Heasman PA, Ritchie M, Asuni A Gingival recession and root caries in the ageing population: a critical evaluation of treatments. J Clin Periodontol. 2017; 44:S178-S193 https://doi.org/10.1111/jcpe.12676
Romandini M, Soldini MC, Montero E, Sanz M. Epidemiology of mid-buccal gingival recessions in NHANES according to the 2018 World Workshop Classification System. J Clin Periodontol. 2020; 47:1180-1190 https://doi.org/10.1111/jcpe.13353
Beck JD, Koch GG, Offenbacher S. Attachment loss trends over 3 years in community-dwelling older adults. J Periodontol. 1994; 65:737-743 https://doi.org/10.1902/jop.1994.65.8.737
Pires IL, Cota LO, Oliveira AC Association between periodontal condition and use of tongue piercing: a case-control study. J Clin Periodontol. 2010; 37:712-718 https://doi.org/10.1111/j.1600-051X.2010.01584.x
Kapferer I, Benesch T, Gregoric N Lip piercing: prevalence of associated gingival recession and contributing factors. A cross-sectional study. J Periodontal Res. 2007; 42:177-183 https://doi.org/10.1111/j.1600-0765.2006.00931.x
Ainamo J, Löe H. Anatomical characteristics of gingiva. A clinical and microscopic study of the free and attached gingiva. J Periodontol. 1966; 37:5-13 https://doi.org/10.1902/jop.1966.37.1.5
Friedman N. Mucogingival surgery: the apically repositioned flap. J Periodontol. 1962; 33:328-340
Rosenberg NM. Vestibular alterations in periodontics. J Periodontol. 1960; 31:231-237
Corn H. Periosteal separation—its clinical significance. J Periodontol. 1962; 33:140-153
Bowers G. A study of the width of attached gingiva. J Periodontol. 1963; 54:201-209
Lang NP, Löe H. The relationship between the width of keratinized gingiva and gingival health. J Periodontol. 1972; 43:623-627
Abolfazli N, Saber FS, Lafzi A, Eskandari A. Evaluation of alteration in mucogingival line location following use of subepithelial connective tissue graft. Indian J Dent Res. 2010; 21:174-178 https://doi.org/10.4103/0970-9290.66628
Ainamo A, Bergenholtz A, Hugoson A, Ainamo J. Location of the mucogingival junction 18 years after apically repositioned flap surgery. J Clin Periodontol. 1992; 19:49-52 https://doi.org/10.1111/j.1600-051x.1992.tb01148.x
Miller PD A classification of marginal tissue recession. Int J Periodontics Restorative Dent. 1985; 5:8-13
Cairo F, Nieri M, Cincinelli S The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol. 2011; 38:661-666 https://doi.org/10.1111/j.1600-051X.2011.01732.x
Agudio G, Nieri M, Rotundo R Periodontal conditions of sites treated with gingival-augmentation surgery compared to untreated contralateral homologous sites: a 10- to 27-year long-term study. J Periodontol. 2009; 80:1399-1405 https://doi.org/10.1902/jop.2009.090122
Mörmann W, Schaer F, Firestone AR. The relationship between success of free gingival grafts and transplant thickness. Revascularization and shrinkage – a one year clinical study. J Periodontol. 1981; 52:74-80 https://doi.org/10.1902/jop.1981.52.2.74
Kao RT, Curtis DA, Kim DM American Academy of Periodontology best evidence consensus statement on modifying periodontal phenotype in preparation for orthodontic and restorative treatment. J Periodontol. 2020; 91:289-298 https://doi.org/10.1002/JPER.19-0577
Chambrone L, Sukekava F, Araújo MG Root-coverage procedures for the treatment of localized recession-type defects: a Cochrane systematic review. J Periodontol. 2010; 81:452-478 https://doi.org/10.1902/jop.2010.090540
Zucchelli G, Mele M, Stefanini M Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol. 2010; 37:728-738 https://doi.org/10.1111/j.1600-051X.2010.01550.x
Han TJ, Takei HH, Carranza FA. The strip gingival autograft technique. Int J Periodontics Restorative Dent. 1993; 13:180-187
Cortellini P, Tonetti M, Prato GP. The partly epithelialized free gingival graft (pe-fgg) at lower incisors. A pilot study with implications for alignment of the mucogingival junction. J Clin Periodontol. 2012; 39:674-680 https://doi.org/10.1111/j.1600-051X.2012.01896.x
Gandara-Rey JM, Diniz-Freitas M, Gandara-Vila P Lesions of the oral mucosa in cocaine users who apply the drug topically. Med Oral. 2002; 7:103-107
Professor/Honorary Consultant in Periodontology; Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London
Recession defects are widely prevalent in the adult population, with some patients being impacted by complications, including the difficulty of cleaning such sites and the risk of continued recession progression. The free gingival graft (FGG) is a form of mucogingival surgery that attempts to improve the height of the keratinized tissue (KT), as well as augment the thickness of the gingival phenotype to facilitate meticulous oral hygiene. This article discusses the indications for the surgery, the procedure, including post-operative care, and possible modifications of the technique.
CPD/Clinical Relevance: Professional intervention involving a free gingival graft may be the only way to empower patients to clean the recession site without discomfort.
Article
Gingival recession can be defined as the exposure of the root surface due to apical migration of the gingival margin.1 Such defects can be localized or generalized, being present interproximally and/or labially/lingually. The latest NHANES data suggest that recession sites are widely prevalent, with 91.6% of the adult population presenting with the condition. Presence of gingival recession is associated with older age, female gender, European ethnicity and the mandibular arch.2
Recession can have a multifactorial aetiology and, therefore, a careful history and examination are required, as well as appropriate investigation of the affected sites (Table 1). The mechanism of recession is not fully understood, but the presence of persistent inflammation is required to lead to recession. Such inflammation can lead to the breakdown of the underlying connective tissue, which eventually leads to gingival tissue recession. Causes of inflammation can be mechanical, such as overzealous brushing3 or the use of overly hard bristles. Traumatic occlusion can also lead to recession in cases of a deep overbite in incisal Class 2 or 3 relationships where the incisal edges can directly contact the soft gingival tissues. Inflammation can also be attributed to a bacterial aetiology, where persistent plaque presence can lead to an inflammatory host response and, if left untreated, may develop into periodontitis.4 Tongue studs and lip piercings are also associated with recession. Individuals with tongue studs can have up to an 11-times greater chance of lingual recession of the mandibular incisors compared to non-users.5 Meanwhile, lip piercings that are positioned close to the cemento-enamel junction (CEJ) are associated with buccal/labial recessions.6 Both objects increase the risk of recession with long-term use.
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