Free Gingival Graft - Clinical Case

The free gingival graft is used when more attached (hard) gingiva must be added around the neck of a tooth. If there is inadequate attached gingiva, spontaneous recession of the gum and bone will occur over time. Typically the normal attached gingiva has been worn away with improper brushing, although some people are born with very little attached gingiva. When a new band of attached gingiva is created with a free gingival graft, the site is stable and, with proper brushing techniques, the results can be expected to last a lifetime. It should be remembered that free gingival grafting is normally not done to re-cover the exposed root. If that is desired, a connective tissue graft is the common procedure used. (See Cosmetic Procedures/Root Coverage)

The first step in grafting is to dissect away the muscle (mucosa) where more attached gingiva is needed. In this case there is a small band of attached gingiva left, but it is not strong enough to prevent the muscle pull from causing recession. The muscle is sutured down away from the tooth, leaving only bone and periosteum (a thin layer of tissue that covers the bone) exposed. The periosteum will supply the graft with blood during healing.


Inadequate attached gingiva
and associated recession.

Muscle dissected back and sutured,
creating bed for new graft
 

The tissue in the roof of the mouth (palate) is composed of dense connective tissue, similar to attached gingiva. A thin layer is removed from near the teeth, and is transplanted to the site needing attached gingiva. The palate looks similar to a skinned knee when the graft is taken. It is generally covered with a periodontal dressing, and heals very quickly. In several weeks, it will not be possible to detect the donor site.


Outline in roof of mouth
of the donor site.

Graft removed from roof,
leaving a skinned knee appearance.
 


Dressing placed over site.

When the graft is removed, it is trimmed to fit the "bed", and secured in place. It is common to glue the graft into position with medical "super glue", or it may be sutured. A periodontal dressing is usually placed to cover and protect the graft. The patient must stay away from the area for 10-14 days, at which time the dressing is removed. Postoperative discomfort is usually minimal, and the success rate near 100%.


Gingiva removed from palate.

Graft glued to position on bed.
 


Final healing of graft, restoring band of hard gum.