Follow-up studies of free gingival grafts

Abstract Vestibuloplasties with free gingival grafts were performed on 42 teeth in 12 patients exhibiting gingival recession. The tendency toward recurrence was studied after postoperative intervals of 1, 6 and 12 months. The extensions (vestibuloplasties), which were always wider than the transplant, recurred up to the transplantation margin. The transplant itself underwent shrinkage averaging 25 per cent. The vestibular depth, which had been increased by the operation, showed a 25 per cent reduction within 1 month, but then had a tendency to deepen again from 1 to 12 months postoperatively. The marginal free gingiva and sulcus depth were not influenced by the operation.     

Creeping attachment after free gingival grafts.

Free gingival grafts were placed in the lower anterior vestibular region of 30 patients each of whom had a gingival recession. According to the width of the recession and to the surgical procedure, the patients were divided into four groups. Group 1 showed a "narrow" (less than 3 mm) type of recession, while Group 2 had a "wide" type. In both of these groups the graft was placed over the denuded root. In Group 3 (narrow recession) and Group 4 (wide), a collar of vestibular gingiva was left in place on the lower margin of the denuded root at the moment of grafting. Measurements and photographs taken before and 1 month after surgery, 6 months and 2 years postoperatively, showed varying degrees of root covering by the phenomenon of creeping attachment. An optimal recovery of the gingival profile was obtained in the three patients of Group 1. In the other categories of patients the creeping of the attachment apparatus was relatively small (between 0 and 33%) within the 2 years of observation. The factors which seem to have a definite influence upon the phenomenon of creeping attachment are the following: width of the recession, position of the graft, bone resorption, position of the tooth and hygiene of the patient.     

Treatment of gingival lichen with free palatal grafts

BACKGROUND: Recalcitrant gingival erythematous lichen planus/lichenoid lesions comprise a considerable therapeutic problem. The objective of this study was to evaluate the therapeutic effect of grafting keratinized oral palatal mucosa to the sites of gingival lichen. METHODS: In 12 patients 20 grafts were transplanted to buccal gingival lesions. Mean age of the patients was 59.8 +/- 7.1 years (range 46-71 years). The mean observation time was 32 +/- 32.7 months (range 5-97 months). RESULTS: On a 4-point clinical grade scale (0-3), 12 (60%) transplants showed complete healing grade 3, six (30%) grade 2 and two (10%) grade 1. CONCLUSIONS: Using oral mucosal grafts from the palatal mucosa for the treatment of recalcitrant erythematous gingival lichen planus/lichenoid lesions seems to be a promising treatment modality.     

Buccal bony exostoses induced by free gingival grafts

Buccal Bony Exostoses (BBE) is a local benign osseous overgrowth continuous with the facial aspect of the jaw. Post operative BBE may be the result of dermal grafts used to restore the buccal vestibulum, of connective tissue graft placement, and of Free Gingival Grafts (FGG) procedures. In 46 patients in whom 72 FGG procedures were performed by the senior author (HT) over the past 12 years, BBE was clinically and radiographically diagnosed. In one case the tumor was surgically removed. The etiology, pathogenesis and frequency of BBE following FGG procedures was reviewed and discussed. We suggest that the BBE may develop owing to periosteal surgical trauma during FGG procedures, and suggest that this phenomenon receives further attention.     

Microscopic evaluation of the healing and revascularization of free gingival grafts

The objective of this study was to observe the microscopic appearance of the healing and revascularization of free gingival grafts when placed over periosteum. Seven rhesus monkeys were used to provide observation periods of 0, 2, 4, 5, 7, 8, 11, 14, 17, 21, 28, and 42 days following surgery. After dissection and excision of a split flap in the anterior region to prepare the graft bed, a mucoperiosteal graft of attached gingiva from the buccal of the premolar area was sutured in place. The animals were injected with carbon serum just before sacrifice and after preparation the histologic and cleared specimens were studied under the microscope.
The results indicate that the healing and revascularization of free gingival graft and skin grafts are similar. Cellular nutrition was maintained for the first few days by a "plasmatic" circulation. Revascularization occured initially by anastomoses between vessels of the graft bed and pre-existing vessels in the graft and later by capillary budding which penetrated the graft. Carbon serum was present in the vessels of the graft at four days. There was increasing vascular density up to seven days followed by a gradual reduction and return to a normal vascular pattern after 14 days. The graft was initially separated from the bed by a thin layer of fibrinous exudate. Fibroblasts proliferated into the area and a firm fibrous union to the periosteum was apparent between 7–11 days. Initial disintegration of most of the graft epithelium ccured. Re-epithelialization resulted from migration of new epithelium from adjacent gingiva and from surviving basal cells of the graft epithelium. The epithelium had a relatively normal appearance by 14 days although new keratinization was not apparent for 28 days. The connective tissue disintegrated in portion of some of the graft and was replaced by granulation tissue which delayed healing.     

Crevicular tissues as donor tissue for free gingival grafts

Free gingiva grafts were placed into six facial sites having minimal width of attached gingiva in three adult patients. The donor tissue consisted of autogenous pocket lining which was surgically excised immediately prior to graft placement. Thus, the graft contained crevicular epithelium and adjacent corium which was placed into the recipient bed with the crevicular epithelium facing the oral environment. Three months post-operatively, all grafts appeared to have taken clinically. At this time, a slit biopsy was obtained from the graft site which included portions of the gingival margin and attached gingiva. Histologically, the graft area appeared different from attached gingiva. The epithelium showed evidence of parakeratinization. However, the cells appeared enlarged, the cellular layers less distinct and the entire epithelium was widened. The corium seemed less well organized than normally seen in attached gingiva. Since the donor tissue consisted of crevicular epithelium and adjacent corium, it would appear that the altered environment into which this tissue was placed affected its normal morphology.     

Influence of free gingival grafts on the health of the marginal gingiva

Abstract In order to evaluate the effect of increasing the width of inadequate attached gingiva on the health of the marginal gingiva, 12 free gingival grafts were performed on 12 patients with less than 1.0 mm of attached gingiva on homologous contralateral pairs of mandibular teeth. A baseline examination, which included measurements of plaque, gingival exudate, sulcus bleeding, sulcus probing depth and width of attached gingiva, was done before surgery. One week after surgery, plaque was eliminated mechanically on the test and control sides. All measurements were repeated 7 and 14 weeks after surgery. During the week following the first postsurgical examination, individual oral hygiene instruction was given until the patient could show plaque-free test and control sites. The width of the attached gingiva increased significantly on the side where the grafting was performed (test side). The only other significant changes observed during the experiment were a decrease of the mid-buccal plaque index on the test side during the first 7 weeks following surgery and a decrease of the buccoproximal plaque index on the test and control sides during the total experimental period (14 weeks). None of the other clinical parameters measured showed significant differences when test and control sites were compared or when the same sites were compared longitudinally.