A longitudinal evaluation of varying widths of attached gingiva.

32 patients with bilateral areas of inadequate attached gingiva on the facial surface of homologous contralateral teeth have been followed for 6 years. Treatment consisted of scaling, root planing, oral hygiene and maintenance at 3- to 6-month intervals or as needed to control inflammation. A free gingival graft was placed on one side (experimental), while the other side served as the unoperated control. Areas of inadequate attached gingiva on control sides, to include those with recession and no attached gingiva, did not demonstrate additional recession or further loss of attachment. Gingival inflammation and plaque were significantly reduced. On experimental sides, the dimension of keratinized and attached gingiva increased and was stable over 6 years. Areas which began with recession and no attached gingiva exhibited a reduction in recession and gain in clinical attachment following the placement of a gingival graft. Examination of patients who had discontinued participation in the study for a period of 5 years revealed a re-establishment of gingival inflammation on the control sides associated with additional recession. Similar changes were not observed in areas treated by a free graft. The findings demonstrate that it is possible to maintain periodontal health and attachment through control of gingival inflammation despite the absence of attached gingiva.

Longitudinal evaluation of free autogenous gingival grafts. A four year report.

This ongoing study was designed to determine the necessity for and effectiveness of the free autogenous graft in maintaining periodontal attachment. Four-year data are presented for 42 patients who initially had bilateral surfaces with inadequate attached keratinized gingiva including 22 patients who began with bilateral areas of recession and no attached gingiva. In both populations a free autogenous gingival graft was placed on one side and the contralateral side was treated by scaling and root planing to serve as the control. The results indicate that plaque and gingival indices significantly decreased over 4 years on both experimental (grafted) and control (nongrafted) sides. Neither side had further attachment loss but the grafted side showed "creeping" attachment with a concomitant decrease in recession. This study would indicate that facial gingival units with minimal or no attached keratinized gingiva can maintain attachment levels when inflammation is controlled.

Longitudinal evaluation of free autogenous gingival grafts.

This study was designed to determine the necessity for and effectiveness of the free autogenous gingival graft in maintaining the periodontal attachment to teeth. Ninety-two patients with bilateral facial surfaces of inadequate keratinized gingiva had a free autogenous gingival graft placed on one of the facial surfaces (experimental side) while the contralateral side served as the control. Measurements were recorded from the CEJ to the 1) free gingival margin, 2) base of the gingival sulcus, and 3) mucogingival junction on the mid-facial of selected teeth. The Gingival Index and Plaque Index (Löe 1967) were also evaluated. A total of 107 grafts were performed and followed from 6 months to 2 years post grafting. Patients were recalled (scaling, root planing, plaque control instruction) and clinical parameters such as pocket depth, recession and attachment level were measured at 3- and 6-month intervals. Both experimental (grafted) and control (unoperated) sides showed marked reduction in the Gingival Index and Plaque Index. Neither side demonstrated further attachment loss. it would appear that minimizing inflammation is sufficient to maintain attachment levels despite the width of keratinized attached gingiva.