Evaluation Of Effectiveness Of Free Gingival Graft
Evaluation Of Effectiveness Of Free Gingival Graft (FGG) For The Escalation Of Gingival Height By Gingival Thickness Augmentation: A Case Series Bushra K Quazi 1, M.L.Bhongade 2 A B S T R A C T INTRODUCTION: Autogenous gingival grafting is a well established pure mucogingival procedure forincreasing the width of keratinized gingiva. This procedure has proven reliable in increasing keratinized gingiva and stopping progressive gingival recession. The long term stability (upto 4 years) of these treatment outcomes has been demonstrated. METHOD AND MATERIAL: In this case series, 3 cases associated with inadequate width of kerationized gingiva in relation with multiple mandibular anterior teeth were treated by autogenous free gingival graft obtained from palatal region for increasing the width of attached gingiva. For clinical evaluation, all the cases were followed 3 months post-surgically. RESULTS: 3 months post surgical re evaluation showed an average of mm increase in width of keratinized gingiva. Healing at the donar site was uneventful in all treated cases. CONCLUSION: The results of the present case series for increasing the width of keratinized gingival and gingival thickness augmentation using free gingival autograft indicate that this procedure could be applied for increasing the width of keratinized gingiva on larger area (2-3 teeth). The free soft gingival autograft when used for increasing the amount of keratinized gingival by escalation of gingival height is a relatively simple surgical procedure. Introduction : For many years, the presence of an‘‘adequate’’ amount of gingiva was considered a keystone for the maintenance of periodontal health.1-4 In an observational study, Lang and Loe5 reported that despite the fact that the tooth surfaces were free from plaque, ‘‘all surfaces with less than 2.0 mm of keratinized gingiva exhibited clinical inflammation and varying amounts of gingival exudates.’’ However, a number of authors suggest that sufficient amount of keratinized tissue is considered essential to preserve the healthy periodontal status and to support the dentogingival unit more resistant during the masticatory function and oral hygiene procedure (Lang and Loe 1972). Therefore the presence of gingival recession associated with a minimal amount or lack of keratinized gingiva may indicate need of gingival augmentation procedure to prevent additional apical displacement of the gingival margin (Agudio 2008,Bertoldi 2007, Camargo et al 2001). In particular, Serino et al.6 showed that sites with gingival recession should be considered susceptible to additional apical displacement of the soft tissue margin. Based on existing evidence, the American Academy of Periodontology suggested several indications for gingival augmentation procedures: to prevent soft tissue damage in the presence of alveolar bone dehiscence during natural or orthodontic tooth eruption; to halt progressive marginal gingival recession; to improve plaque control and patient comfort around teeth and implants; and to increase the insufficient dimension of gingiva in conjunction withfixed or removable prosthetic dentistry.7 To achieve respectable periodontal esthetics is always an important, yet difficult,but predictable part of practice in periodontology, for which gingival biotype has been the subject of considerable interest amongst periodontists, especially in the last decade. Direct correlation has been suggested to exist between gingival biotype and the susceptibility to gingival recession following surgical and restorative procedures.8 Soft-tissue biotype (gingival thickness) is a critical factor that determines the result of dental treatment. Periodontal surgical procedures can improve soft-tissue quality resulting in a favorable treatment outcome. Numerous surgical procedures have been advocated to achieve predictable gingival augmentation. Amongst them, autogenous gingival grafting or epithelialized free gingival grafting is a well-established pure mucogingival procedure for increasing the zone of the attached gingival and stopping progressive gingival recession.9 A free gingival graft procedure is one of the most common approaches for gingival augmentation.10-14 This technique accomplishes the following objectives: enhances plaque removal around the gingival margin, reduces gingival inflammation and improves esthetics(Sangnes and gjermo 1976). Some studies reported short- or medium-term data dealing with the stability of the gingival margin after free gingival graft procedures. Very limited data on the position of the gingival margin after the use of free gingival graft over a long period of time is available. Therefore the aim of the present study was to evaluate the effectiveness of free gingival graft for the escalation of gingival height by gingival thickness augmentation. Method and materials: A total of 3 patients with age, ranging from 17 –25 years were selected randomly for examination from the outpatient Department of Periodontics, sharad Pawar dental College Sawangi(Meghe) Wardha. The patients were selected using the following criteria: Inclusion criteria: 1) Full mouth plaque and bleeding score<20% 2) Presence of atleast one site with complete absence of attached gingival associated with gingival recession and normal sulcus depth Exclusion criteria: 1) Systemically unhealthy patiens. 2) History of periodontal surgery in selected area. Prior to initiating of this study, the purpose and diagnostic procedure of this clinical trial was explained to the patients and provided verbal informed consent to participate in the study. The study protocol was first approved by the research and ethical committee of Datta Meghe Institute Of medical Sciences, Sawangi (Meghe), Wardha. Information concerning dietary status, mouth cleaning habits, systemic background, gingival and periodontal status along with other routine clinical details was recorded . Patients were examined under good illumination with the help of mouth mirror and William’s graduated periodontal probe. Patient’s oral hygiene was evaluated by using Plaque Index (Turkesy-Gilmore-Glickman Modification of Quigley-Hein, 1970) as an expression of the level of localized mouth supragingival plaque accumulation. Gingival inflammation was assessed by papillary bleeding index (Muhlemann H.R; 1977). Clinical measurements: The following measurements were recorded at baseline and 3 months after surgery. – Gingival recession depth (the distance between the gingival margin and the cemento-enamel junction at the mid-buccal point); – Width of the keratinized gingiva (the distance fromthe gingival margin to the mucogingival junction at themid-buccal point); – Probing depth at the experimental site (the distance from the gingival margin to the bottom of the gingival sulcus). Surgical procedure Preparing the recipient site: After achieving adequate local anesthesia (2% lignocaine with 1:80,000 adrenaline), the exposed root surface was planed thoroughly with a Gracey 1-2
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