display and abnormal gingival colour. Numerous periodontal plastic operations have been used to treat these issues. However, each approach has its own drawbacks and is technique-dependent. Adequate depth of vestibule is necessary to maintain good oral health as shallow vestibule leads to accumulation of food and thus impedes oral hygiene maintenance. This case series describes a vestibular deepening procedure performed using modification of periosteal fenestration technique. This technique includes a series of eight cases of shallow vestibule where vestibular deepening was conducted by giving a full-thickness incision to expose the periosteum and create a window of fenestration followed by suturing the labial mucosa to the periosteum at the apical level. The results reported an excellent post-operative outcome showing increased depth of the vestibule.

Successful management of gingival recession with creeping attachment: A case report

Key Clinical Message

A successful management of a mandibular recession with creeping attachment using free gingival graft. This case highlights the "wait-and-see" approach in the treatment plan, emphasizing the root coverage.

Abstract

This clinical report describes the case of a 23-year-old female patient with gingival recession of the mandibular left central incisor. The patient's symptoms included hypersensitivity and cosmetic improvements. After thorough examination, the patient was diagnosed with plaque-induced gingivitis on a reduced periodontium with acquired mucogingival deformities. Gingival recession was classified as Miller class II or Cairo Recession Type 1. The treatment plan consisted of a nonsurgical phase, followed by a surgical phase using a free gingival graft. The surgical procedure involved harvesting the graft from the palatal mucosa and placing it in the recipient site. Post-operative care and instructions were provided and a comprehensive follow-up schedule was established. At the 12-month evaluation, the patient exhibited healthy periodontal conditions with creeping attachment and complete root coverage. The success of the treatment approach demonstrates its effectiveness in addressing hypersensitivity and cosmetic concerns, while improving periodontal health. Factors influencing the achievement of creeping attachment are discussed, including recession width, graft position, bone support, tooth position, patient hygiene, graft thickness, and root surface treatment.

Comparison of the effectiveness of Gingival unit transfer and free Gingival graft in the management of localized Gingival recession - A systematic review

Background

Gingival Recession (GR) is defined as the displacement of the soft tissue margin apical to the cementoenamel junction which can lead to root exposure and hypersensitivity. Treatment of GR has become an important therapeutic issue due to the increasing number of cosmetic requests from patients. Several techniques exist for the management of GR that include Sub-Epithelial Connective Tissue Graft (SECTG), Pedicle Graft (lateral and coronal), and Free Gingival Graft (FGG) and more. FGG is a non-submerged grafting procedure carried out for the management of recession defects. However, FGG has limitations like aesthetic mismatch and bulky appearance. A relatively newer modification of FGG was introduced by Allen in 2004 wherein a palatal graft including the marginal gingiva and interdental tissue was used as donor tissue for recession coverage. This review aims to study and compare the use of Gingival Unit Graft/Transfer (GUG/GUT) (palatal graft including the marginal gingiva and papillae) and FGG in the management of GR.

Materials and Methods

Randomized Clinical Trials, Non-Randomized Controlled Clinical Trials for the treatment of Miller Class I,II, and III of GRs by GUG with FGG were identified. Data sources included electronic databases and hand-searched journals. The primary outcome variables were complete root coverage, mean root coverage, vertical recession depth. The secondary outcome variables were keratinized tissue width gain, clinical attachment level and probing depth.

Results

Three Randomized Control Trials (RCTs) met the inclusion criteria and were evaluated in this systematic review. Both techniques showed significant improvement in clinical parameters. GUG procedure resulted in a greater percentage of sites achieving complete root coverage and vertical recession depth reduction when compared to FGG group in all the studies. Two studies reported significantly greater mean root coverage in GUG group compared to FGG group. GUG procedure revealed statistically significant greater gain in keratinized tissue width when compared to FGG group in all the studies.

Conclusion

Because of the limited number of selected studies, no conclusive statement could be made regarding the advantage of the GUG technique over FGG. However, the percentage of sites with complete root coverage obtained in the GUG technique is higher than FGG. More RCTs with aesthetic and patient satisfaction-related parameters are needed to provide definite evidence.

Clinical comparison between different surgical techniques used to manage advanced gingival recession (Miller's class III & IV)

Advanced gingival recession is considered a complex soft tissue problem, which is increased in severity with age, and has multiple etiological factors. Therefore, the treatment is very complicated with low predictability. However, in the last decade, many clinical trials have shown highly predictable results when managing advanced recession cases by surgical intervention.

The present review shows different surgical techniques with their clinical outcomes in order to choose the most suitable technique required by the clinical condition. Although there are relatively few studies, modified tunnel technique and coronal advanced flap (CAF) showed the highest percentage of root coverage (%RC) during the first year (up to 86%). These techniques are primarily indicated to manage advanced recession in the esthetic zone. Pedicle buccal fat pad (PBFP) also had a good percentage of root coverage when used in the maxillary posterior area, as it has a high blood supply with minimal risk for infection and necrosis. Free gingival graft (FGG) can be used in the mandibular anterior area, as it creates a band of keratinized tissue that can resist recession with a fair percentage of root coverage. However, color match and graft shrinkage are the main problems of this procedure.

Enhancing Gingival Phenotype With Vestibuloplasty and Free Gingival Graft: Improving Maintenance of Regular Oral Hygiene

This case report describes Clark's technique of vestibuloplasty to treat shallow vestibule and, in addition, the use of free gingival autograft to augment attached gingiva to treat Miller's recession. Vestibuloplasty is performed to deepen a shallow vestibule. Different vestibuloplasty techniques are used to deepen the shallow vestibule by modifying the soft tissue attachment. A 29-year-old male presented to the Department of Periodontics and Oral Implantology, Regional Dental College, Guwahati, India with the chief complaint of bleeding from the lower anterior along with the gingival recession. Maintenance of regular oral hygiene was an added hindrance. The combined technique of vestibuloplasty and use of free gingival graft was performed to achieve dual benefits of increasing the vestibular depth and attainment of a thick gingival phenotype.