Management of inadequate keratinized gingiva and millers class III or IV gingival recession using two-stage free gingival graft procedure

Abstract

Background: Prognosis in the management of Millers Class III or IV gingival recession is often fair to poor, which is further decreased by factors such as inadequate keratinized gingiva. Very few modalities show long-term success in the management of gingival recession with inadequate keratinized gingiva, free gingival graft (FGG) being one such technique.

Materials and methods: Ten individuals with Millers Class III or IV recession and inadequate keratinized gingiva were recruited for the study. The first surgical procedure involved the FGG procedure to increase the width of keratinized gingiva (WOKG). Patients were recalled after 3 months for the second surgical procedure, where the flap was coronally advanced. They were recalled 9 months after the second surgery. WOKG was examined at baseline and 3 months (before the second surgical procedure). Recession depth (RD) and clinical attachment level (CAL) was examined at baseline, at 3 months (before the second surgical procedure) and at 12 months (9 months after the second surgical procedure). The percentage of root coverage was measured at 12 months from baseline.

Results: Significant increase in WOKG was seen at 3 months. Significant decrease in RD and CAL was observed at 12 months from baseline. The percentage of root coverage was 76.4%.

Conclusion: Two-stage FGG procedure can be a successful modality in the management of Millers Class III or IV recession with inadequate keratinized gingiva. This technique improves the prognosis of such compromised cases.

Keywords: Free gingival graft; gingival recession; inadequate keratinized gingiva; two stage.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2020 Indian Society of Periodontology.

Figures

Figure 1

Gingival recession at baseline

Figure 2

Clinical attachment level and recession depth in relation to 41 and 31

Figure 3

Width of keratinised gingiva in relation to 41 and 31

Figure 4

First surgical procedure-horizontal and vertical incisions

Figure 5

Partial thickness flap sutured to the periosteum at base

Figure 6

Harvesting of free gingival graft

Figure 7

Free gingival graft

Figure 8

Immobilisation of graft to recipient bed by suturing

Figure 9

Recipient site after 14 days

Figure 10

Recession depth and clinical attachment level at 3 months from baseline

Figure 11

Width of keratinised gingiva at 3 months from baseline

Figure 12

Second surgical procedure at 3 months from baseline-horizontal and vertical incisions

Figure 13

Partial thickness flap elevated

Figure 14

Coronally advanced flap sutured

Figure 15

Parameters at 12 months from baseline (9 months after second surgery)

Figure 16

Clinical attachment level and recession depth in relation to 41 and 31

Figure 17

Width of keratinised gingiva in relation to 41 and 31