Modified Free Gingival Autograft: A Case Report

The purpose of this case study was to introduce an innovative method utilizing a modified free gingival graft technique, with the goal of accomplishing vertical and horizontal augmentation of soft tissue in the mandibular anterior region. A 35-year-old female patient underwent the modified free gingival graft technique in the anterior mandibular area. Remarkably, after a span of nine months, an increase was noted in both horizontal and vertical dimensions of the gingival tissue. This transformation was met with satisfaction from the patient. Following the successful graft procedure, a vertical gain of 3 mm was observed in the keratinized gingiva.

Modified-free gingival graft technique for treatment of gingival recession defects at mandibular incisors: A randomized clinical trial

BACKGROUND

The aim of this study was to evaluate clinical and patient-reported outcomes following surgical root coverage at RT1 gingival recession defects at mandibular incisors, using either a conventional free gingival graft (FGG) or a modified FGG (ModFGG).

METHODS

Total of 30 patients with RT1 gingival recessions at mandibular incisors were enrolled and randomly allocated to either a control (FGG) or test group (ModFGG). Evaluations of clinical changes (recession depth, height of keratinized tissue) and patient satisfaction were performed over a follow-up period of 12 months. Post-surgical changes of keratinized tissue height (shrinkage) were assessed from 1 month and onward.

RESULTS

ModFGG resulted in more pronounced root coverage at 1 year compared to FGG (91.8% vs. 60.7%, p < 0.001). Height of keratinized tissue was improved by 4.2 and 2.2 mm (p < 0.001), respectively, with significantly less shrinkage in ModFGG. Post-surgical morbidity was significantly lower for ModFGG at 2 weeks and patient satisfaction was significantly higher 12 months after treatment (9.1 vs. 5.4; p < 0.001).

CONCLUSIONS

ModFGG represents a valid approach for the management of RT1 recession defects at mandibular incisors. The technique is superior to traditional FGG in terms of root coverage, the gain of keratinized tissue height, and patient satisfaction.

Hyaluronic Acid as an Adjunct to Coronally Advanced Flap Procedures for Gingival Recessions: A Systematic Review and Meta—Analysis of Randomized Clinical Trials

Previous systematic reviews have reported that coronally advanced flap (CAF) + connective tissue graft (CTG) are the gold standard in root coverage procedures (RCP). Nevertheless, adjunctive treatment with hyaluronic acid (HA) has been proposed to aim at improving clinical outcomes and reducing patient morbidity. The aim of this systematic review and meta-analysis is to compare the use of HA as an adjunctive treatment to CAF procedures in Miller class I and II (recession type 1; RT1) gingival recession (GR) defects treatment with no adjunctive/other treatments. MEDLINE, The Cochrane Central Register of Controlled Trials, Web of Science, Scopus databases and gray literature were searched up to April 2022. The primary outcome variables were mean recession coverage (MRC) and reduction of the recession depth (RecRed). Weighted mean differences and 95% confidence intervals between treatments were estimated using a random-effect mode. From 264 titles identified, 3 RCTs reporting 90 GR defects in 60 patients were included. Overall analysis of MRC and RecRed were 0.27% (p = 0.01) and 0.40 mm (p = 0.45) in favor of CAF + HA compared to CAF alone/CAF + subepithelial connective tissue graft (SCTG), respectively, with a statistically significant difference only for MRC values. Nevertheless, due to the limited number and heterogeneity of the included studies, well-performed RCTs are needed to clarify a potential advantage of HA in RCPs in the future.

New surgical approach for mandibular anterior root coverage by modified tunnel technique with simultaneous frenuloplasty: Technical description and 5-year recall case report

INTRODUCTION

Root coverage of gingival recessions in the anterior mandible has limited predictability. Mandibular incisors often offers a thin phenotype, a lack of keratinized tissue and moreover a shallow vestibule with high labial frenum attachment. These conditions induce tensions on the surgical site in conventional coronally advanced flap (CAF) procedures and may compromise the complete root coverage. The purpose of this case report is to present a novel surgical technique for deep labial recessions on mandibular incisors, based on a modified tunnel technique with subepithelial connective tissue graft (CTG) in combination with simultaneous frenuloplasty.

CASE PRESENTATION

A 20-year-old female patient was referred to the office for treatment of an isolated RT1 in Cairo classification buccal recession on #24 with a shallow vestibule. The design of the recipient site consisted of a full-thickness modified tunnel preparation extending 4 mm bilaterally to the recession and beyond the crestal bone. A CTG was harvested from the palate and properly adapted to the root surface. The graft and flap were secured with single-interrupted sutures and double-crossed sutures to achieve complete root coverage. Frenuloplasty was then performed with a single incision in the bottom of the vestibule and careful sectioning of frenum fibers to release vestibular tensions. Complete root coverage was maintained at 5 years with completely satisfactory esthetic outcomes.

CONCLUSION

Treatment of single deep mandibular anterior recessions with a combined tunneled CTG approach in addition to frenuloplasty appears to lead to complete long-term root coverage in one surgery with lasting esthetics results.