INDERPRASTHA DENTAL COLLEGE & HOSPITAL

DEPARTMENT OF ORAL PERIODONTOLOGY

TOPIC: FREE GINGIVAL GRAFT
DEFINITION: A free gingival graft is a dental procedure where a small layer of tissue is removed from the
palate of the patient's mouth and then relocated to the site of gum recession. It is sutured (stitched) into
place and will serve to protect the exposed root as living tissue

Disadvantages
Ÿ Advantages
• Compromised blood supply
Ÿ High degree of predictability—only with
• Greater discomfort
increasing width of keratinized gingiva • Lack of predictability in attempting root coverage.
Ÿ Simplicity
Ÿ Ability to treat multiple teeth at the same time Free soft tissue autografts are indicated in the presence of:
Ÿ This procedure can be performed where there is • An inadequate zone of attached gingiva
inadequate keratinized gingiva adjacent to the • Abnormal muscle attachment
• Shallow vestibular depth
• Gingival recession
Ÿ Deep pockets to prevent rapid initial down growth of epithelium.

FREE GINGIVAL GRAFT PROCEDURE

Ÿ CLASSIC TECHNIQUE
Ÿ VARIANT TECHNIQUE

Variant techniques
Four variants to the classic technique are described:
a. Accordion technique
b. Strip technique
c. The connec ve ssue technique
d. Combina on of strip and connec ve ssue techniques.
Accordion technique
Accordian technique has been described by Rateitschak and colleagues. Expansion can be
achieved by giving alternate incisions on the opposite sides of the gra .
Strip technique
The strip technique by Han and associates consists of 2 or 3 strips of ssue about 1 mm wide
and long enough to cover the en re length of the recipient site. These strips are placed at the
center and base of the recipient site and sutured from the oral mucosa. The area is then
covered with nfoil and asurgical pack.
Connec ve ssue technique
The connec ve ssue technique was originally described by Edel. The advantages of this
technique include:a. Donor site—Healing by primary inten on is achieved because the donor
material can be obtained from connec ve ssue that is present beneath the palatal flap.b.
CLASSIC TECHNIQUE
VARIOUS STEPS IN THE CLASSIC TECHNIQUE Color matching is be er.
Combina on techniques
It can be performed as follows:Remove a strip of ssue about 3 to 4 mm thick from the palate, Figs A to F: Free soft tissue autograft (Accordion technique): (A) Lack of attached gingiva,
(B) Recipient bed preparation, (C) Donor site immediately after the removal of tissue for
place it between two wet tongue depressors, and slice it longitudinally with a sharp BP blade grafting, (D) Donor tissue (with alternate incisions), (E) Graft transferred to recipient site and
sutured in place, (F) Various steps in Accordion technique.
. Use a superficial por on that contains epithelium and connec ve ssue, and the deeper
por on that only consists of connec ve ssue.

HEALING OF THE GRAFT C

H
A
P
T
E
R
4
3

Healing of the gra

The full thickness gra consists of fat, glandular ssue aswell as the epithelium. It is not easily accepted
and notrequired in periodontal surgery.
The process of accep ng a gra :

I. Plasma c circula on stage (2-3 Days): Direct joining of capillaries between the gra and the recipient
HEALING OF THE GRAFTED SITE
bed is seen and capillaries of the recipient bed invade the gra .
HEALING PHASES OF THE GRAFT

II. Capillary circula on stage (4-5 Days): Capillaries start func onal circula on again. The epithelium at this

stage is almost desquamated and sparse.

III. Organiza on stage (10-14 Days): Organiza on is completed by growth of fibroblasts in the gra and in

the recipient bed. The network of capillaries become dense and regenera on of epithelium beco

ac ve to complete the epithelializa on (wound healing is by secondary inten on).

.

BEFORE AFTER

SUBMITTED BY
UNDER THE GUIDANCE OF :-
(6086046)
Dr Vikram Balangna
(6086047)
Dr. Preeti (6086048)
Dr. Pragya (6086049)
(6086050)