This document discusses the history and techniques of free gingival grafts (FGG), a periodontal plastic surgery procedure used to widen attached gingiva. It describes the classic FGG technique which involves preparing the recipient site, obtaining a partial-thickness graft from the palate donor site, suturing the graft into place, and protecting the donor site. Variant techniques like the accordion, strip, and combination methods are also outlined. The healing process of FGG grafts is explained, noting revascularization begins after 2-3 days and integration is largely complete by 10-17 days, though thicker grafts may take longer. FGG procedures aim to enhance plaque removal, improve tooth stability, and provide tissue

1. In the name of God
name: Maryam Adham Haghighipour
Guilan university of medical science/ Iran
Free Gingival Graft
(FGG)

2. History:
Friedman mucogingival surgery :
describes surgical procedures ,reference to three problem areas:
- Attached gingiva,
- Shallow vestibules,
- Frenum interfering with the marginal gingiva
Miller  periodontal plastic surgery:
Correct anatomic, developmental, or traumatic deformities of the gingiva or alveolar
mucosa.
finally:  the 1996 World Workshop
in Clinical Periodontics renamed mucogingival surgery as periodontal plastic surgery, a term originally
proposed by Miller in 1993 and broadened to include the following areas

3. Mucogingival therapy:
is a broader term that includes non-surgical procedures such as : papilla reconstruction by means of
orthodontic or restorative therapy.
1.Problems associated with attached gingiva
2. Problems associated with a shallow vestibule
3. Problems associated with an aberrant
frenum
4. Aesthetic surgical therapy
5. Tissue engineering

4. Widening the attached gingiva accomplishes four objectives:
Enhances plaque removal around the gingival margin
 Bind better around teeth and implants
 Abutments for fixed or removable partial dentures
 Subgingival restorations and narrow zones of keratinized gingiva

5. • Gingival augmentation apical to the area of recession
• Gingival augmentation coronal to the recession (i.e., root coverage).
Techniques to Increase Attached Gingiva:

6. Free Gingival Autografts:
Free gingival grafts are used to create a widened zone of
attached gingiva.
• 1. The Classic Technique
• 2. Variant Techniques :
• A) Accordion technique B) Strip technique C) Combination

7. 1. The Classic Technique :
• Step 1: Prepare the recipient site
• Step 2: Obtain the graft from the donor site
• Step 3: Transfer and immobilize the graft
• Step 4: Protect the donor site
Extend the incision to approximately twice the desired width of the attached gingiva
allowing for 50% contraction of the graft when the healing is complete
For the classic technique, a partial-thickness graft is used
Make an aluminum foil template of the recipient site.
Proper thickness is important for survival of the graft, not too thin or too thick. The ideal
thickness of a graft is between 1.0 and 1,5 mm.
Tissue forceps should be used delicately and a minimum number of sutures used to avoid
unnecessary tissue perforation
Cover the donor site with a periodontal pack for 1 week, and repeat if necessary

8. 2. Variant Techniques:
• A) Accordion technique:
This technique increases the donor graft
by changing the configuration of the tissue

9. B) Strip technique:
consists of obtaining two or three strips of
gingival donor tissue about 3 to 5 mm wide and
long enough to cover the entire length of the
recipient site .
 These strips are placed side by side to form
one donor tissue and sutured on the recipient
site.
The area is then covered with aluminum foil
and surgical pack.
The advantages of this technique are the
rapid healing of the donor site.
The donor site usually does not require
suturing and heals uneventfully in 1 week

10. C) Combination:
Remove a strip of tissue from the palate about 3 to 4 mm thick, place
it between two wet tongue depressors, and split it longitudinally with a
sharp #15 blade.
Both will be used as free grafts.
The superficial portion consists of epithelium and connective tissue,
and the deeper portion consists only of connective tissue.
These donor tissues are placed on the recipient site as in the strip
technique.
The minimal donor site wound by obtaining two donor tissues from
one site is the advantage of this technique.

11. HEALING OF THE GRAFT:
• The success of the graft depends on survival of the connective tissue.
• Fibrous organization of the interface between the graft and the recipient bed
occurs within 2 to several days.
• The graft is initially maintained by a diffusion of fluid from the host bed, adjacent
gingiva, and alveolar mucosa.
• The fluid is a transudate from the host vessels and provides nutrition and
hydration essential for the initial survival of the transplanted tissues.
• During the first day, the connective tissue becomes edematous and disorganized
and undergoes degeneration and lysis of some of its elements.
• As healing progresses, the edema is resolved, and degenerated connective tissue
is replaced by new granulation tissue.
• Revascularization of the graft starts by the second or third day.
• The graft is pale and the pallor changes to an ischemic grayish white during the
first 2 days until vascularization begins and a pink color appears.
• Loss of epithelium leaves the graft smooth and shiny.
• Functional integration of the graft occurs by the seventeenth day

12. • Capillaries from the recipient bed proliferate into the graft to form a network of
new capillaries and anastomose with preexisting vessels.
• The central section of the surface is the last to vascularize, but this is complete by
the tenth day.
• The epithelium undergoes degeneration and sloughing which is replaced by new
epithelium from the borders of the recipient site.
• A thin layer of new epithelium is present by the fourth day, with rete pegs
developing by the seventh day.
• As seen microscopically, healing of a graft of intermediate thickness (0.75 mm) is
complete by 10.5 weeks and thicker grafts (1.75 mm) may require 16 weeks or
longer.

13. Thank you
