Title: Management of Multiple Mucogingival Defects by way of Versatile Free Gingival Graft

Authors: Dr Suchetha A, Dr Joseph Kishore Reddy, Dr Darshan BM, Dr Sapna N, Dr Apoorva SM, Dr Divya Bhat, Dr Freeda Ampotti

 DOI: https://dx.doi.org/10.18535/jmscr/v8i9.42

Abstract

Background: Gingival recession is defined as exposure of the root surface by an apical shift in the position of the gingiva. It is most probably the result of the cumulative effect of minor pathologic involvement like inflammation or repeated trauma to the gingiva.2 The other  etiologic factors are faulty tooth brushing technique (gingival abrasion), tooth malposition, friction from soft tissues (gingival ablation),abnormal frenum attachment. The treatment of gingival recession comes under mucogingival surgery. There are many treatment modalities are present to correct gingival recession defects. They are use of free gingival autograft, free connective tissue autograft, pedicle autografts, laterally (horizontally) positioned, Coronally positioned, Semilunar pedicle (Tarnow), Sub epithelial connective tissue graft (Langer), Guided tissue regeneration, Pouch and tunnel technique. Despite of the advances in technique of correction of gingival recession, free gingival graft continues to be a reliable procedure for increasing the width of keratinized gingiva and stopping the progression of gingival recession.

Case Presentation: In the present article discussing two case reports presented with millers class II GR with abnormal frenum pull. Classic technique given Bjorn by using free gingival graft was used.There was a significant reduction in RD after one month and 3months post operatively.

Conclusion: The free gingival graft for root coverage is a feasible and effective treatment procedure in mucogingival surgery. Despite the fact that other effective root coverage techniques have been described, the free gingival graft may still be the best treatment choice for gingival recession.

References

  1. Sabarinathan Prevalence of Gingival Recession among the Different Races of Patients Reporting to Penang International Dental College, International Journal of Dental Sciences and Research, 2014, Vol. 2, No. 4A, 1-3.
  2. Susin C, Haas AN, Oppermann RV, Haugejorden O, Albandar JM. Gingival recession: epidemiology and risk indicators in a representative urban Brazilian population. J Periodontol 2004;75(10):1377–86.
  3. Hall WB. Present status of soft tissue grafting. J Periodontol 1977; 48:587-597
  4. Breitenmoser, Mormann W, Muhlemann HR. Damaging effects of toothbrush bristle end form on gingiva. J Periodontol 1979; 50:212- 216.
  5. Baker D.L., & Seymour, D.J. The possible pathogenesis of gingival recession. A histological study of induced recession in the rat. J Clin Periodontol 1976; 3:208-219.
  6. Waerhaug, J. The gingival pocket. Anatomy, pathology, deepening and elimination. Odontologisk Tidskrift 1952; 60, suppl.
  7. American Academy of Periodontology: Proceedings of the World Workshop in Clinical Periodontics. Annals of Periodontology. Chicago, 1989, The Academy.
  8. American Academy of Periodontology: Proceedings of the World Workshop in Periodontics. Annals of Periodontology. Chicago, 1996, The Academy.
  9. Bowers, G.M. (1963). A study of the width of attached gingiva. Journal of Periodontology 34, 201–209.
  10. Freedman, A.L., Green, K., Salkin, L.M., Stein, M.D. & Mellado, J.R. (1999). An 18-year longitudinal study of untreated mucogingival defects. Journal of Periodontology 70, 1174–1176.
  11. Ochsenbein, C. (1960). Newer concept of mucogingival surgery. Journal of Periodontology 31, 175–185.
  12. Gottsegen, R. (1954). Frenulum position and vestibular depth in relation to gingival health. Oral Surgery 7, 1069–1078.
  13. Vikas Jindal,Variations in the frenal morphology in the diverse population: A clinical study, Journal of indian society of periodontology. Vol 20,Issue 3,Page no 320-323.
  14. Kan JY, Morimoto T, Rungcharassaeng K, Roe P, Smith DH Int J Periodontics Restorative Dent. 2010 Jun; 30(3):237-43.
  15. Review Flap thickness as a predictor of root coverage: a systematic review. (Hwang D, Wang HLJ Periodontol. 2006 Oct; 77(10):1625-34.)
  16. Philippe bouchard. Decision-making in aesthetics: root coverage revisited, Periodontology 2000, Vol. 27, 2001, 97–12.
  17. Barbosa FI, Corrêa DS, Zenóbio EG, Costa FO, Shibli JA. Dimensional changes between free gingival grafts fixed with ethyl cyanoacrylate and silk sutures. J Int Acad Periodontol. 2009;11 (2):170‐176.)
  18. Bjorn H: Free transplantation of gingiva propia. Sveriges Tandlak T 1963; 22:684.
  19. Sullivan HC, Atkins JC: Free autogenous gingival grafts. III. Utilization of grafts in the treatment of gingival recession. Periodontics 1968; 6:152.
  20. Gudio G, Nieri M, Rotundo R, Cortellini P, Pini Prato G. Free gingival grafts to increase keratinized tissue: A retrospective long-term evaluation (10 to 25 years) of outcomes. J Periodontol 2008;79:587- 94.

Corresponding Author

Dr Joseph Kishore Reddy

Post Graduate Student, Department of Periodontology, DAPMRV Dental College, Bangalore, Karnataka