Quantitative assessment of free gingival grafts with and without periosteum and osseous perforation

Freeze-dried skin allografts. A human clinical and histological study

Free gingival autografts still remain the most predictable method for creating attached gingiva. However, a need exists for sources of connective tissue other than the patient's own connective tissue. Yukna et al. have proposed freeze-dried skin (FDS) allografts as a substitute for gingival autografts. The purpose of the present study was to evaluate FDS allografts on humans, clinically and histologically. Ten FDS allografts and two free gingival (FG) autografts were performed on ten patients, two of them receiving both FDS and FG grafts. Clinical measurements were made before surgery, immediately after surgery and then 2 and 6 months after surgery. After 4 and 24 months, biopsies were performed on both FG and FDS grafts. Routine histologic staining was done. The results show a mean gain of attached gingiva of 0.32 mm with a range from 0 to 0.8 mm. Compared biopsies sections of FDS allografts and FG autografts show that the tissue obtained with the FDS allografts do not display the histomorphologic pattern of attached gingiva. The FDS allografts do not seem to represent a good substitute to free gingival autografts. However, they might be used successfully as a biological bandage.

Revascularization of gingival autografts placed on different receptor beds. A fluoroangiographic study

The revascularization of gingival autografts, placed either on fenestrated periosteum or on non-fenestrated periosteum, has been compared by means of 12 fluorescein angiographs, taken 8, 10 and 12 days postoperatively on 12 patients, 18-32 years of age. The grafts placed on periosteum (P-zone) showed a mean increase of fluorescence of 10.6% between the 8th and 10th day and of 19.4% between the 10th and 12th day. At that time the circulatory system in the graft seemed to be established for 97.7%. The grafts placed on fenestrated periosteum (B-zone) showed a mean increase of fluorescence of 13.2% between the 8th and the 10th day and of 13.5% between the 10th and 12th day. The revascularization reached 96.1% at that time. Between both groups no statistically significant difference has been found. It can be concluded that a periosteal receptor side is not a prerequisite for the formation of an even circulatory pattern in gingival autografts.