Free gingival grafts for the treatment of gingival recession. A review of some techniques.

Free gingival grafts can be utilized, alone or in combination with a coronally positioned flap, for the prevention and the treatment of gingival recession. The graft can be placed directly on the denuded root, as first described by Sullivan & Atkins (1968). This technique will provide adequate results, especially in cases with relatively little recession. After placing a free gingival graft in such an area, one can often observe bridging and/or creeping attachment. In the case of bridging, some of the grafted tissue will remain vital over the avascular zone, i.e. the root. Creeping attachment is the result of coronal migration of the grafted gingiva and will take place during the years following surgery. Bridging and creeping are most likely to occur in cases of narrow recession where the grafts had been placed directly over the denuded zone. In a second type of surgical procedure, an enlargement of the attached gingiva is first obtained through the graft. The area of recession is later covered by a coronally positioned flop. Several cases are presented which illustrate the results obtained with this procedure. In children, when there is insufficient attached gingiva, it is often desirable to place grafts before orthodonic therapy. In the prevention or treatment of gingival recessions, four possibilities may be considered: 1) no treatment, 2) placement of a graft to prevent recession, 3) stabilizing an existing recession, 4) attempt to cover the denuded root.