Use of the Free Gingival Graft as a Pre-prosthetic Procedure

Introduction:
One objective of periodontal plastic surgery is the creation ofadequate vestibular depth and an increase in the keratinized tissue. The keratinized tissue provides increased resistanceto the periodontium, contributes to the stabilization of the gingival margin position, and aids in the dissipation of physiological forces that are exerted by the muscular fibers of the alveolar mucosa. Improvement of oral hygiene was seen with the increase in keratinized tissue.The free gingival graft (FGG) is known to be one of the most common and predictable methods for augmenting
gingival tissue dimensions, and FGG was applied as a preprosthetic procedure in two cases. In the first case, FGG was used to overcome the patient’s discomfort and to achieve a better condition around the abutments and pontic area for the fixed prosthesis. In the second case report, the modified FGG technique was used to achieve a greater increase in keratinized tissue using less donor tissue by placing the graft material in the most apical way with the periosteum coronal exposed to the graft.


 Case 1
A 58-year-old female was referred, seeking treatment for the mandibular left posterior area. The patient had a non-contributory medical history and was not taking any medications associated with a compromised bone-healing response. The patient complained of discomfort during tooth brushing. Clinical examinations revealed that the  mandibular left first molar was missing, and restoration of the missing are was planned using a 3-unit fixed prosthesis. The keratinized tissue on the buccal side was less than 1mm and the clinical probing depths ranged from 2 to 3m. Plaque could be seen and isolated bleeding spots were noticed when a North Carolina periodontal probe (HuFriedy, Chicago, IL) was passed along the mucosal margin. Soft tissue graft from the palate was planned after consulting with the patient about the treatment period and the possible complications, and after an informed consent was achieved.

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