Total coverage of multiple and adjacent denuded root surfaces with a free gingival autograft. A case report

Oral reconstructive and corrective considerations in periodontal therapy

This paper was prepared by the Research, Science and Therapy Committee of the American Academy of Periodontology. It is intended to provide information for the dental profession and other interested parties. The purpose of this paper is to provide a general overview of oral reconstructive and corrective procedures used in periodontal therapy. It is not intended to be a comprehensive review of this subject.

A critical evaluation of methods for root coverage

Gingival recession is the exposure of root surfaces due to apical migration of the gingival tissue margins. Although it seldom results in tooth loss, marginal tissue recession is associated with thermal and tactile sensitivity, esthetic complaints, and a tendency toward root caries. This article reviews the current surgical procedures for the coverage of exposed root surfaces, including their advantages and disadvantages. Today, the outcome of root coverage procedures is predictable, aesthetically acceptable, and, together with the use of guided tissue regeneration, at the forefront of regenerative procedures.

Free autogenous graft coverage of vital retained roots

The use of free autogenous grafts to the alveolus during root submergence was shown to be a method that might be used to prevent the loss of masticatory mucosa and vestibular depth, which have been regarded as problems associated with the procedure.

Free gingival grafts for the treatment of gingival recession. A review of some techniques

Free gingival grafts can be utilized, alone or in combination with a coronally positioned flap, for the prevention and the treatment of gingival recession. The graft can be placed directly on the denuded root, as first described by Sullivan & Atkins (1968). This technique will provide adequate results, especially in cases with relatively little recession. After placing a free gingival graft in such an area, one can often observe bridging and/or creeping attachment. In the case of bridging, some of the grafted tissue will remain vital over the avascular zone, i.e. the root. Creeping attachment is the result of coronal migration of the grafted gingiva and will take place during the years following surgery. Bridging and creeping are most likely to occur in cases of narrow recession where the grafts had been placed directly over the denuded zone. In a second type of surgical procedure, an enlargement of the attached gingiva is first obtained through the graft. The area of recession is later covered by a coronally positioned flop. Several cases are presented which illustrate the results obtained with this procedure. In children, when there is insufficient attached gingiva, it is often desirable to place grafts before orthodonic therapy. In the prevention or treatment of gingival recessions, four possibilities may be considered: 1) no treatment, 2) placement of a graft to prevent recession, 3) stabilizing an existing recession, 4) attempt to cover the denuded root.

The sutureless free gingival graft

A technique designed to utilize the autogenous free gingival graft without the use of sutures was demonstrated. Necessary objectives were maintained but achieved without unnecessarily piercing the graft, and in less time. The only variance in results would be due to the underlying physical properties of the recipient site. This new approach to grafting avoids the cyanoacrylate from getting between the graft and recipient site, therefore acting as a foreign body. Also shown was the complete coverage of a denuded root surface by this technique using a free autogenous gingival graft. This technique enables the surgeon to achieve the results of a predictable technique (autogenous free gingival graft) even more predictably simple.

The presence of "creeping attachment" in human gingiva

Standardized photography was used to determine the presence of "creeping attachment" after free autogenous graft procedures on localized areas of root recessions. "Creeping attachment" occurred in all seven experimental teeth with an average of 0.89 +/- 0.46 mm and a range of 0.38--0.61 mm during a period of 1 year. The results encourage the use of grafts over exposed root surface in an attempt for gingival coverage.

Placement of free gingival grafts on denuded alveolar bone. Part I: clinical evaluations

Fourteen patients were examined and determined to lack an adequate zone of attached gingiva in the mandibular incisor region. Each patient was treated on the left side of the mandible by placement of a free gingival graft on denuded bone and 12 of the 14 patients received a free gingival graft on retained periosteum in the right mandibular anterior region. Two patients were treated on the right side by either bone denudation or periosteal bed preparation without graft placement to permit histological evaluation of wound healing under these circumstances. Grafts were retained for time intervals from 1 week to 24 weeks. All patients were evaluated clinically for graft "take", graft healing, graft shrinkage, and graft mobility.