• palatal rugae
• posterior extension
• rugae patterns
• saudi arabian population
• soft tissue grafts

Advanced gingival recession is considered a complex soft tissue problem, which is increased in severity with age, and has multiple etiological factors. Therefore, the treatment is very complicated with low predictability. However, in the last decade, many clinical trials have shown highly predictable results when managing advanced recession cases by surgical intervention.

The present review shows different surgical techniques with their clinical outcomes in order to choose the most suitable technique required by the clinical condition. Although there are relatively few studies, modified tunnel technique and coronal advanced flap (CAF) showed the highest percentage of root coverage (%RC) during the first year (up to 86%). These techniques are primarily indicated to manage advanced recession in the esthetic zone. Pedicle buccal fat pad (PBFP) also had a good percentage of root coverage when used in the maxillary posterior area, as it has a high blood supply with minimal risk for infection and necrosis. Free gingival graft (FGG) can be used in the mandibular anterior area, as it creates a band of keratinized tissue that can resist recession with a fair percentage of root coverage. However, color match and graft shrinkage are the main problems of this procedure.

• Advanced gingival recession
• Clinical condition
• Clinical outcomes
• Surgical techniques

Gingival recession leads to root surface exposure devoid of periodontal attachment. Recession defects with interdental attachment loss (RT2, RT3), further increase the avascular area which is critical for survival of soft-tissue grafts. Nonsubmerged grafts such as free gingival grafts and gingival unit grafts (GUGs) rely primarily on plasmatic circulation from the recipient area during the initial stages of healing for its survival.

Nineteen isolated RT2 recession defects, in the mandibular anterior region, were treated using GUG. The clinical parameters of recession depth (RD), recession width (RW), interdental clinical attachment levels (iCAL) were measured at baseline. Percentage of mean root coverage (MRC) was calculated at 3 months and 6 months.

The percentage of mean root coverage (MRC) achieved at the end of 6 months was 81.79% ± 6.16%. Further, Simple linear regression analysis to predict MRC at 6 months using baseline RW revealed, for every 1 mm decrease in RW, the percentage of root coverage significantly increased by 5.25% (P = 0.04).

GUG can be used as an alternative treatment modality to achieve successful root coverage in RT2 recession defects. Baseline RW can be used to predict the outcome of root coverage at the end of 6 months.

The purpose of the cross sectional study was to investigate the distal extension of the rugae area in a Jordanian (Middle Eastern) population, as an anatomical limitation influencing the surgical decision of harvesting a palatal soft tissue graft. Factors that may influence or predict the extension were also assessed.

Sixty periodontally healthy participants (29 males and 31 females) were included. Maxillary alginate impressions were made and casts were poured. The measurements were highlighted from the origin of the rugae (near mid palatine raphe) to the terminal end with a sharp graphite pencil on the cast and a magnification lens was used for identification. The most posterior extension of the rugae were marked on the casts and determined by a standardized periodontal probe. The normal approximation test for binomial distribution was used to determine the proportion of the subjects with rugael extensions beyond the mesial end of the upper second premolar and fisher’s exact test for the purpose of analysis of the association of this extension with other factors.

In almost half (41.7%) of the sample, the rugae extended distal to the upper second premolar, 23.3% extended to the mid-palatal of the upper second premolar, and 11.7% extended to the mesial of the upper second premolar. The implication is that 90.0% of the rugae reached the upper second premolar and 78.3% extended beyond its mesial aspect. The normal approximation test performed with 95% CI with the "rugael extension proximal to the mesial end of the upper 2nd premolar" considered to be the "success" category revealed that the proportion of the subjects with rugael extensions proximal to the mesial end of the upper second premolar was significantly lower than the proportion beyond the mesial end of the upper second premolar (95% CI of 11.2–32.0%, p = .00001). There was no significant difference between gender, smoking status, gingival phenotype and palatal shape with the posterior extension of palatal rugae.

Palatal rugae in a sample of a Jordanian population extends beyond the mesial aspect of the upper second premolar which may cause a substantial limitation for graft harvesting from the palate. The hard palate of Jordanian patients may not be a reliable source of soft tissue grafts required for aesthetic mucogingival surgery. No significant association existed between the most posterior extent of palatal rugae and gender, gingival phenotype or palatal shape. Other possible sources should be explored.

• Jordanian population
• Palatal rugae
• Posterior extension
• Rugae patterns

• Er: YAG laser
• Isoamyl-2 cyanoacrylate
• clinical attachment
• silk suture

• Cyanoacrylates/therapeutic use
• Follow-Up Studies
• Gingiva/transplantation
• Gingival Recession/drug therapy
• Gingival Recession/surgery
• Humans
• Silk
• Sutures
• Tooth Root/surgery

Prognosis in the management of Millers Class III or IV gingival recession is often fair to poor, which is further decreased by factors such as inadequate keratinized gingiva. Very few modalities show long-term success in the management of gingival recession with inadequate keratinized gingiva, free gingival graft (FGG) being one such technique.

Ten individuals with Millers Class III or IV recession and inadequate keratinized gingiva were recruited for the study. The first surgical procedure involved the FGG procedure to increase the width of keratinized gingiva (WOKG). Patients were recalled after 3 months for the second surgical procedure, where the flap was coronally advanced. They were recalled 9 months after the second surgery. WOKG was examined at baseline and 3 months (before the second surgical procedure). Recession depth (RD) and clinical attachment level (CAL) was examined at baseline, at 3 months (before the second surgical procedure) and at 12 months (9 months after the second surgical procedure). The percentage of root coverage was measured at 12 months from baseline.

Significant increase in WOKG was seen at 3 months. Significant decrease in RD and CAL was observed at 12 months from baseline. The percentage of root coverage was 76.4%.

Two-stage FGG procedure can be a successful modality in the management of Millers Class III or IV recession with inadequate keratinized gingiva. This technique improves the prognosis of such compromised cases.

• Free gingival graft
• gingival recession
• inadequate keratinized gingiva
• two stage

Gingival recession is a frequent issue encountered by both the clinician and the patient. This study was aimed to assess the predictability of the free gingival graft as a single step procedure in terms of root coverage and aesthetics in Miller Class I and II mandibular gingival recession. 

Ten patients (4 males, 6 females) aged 25-30 years with a total of 12 mandibular sites having Miller class I and II recession were selected. All recession sites were treated with single step free gingival graft procedure. Clinical parameters like recession depth, recession width, width of attached gingiva, probing depth and clinical attachment level were recorded at baseline, 6 and 9 months. Visual analog score at 1, 6 and 9 months postoperatively was provided. 

There was a reduction in mean recession depth from 3.66±1.20 to 0.91±0.99 mm suggesting coverage of 82% over a period of 9 months. There was statistically significant gain in clinical attachment level and width of attached gingiva. Aesthetically, it was acceptable by patients as measured by visual analog scores. 

Free gingival graft as a single step procedure is acceptable in terms of root coverage and aesthetics.

The most significant factor for the success in soft tissue grafts is the synergistic relation between vascular configuration and involved tissues. In the soft tissue graft procedures, site specific donor tissue is assumed to have improved potential for function and aesthetic survive at recipient sites. On a clinical level, using site specific gingival unit graft that placed on traditionally prepared recipient site, results in predictable root coverage. In this case report the clinical effectiveness of gingival unit transfer (GUT) technique performed on Miller III recession was presented and a similar recession case treated with free gingival graft (FGG) technique for comparison. Probing depth, recession depth, keratinized tissue width and clinical attachment level clinical parameters were measured at baseline and postoperative 8 mo. Percentage of defect coverage was evaluated at postoperative 8 mo. Creeping attachment was assessed at postoperative 1, 3, 6 and 8 mo. The GUT revealed better defect coverage and creeping attachment results than the FGG in the treatment of Miller III defects.

• Autografting
• Gingiva
• Gingival recession
• Tooth root
• Transplants

• Attached gingiva
• bridge flap
• mucogingival surgery

• Gingiva/abnormalities
• Gingiva/transplantation
• Gingival Diseases/surgery
• Gingivoplasty/trends
• Guided Tissue Regeneration, Periodontal
• Humans
• Surgical Flaps
• Vestibuloplasty/trends