Introduction: Gingival recession presents an apical proliferation of the gingival margin to the cemento-enamel junction of the tooth and can be accompanied by aesthetics dissatisfaction and be associated with insufficient width of keratinized gingiva. Some surgical interventions are proposed for augmentation of gingival tissues when there is an insufficient width of keratinized gingival tissues. Such surgical approach is the use of a free gingival graft. This technique shows good results in gingival augmentation and treatment of shallow recessions with depth less than 3 mm.
Aim: The aim of this case report is to demonstrate the creeping attachment of the gingival margin after use of a free gingival graft for augmentation of the width of keratinized gingival tissues on the vestibular side of the mandibular anterior area.
Case Presentation: Lack of keratinized attached gingival tissues apically to the mandibular central incisors is established. A free gingival graft is used for augmentation of the width of the insufficient keratinized gingiva.
Results: Three months after gingival augmentation with a free gingival graft, the reduction of the depth of gingival recessions was not significant. Compared to baseline, a significant increase in the width of keratinized attached gingiva was reported 6 months later. The depth of gingival recessions was reduced and gain of clinical attachment level was achieved on the vestibular side in both lower central incisors.
Conclusion: The presented case report confirmed that, due to creeping attachment, a reduction of depth of gingival recessions and vestibular clinical attachment level gain were recorded after gingival augmentation with a free gingival graft.
Kim DM, Neiva R. Periodontal soft tissue non‐root coverage procedures: a systematic review from the AAP regeneration workshop. J Periodontol. 2015; 86(S2):S56–S72. doi: 10.1902/jop.2015.130684.
Mythri S, Arunkumar SM, Hegde S, Rajesh SK, Munaz M, Ashwin D. Etiology and occurrence of gingival recession - an epidemiological study. J Indian Soc Periodontol. 2015; 19(6):671-5. doi: 10.4103/0972-124X.156881.
Addy M. Tooth brushing, tooth wear and dentine hypersensitivity-are they associated? Int Dent J. 2005;55(4 Suppl 1):261-7. doi: 10.1111/j.1875-595x.2005.tb00063.x.
Georgieva I. Classification of gingival recessions - a review. Varna Med Forum. 2019;8(2):122-30. doi:10.14748/vmf.v8i2.5936.
Seong J, Bartlett D, Newcombe RG, Claydon NCA, Hellin N, West NX. Prevalence of gingival recession and study of associated related factors in young UK adults. J Dent. 2018; 76:58-67. doi: 10.1016/j.jdent.2018.06.005.
Georgieva I. Etiology of gingival recessions – a literature review. Scr Sci Med Dentalis. 2019; 5(2):7-12. doi:10.14748/ssmd.v5i2.5970.
Chapple ILC, Mealey BL, Van Dyke TE, Bartold PM, Dommisch H, Eickholz P, et al. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;45 Suppl 20:S68-S77. doi: 10.1111/jcpe.12940.
Müller HP, Heinecke A. The influence of gingival dimensions on bleeding upon probing in young adults with plaque-induced gingivitis. Clin Oral Invest. 2002; 6(2):69-74. doi: 10.1007/s00784-001-0141-4.
Bertl K, Melchard M, Pandis N, Muller-Kern M, Stavropoulos A. Soft tissue substitutes in non-root coverage procedures: a systematic review and metaanalysis. Clin Oral Invest. 2017;21(2):505-518. doi: 10.1007/s00784-016-2044-4.
Wennstrom JL, Zucchelli G. Increased gingival dimensions. A significant factor for successful outcome of root covearaege procedures? A 2-year prospective clinical study. J Clin Periodontol.1996; 23(8):770-7. doi: 10.1111/j.1600-051x.1996.tb00608.x.
Chambrone LA, Chambrone L. Root coverage in a class IV recession defect achieved by creeping attachment: a case report. J Int Acad Periodontol. 2006;8(2):47-52.
Matter J, Cimasoni G. Creeping attachment after free gingival grafts. J Periodontol. 1976;47(10):574-9. doi: 10.1902/jop.1976.47.10.574.
Al-Rasheed A. Creeping attachment after free connective tissue graft for treatment of gingival recession. Saudi Dent J. 2006;18(1):41-6.
Agudio G, Chambrone L, Pini Prato G. Biologic remodeling of periodontal dimensions of areas treated with gingival augmentation procedure: a 25- year follow-up observation. J Periodontol. 2017;88(7):634-42. doi: 10.1902/jop.2017.170010.
Gul S, Zardawi F, Sha1 AM, Rauf AM. Assessment of creeping attachment after free gingival graft in treatment of isolated gingival recession. J Int Acad Periodontol. 2019; 21(3):125–31.
Georgieva I. Bilaminar technique for treatment of multiple Miller’s class III recession defects in the mandibular frontal area. A case report. Scr Sci Med Dentalis. 2020;6(1):30-7. doi:10.14748/ssmd.v6i1.6455.
Matter J, Cimasoni G. Creeping attachment after free gingival grafts. J Periodontol. 1976;47(10):574-9. doi: 10.1902/jop.1976.47.10.574.
Kennedy JE, Bird WC, Palcanis KG, Dorfman HS. A longitudinal evaluation of varying widths of attached gingiva. J Clin Periodontol. 1985; 12(8):667-75. doi: 10.1111/j.1600-051x.1985.tb00938.x.
Aimetti M, Romano F, Peccolo DC, Debernardi C. Non-surgical periodontal therapy of shallow gingival recession defects: evaluation of the restorative capacity of marginal gingiva after 12 months. J Periodontol. 2005;76(2):256-61. doi: 10.1902/jop.2005.76.2.256.
Uslu MO, Uslu F, Kirmizigul OA. The creeping attachment following the free gingival graft surgery after orthodontic treatment: a case report. Acta Sci Dent Sci. 2018;2(11):138-42.
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