Vertical and horizontal dimensional evaluation of free gingival grafts in the anterior mandible: a case report series

Abstract

The shrinkage of free gingival grafts (FGGs) is a well-known clinical phenomenon but there are limited studies demonstrating the dimensional changes during healing in FGGs. The aim of the study is to examine the shrinkage of FGG in both horizontal and vertical dimensions and calculate the changes in the surface area of the graft at early and delayed periods of healing. The FGG procedure was applied to 15 consecutive patients in their mandibular anterior area. The graft sizes and areas were measured and the shrinkage of the graft was calculated at baseline and days 10, 21 and 180. Hemorrhage, sense alteration and pain symptoms were also examined. Change in the horizontal direction was not statistically significant during the whole study period (p > 0.05). However, there was a statistically significant reduction in the vertical direction in all visits, except day 10 (p < 0.05). Calculated graft area was also significantly reduced during the study period at all time-points compared to the baseline (p < 0.001). At day 10, 4 (26.7%) recipient sites and 5 (33%) donor sites demonstrated paresthesia. Only one (0.07%) recipient site demonstrated paresthesia at day 21 where the donor site resulted with an uneventful healing. At day 10, 5 (33%) patients demonstrated bleeding at their donor regions and resulted with a complete cessation of bleeding at day 21. Pain symptom was found in 8 (53.3%) recipient sites where 3 (20%) donor regions presented pain symptom at day 10. Graft shrinkage in the vertical dimension seems to affect the clinical outcomes of the FGG procedure. However, the influence of horizontal graft shrinkage was minimal.

Free Gingival Grafts: Graft Shrinkage and Donor‐Site Healing in Smokers and Non‐Smokers

“…Only one other study 39 provides 1‐month results on FGG length or area changes for sutured grafts, and the respective values were 4% and 41% 39 . Hatipoğlu et al 21 reported results for 3 weeks postoperatively, also in non‐smokers, and the FGG shrinkage (width, length, and area), based on our own calculations from their individual patient data, was 20%, 8%, and 27%. The results of the three studies (present study, Hatipoğlu et al, 21 and Barbosa et al 39 ) that evaluated both width and length changes consistently show that width shrinkage is much greater than length shrinkage and typically doubles in magnitude.…”

“…The free gingival graft (FGG) is a surgical technique introduced more than 40 years ago to address the lack of keratinized tissue 9‐11 . The FGG has been, and continues to be, the subject of extensive research focusing on either the graft itself 12‐21 or the donor site 19,22‐24 . Although other techniques, such as the subepithelial connective tissue graft, 22‐24 are now more widely used for root coverage procedures, the FGG is still commonly used to increase keratinized tissue dimensions.…”

Epithelized Free Autograft-A Case Report Series with Different Healing Outcomes

“…Similarly, tissue biotype can act as a significant factor that influences the esthetic treatment outcomes. Claffey and Shanley [21] noticed thin gingival tissue biotype to show more gingival recession than the thicker biotype and even the thin gingival biotypes to exhibit more shrinkage [17]. Case II and IV had biotype measurement of 1.5mm that was more on the thinner aspect which might be one of the reasons for maximum shrinkage in these cases.…”

“…However, at two years followup considerable amount of shrinkage resulted in both vertical and horizontal dimensions in case II and case IV. Various amounts of graft shrinkage during the healing period have been reported which ranges between 12% and 48% [15][16][17]. Studies show that shrinkage occurs during the first year after surgery and the width of keratinized tissue remains stable after that [18,19].…”

Simultaneous placement of an interpositional free gingival graft with nonsubmerged implant placement

“…Performing a free gingival graft (FGG) prior to implant surgery has been suggested when there is minimal keratinized tissue over the edentulous ridge [25,26], and APF and FGG can be combined in shallow vestibules with minimal keratinized tissue [27]. …”