A Case Report of a Free Gingival Graft Done to Rectify Gingival Recession

Gingival recession is associated with functional problems such as dentinal hypersensitivity and root caries. This case report describes treatment of gingival recession with free gingival graft technique. Free gingival grafting was done in relation to 31. Split-thickness flap was elevated in the region of 31. The area to be taken for grafting was selected between first and second premolar. The graft was placed on the recipient bed and suturing was done. Complete recession coverage was observed. Results of free gingival grafting show fairly acceptable results in terms of tissue gain suggesting free gingival graft as a viable option.


INTRODUCTION
Gingival recession is the displacement of the soft tissue margin apical to the cementoenamel junction (CEJ) with exposure of the root surface.The distance between the CEJ and gingival margin gives an estimation of the level of recession.There are many aetiologic factors for recession such as periodontal disease, accumulations, inflammation, aggressive tooth brushing and dominant roots.It is also associated with functional problems such as dentinal hypersensitivity and root caries. 1 The palatal masticatory mucosa is widely used as a donor site in gingival recession treatment.In this case, free gingival grafting was chosen as the procedure to be followed.

CASE REPORT
A 23-year-old female patient came to the clinic with chief complaint of receding gums in lower front tooth.Upon inspection, gingival recession was observed in the region of 31 (according to two-digit numbering system).The patient was scheduled to undergo mucogingival surgery.Before any incisions, the exposed root surface was carefully scaled and root planed.A 3-4 mm wide recipient connective tissue bed was prepared apical and lateral to the recession defect.
Dr. Rahul Shah, 1 Dr. Chirag Shah, 2 Dr. Kunjal Chirag Shah, 2 Dr. Bhavika Shah, 3 Dr.Praveena Lakshmi          In the current era, various treatment modalities are available.The ideal procedure to be chosen depends upon local anatomic conditions, choice of operator and patient's comfort.The presence of adequate keratinised gingiva serves as a barrier to physical trauma and future progression of recession.There is no universal harmony on amount of attached gingiva for periodontal health, but it is common opinion that area with less than 2 mm of keratinised gingiva is more viable for recession. 4e key factors which determine the successful management of gingival recessions are the identification of its etiologic agents and their elimination, the assessment of the degree of tissue involvement and last but not least, the selection and the careful implementation of the appropriate surgical procedure in order to achieve optimal root coverage, improved soft tissue aesthetics and reduced sensitivity.A previous systematic review showed that the connective tissue graft (CTG) plus coronally advanced flap (CAF) is considered the gold standard technique in treatment of gingival recessions.A possible explanation for the clinical efficacy of CTG may be related to the specific healing model of the procedure.In fact, the high stability of the wound over CTG is associated with graft vascularisation which is originated from both the periodontal plexus and the overlying flap leading to a complete blood supply for the graft after two weeks. 5owever, CTG has a number of disadvantages: a secondary harvesting surgery for donor tissue is required; increased morbidity may be associated with the donor surgery; and a limited amount of donor tissue is available, limiting the number of defect sites treated per patient visit. 6ere are various surgical techniques available for root coverage like rotational flaps, coronally advanced flap, free gingival graft, guided tissue regeneration, connective tissue graft and combination of these. 7

Figure 3 :
Figure 3: Area demarcated to be harvested for grafting.
The surgical root coverage techniques which are available right now, are: (i) Free epithelialised gingival graft, (ii) Subepithelial connective tissue graft, (iii) Semilunar flap, (iv) Coronally advanced flap, (v) Guided tissue regeneration.1 Free gingival graft is a versatile mode of treatment which can be used to cover denuded roots and to increase the width of attached gingiva.It can be used as a single step or two step procedure.The technique proposed by Miller is a one-step procedure or the direct approach, whereas the one described by Bernimoulin 9 et al. involves two surgical steps and is referred to as the indirect approach.healing, excessive smoking.Free gingival graft, though lagging behind the connective tissue graft in terms of accuracy, still holds an edge as far as simplicity and invasiveness of the procedure is concerned.Free gingival graft was used in this study because: (i) Shallow palatal vault was observed in the studied population which was not suitable for harvesting the connective tissue graft.(ii) The patient presented with relatively thin gingiva phenotype.Technique such as laterally placed flap could not be implemented as chances of donor tissue recession was there.Therefore, free gingival grafting is still a viable option and can be a preferred mode of surgery for treatment of gingival recession in cases where connective tissue grafting is not ideal.