Document Type : Original Article

Authors

Dept. of Periodontology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract

Statement of the Problem:The periodontal health and marginal stability of gingiva can be negatively affected by a number of dental conditions in association with deficiency of attached gingiva.
Purpose: This study aimed to compare the color and width of tissue grafted by two surgical techniques of keratinized gingival augmentation, namely free gingival graft(FGG) and connective tissue graft (CTG) covered by thin mucosal flap .
Materials and Method: This clinical trial was performed on 15 adult individuals. The patients showed less than 2mm keratinized gingiva on two different recipient sides. One side was to be treated with CTG as the test group and the other side to be treated with FGG as the control group. The amount of keratinized gingiva before the surgery, size of grafted tissue during the surgery and 6 month after the surgery was documented. Six months after healing, the test and control sides were compared in terms of the width of generated gingiva on both sides, and the color match of the grafted areas with the surrounding gingiva or mucosa. The color of the grafted areas was determined and compared by using both professional evaluation and digital evaluation.
Results: In digital evaluation, ∆E (which shows color mismatch) was higher in FGG. In professional evaluation, visual analogue scale (VAS) was used by two blinded periodontists. The mean VASin FGG was less than CTG. The mean increase of gingival width was higher in CTG. The increased width in CTG technique was more than that in FGG technique. This difference was statistically, but not clinically, significant.
Conclusion: Higher ∆E in control side and higher mean VAS CTG both showed better color adaptation of CTG side. FGG can be used in case of increasing keratinized gingiva, vestibular depth, and in patients with low smile line without esthetic concerns. However, using connective tissue in the underlying thin mucosal layer is preferred for gingival augmentation if there are adequate vestibule depth and esthetic concerns, like in maxillary canine.
 

Keywords

1. Agudio G, Cortellini P, Buti J, Pini Prato G. Periodontal Conditions of Sites Treated With Gingival Augmentation Surgery Compared With Untreated Contralateral Homologous Sites: An 18- to 35-Year Long-Term Study. J Periodontol. 2016; 87: 1371–1378. [PubMed[Google Scholar]
2. Kim DM, Neiva R. Periodontal soft tissue non-root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol. 2015; 86(2 Suppl): S56–S72. [PubMed[Google Scholar]
3. Wennström JL. Commentary: Treatment of periodontitis: effectively managing mucogingival defects. J Periodontol. 2014; 85: 1639–1641. [PubMed[Google Scholar]
4. Zigdon H, Machtei EE. The dimensions of keratinized mucosa around implants affect clinical and immunological parameters. Clin Oral Implants Res. 2008; 19: 387–392. [PubMed[Google Scholar]
5. Scheyer ET, Sanz M, Dibart S, Greenwell H, John V, Kim DM, et al. Periodontal soft tissue non-root coverage procedures: a consensus report from the AAP Regeneration Workshop. J Periodontol. 2015; 86(2 Suppl): S73–S76. [PubMed[Google Scholar]
6. Lang NP, Lindhe J. Clinical Periodontology and Implant Dentistry. 6th ed. John Wiley & Sons : New Jersey; 2015. [Google Scholar]
7. Camargo PM, Melnick PR, Kenney EB. The use of free gingival grafts for aesthetic purposes. Periodontol 2000. 2001; 27: 72–96. [PubMed[Google Scholar]
8. Griffin TJ, Cheung WS, Zavras AI, Damoulis PD. Postoperative complications following gingival augmentation procedures. J Periodontol. 2006; 77: 2070–2079. [PubMed[Google Scholar]
9. Shah R, Thomas R, Mehta DS. Recent modifications of free gingival graft: A case series. Contemp Clin Dent. 2015; 6: 425–427. [PMC free article] [PubMed[Google Scholar]
10. Cortellini P, Tonetti M, Prato GP. The partly epithelialized free gingival graft (pe-fgg) at lower incisors. A pilot study with implications for alignment of the mucogingival junction. J Clin Periodontol. 2012; 39: 674–680. [PubMed[Google Scholar]
11. Karring T, Lang NP, Löe H. The role of gingival connective tissue in determining epithelial differentiation. J Periodontal Res. 1975; 10: 1–11. [PubMed[Google Scholar]
12. Lopes TR, Machado CN, Rogacheski MC, Verbicaro T, Giovanini AF, Deliberador TM. Aesthetic improvements in free gingival graft due to its association with frenectomy. RSBO (online) 2013; 10: 135–142. [Google Scholar]
13. Donn BJ Jr. The free connective tissue autograft: a clinical and histologic wound healing study in humans. J Periodontol. 1978; 49: 253–260. [PubMed[Google Scholar]
14. Bouchard P, Malet J, Borghetti A. Decision-making in aesthetics: root coverage revisited. Periodontol 2000. 2001; 27: 97–120. [PubMed[Google Scholar]
15. Burak AK. Color distribution of gingiva created by color schema maker software. East J Med. 2016; 21: 69–74. [Google Scholar]
16. Ho DK, Ghinea R, Herrera LJ, Angelov N, Paravina RD. Color Range and Color Distribution of Healthy Human Gingiva: a Prospective Clinical Study. Sci Rep. 2015; 5: 18498. [PMC free article] [PubMed[Google Scholar]
17. Raoofi S. Inductive effect of keratinized connective tissue on overlying alveolar mucosa by underlying connective tissue. Thesis for post graduation, Mashhad University of Medical Science. 1371-72. pp. 20–35. [Google Scholar]
18. Goshtasbpour M, Kiani F. Evaluation of inductive effect of palatal connective tissue on alveolar mucosa after subepithelial connective tissue graft: a clinical & histological study. J Shiraz Univ Med Scien. 2000; 2: 9–20. [Google Scholar]
19. Silva CO, Ribeiro Edel P, Sallum AW, Tatakis DN. Free gingival grafts: graft shrinkage and donor-site healing in smokers and non-smokers. J Periodontol. 2010; 81: 692–701. [PubMed[Google Scholar]
20. Lang NP, Lindhe J. Clinical Periodontology and Implant Dentistry. 6th ed. John Wiley & Sons: New Jersey; 2015. [Google Scholar]
21. Thoma DS, Buranawat B, Hämmerle CH, Held U, Jung RE. Efficacy of soft tissue augmentation around dental implants and in partially edentulousareas: a systematic review. J Clin Periodontol. 2014; 41 Suppl 15: S77–S91. [PubMed[Google Scholar]
22. Batal H, Yavari A, Mehra P. Soft tissue surgery for implants. Dent Clin North Am. 2015; 59: 471–491. [PubMed[Google Scholar]
23. Ioannou AL, Kotsakis GA, McHale MG, Lareau DE, Hinrichs JE, Romanos GE. Soft Tissue Surgical Procedures for Optimizing Anterior Implant Esthetics. Int J Dent. 2015; 2015: 740764. [PMC free article] [PubMed[Google Scholar]