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Short-Term Clinical Evaluation of Free Gingival Graft Healing in Young and Adult Patients: A Pilot Study

Yıl 2025, Cilt: 9 Sayı: 1, 55 - 63, 30.04.2025

Selin Babalı , Başak Doğan , Leyla Kuru , Hatice Selin Güngörmek

Öz

Objectives: Aging affects wound healing, reducing fibroblast activity, collagen synthesis, and slowing wound contraction and epithelialization. This pilot study aimed to assess the effects of age on early clinical healing outcomes following free gingival graft (FGG) operation.
Materials and methods: The study included systemically healthy 10 patients; 5 patients in young group (aged: 20-35) and 5 patients in adult group (aged: 50-65) with ≤2 mm keratinized gingival width (KGW) at mandibular anterior region. A recipient bed was prepared. The FGG harvested from the palatal area was sutured to the recipient site with 6/0 silk sutures. Plaque and gingival index, probing depth, clinical attachment level (CAL), bleeding on probing and KGW were recorded before and 3 months after operation. Vertical and horizontal dimensions of graft (HDG) were recorded during surgery and 3 months after operation. Graft area (GA) was measured on standard photographs with a Java-based program at baseline, 2 weeks and 3 month follow-ups. The shrinkage percentage (SP) was calculated based on the reduction of GA.
Results: Clinical measurements before and 3 months after operation were similar between groups (p>0.05) except CAL was higher in the adult group on 3 months (p<0.05). Statistically significant gain was found in CAL and KGW in both groups on 3 months (p<0.05). SP was significantly lower in the adult group than the young group at all post-surgical time points (p<0.05), and a negative correlation was found between age, HDG and SP (p<0.05).
Conclusion: The present study suggests that age may affect the shrinkage of FGG at early healing stages.

Anahtar Kelimeler

Gingiva Tissue Graft Wound Healing

Kaynakça

  • Agudio G, Nieri M, Rotundo R, Franceschi D, Cortellini P, Pini Prato GP. Periodontal Conditions of Sites Treated With Gingival‐Augmentation Surgery Compared to Untreated Contralateral Homologous Sites: A 10‐ to 27‐Year Long‐Term Study. J. Periodontol. 2009;80(9):1399-405.
  • Anderson K, Hamm RL. Factors That Impair Wound Healing. J. Am. Coll. Clin. Wound. Spec. 2012;4(4):84-91.
  • Andia DC, Martins AG, Casati MZ, Sallum EA, Nociti FH. Root coverage outcome may be affected by heavy smoking: a 2-year follow-up study. J. Periodontol. 2008;79(4):647-53.
  • Barbosa FI, Zenóbio EG, Costa FO, Shibli JA. Dimensional changes between free gingival grafts fixed with ethyl cyanoacrylate and silk sutures. J. Int. Acad. Periodontol. 2009;11(2):170-6.
  • Bjorn H. Free transplantation of gingival propria. Sven Tandlak Tidskr. 1968;22:684-9.
  • Brackett RC, Gargiulo AW. Free gingival grafts in humans. J. Periodontol. 1970;41(10):581-6.
  • Caffesse RG, Burgett FG, Nasjleti CE, Castelli WA. Healing of free gingival grafts with and without periosteum: part I. Histologic Evaluation. J. Periodontol.1979;50(11):586-94.
  • Calsina G, Ramón JM, Echeverría JJ. Effects of smoking on periodontal tissues. J. Clin. Periodontol. 2002;29(8):771-6.
  • Camargo PM, Melnick PR, Kenney EB. The use of free gingival grafts for aesthetic purposes. Periodontol. 2000. 2001;27(1):72-96.
  • Çifçibaşı E, Karabey V, Koyuncuoğlu C, Düzağaç E, Genceli E, Kasalı K, et al. Clinical Evaluation of Free Gingival Graft Shrinkage in Horizontal and Vertical Dimensions. J. Istanbul. Univ. Fac. Dent. 2015;49(3):105-112.
  • Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. J. Clin. Periodontol. 2018;45(S20):S190-S198.
  • Deo SD, Shetty SK, Kulloli A, Chavan R, Dholakia P, Ligade S, et al. Efficacy of free gingival graft in the treatment of Miller Class I and Class II localized gingival recessions: A systematic review. J. Indian. Soc. Periodontol. 2019;23(2):93-9.
  • Donoff RB. Biological basis for vestibuloplasty procedures. J. Oral. Surg. 1976;34(10):890-6.
  • Dorfman HS, Kennedy JE, Bird WC. Longitudinal evaluation of free autogenous gingival grafts. J. Clin. Periodontol. 1980;7(4):316-24.
  • Dreeskamp M, de Jacoby LF. Breadth of the gingiva propria in vestibuloplasty following gingiva transplantation. Dtsch. Zahnarztl. Z. 1973;28(2):192-7.
  • Edel A. Clinical evaluation of free connective tissue grafts used to increase the width of keratinised gingiva. J. Clin. Periodontol. 1974;1(4):185-96.
  • Egli U, Vollmer WH, Rateitschak KH. Follow-up studies of free gingival grafts. J. Clin. Periodontol. 1975;2(2):98-104.
  • Friedman N. Mucogingival Surgery: The Apically Repositioned Flap. J. Periodontol. 1962;33(4):328-40.
  • Gapski R, Parks CA, Wang HL. Acellular Dermal Matrix for Mucogingival Surgery: A Meta-Analysis. J. Periodontol. 2005;76(11):1814-22.
  • Gerstein AD, Rogers GS, Gilchrest BA. Wound healing and aging. Dermatol. Clin. 1993;11(4):749-57.
  • Goldman HM, Isenberg G, Shuman A. The gingival autograft and gingivectomy. J. Periodontol. 1976;47(10):586-9.
  • Gümüş P, Buduneli E. Graft stabilization with cyanoacrylate decreases shrinkage of free gingival grafts. Aust. Dent. J. 2014;59(1):57-64.
  • Güncü GN, Keçeli HG, Ercan E, Hatipoğlu H, İlhan D, Tözüm TF. Vertical and horizontal dimensional evaluation of sutureless free gingival grafts. Clin. Dentistry. Res. 2012;36:29–35.
  • Guo S, DiPietro LA. Factors Affecting Wound Healing. J Dent Res. 2010;89(3):219-29.
  • Hangorsky U, Bissada NF. Clinical assessment of free gingival graft effectiveness on the maintenance of periodontal health. J. Periodontol. 1980;51(5):274-8.
  • Hatipoğlu H, Keçeli HG, Güncü GN, Sengün D, Tözüm TF. Vertical and horizontal dimensional evaluation of free gingival grafts in the anterior mandible: a case report series. Clin. Oral. Investig. 2007;11(2):107-13.
  • James WC, McFall WT. Placement of free gingival grafts on denuded alveolar bone. Part I: clinical evaluations. J. Periodontol. 1978;49(6):283-90.
  • Karakış Akcan S, Güler B, Hatipoğlu H. The effect of different gingival phenotypes on dimensional stability of free gingival graft: A comparative 6‐month clinical study. J. Periodontol. 2019;90(7):709-17.
  • 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.
  • Lang NP, Löe H. The relationship between the width of keratinized gingiva and gingival health. J. Periodontol. 1972;43(10):623-7.
  • Löe H. The Gingival Index, the Plaque Index and the Retention Index Systems. J. Periodontol. 1967;38(6):Suppl:610-6.
  • Matter J, Cimasoni G. Creeping attachment after free gingival grafts. J. Periodontol. 1976;47(10):574-9.
  • Mörmann W, Schaer F, Firestone AR. The relationship between success of free gingival grafts and transplant thickness: revascularization and shrinkage—a one year clinical study. J. Periodontol. 1981;52(2):74-80.
  • Nabers JM. Free gingival grafts. Periodontics. 1966;4(5):243-5.
  • Oliver RC, Löe H, Karring T. Microscopic evaluation of the healing and revascularization of free gingival grafts. J. Periodontal. Res. 1968;3(2):84-95.
  • Prato GP, Clauser C, Cortellini P. Periodontal plastic and mucogingival surgery. Periodontol. 2000. 1995;9(1):90-105.
  • Rateitschak KH, Egli U, Fringeli G. Recession: a 4-year longitudinal study after free gingival grafts. J. Clin. Periodontol. 1979;6(3):158-64.
  • Richard C, Oliver HL, Karring T. Microscopic evaluation of the healing and revascularization of free gingival grafts. J. Periodontol. 1968:84-95.
  • Rodriguez PG, Felix FN, Woodley DT, Shim EK. The Role of Oxygen in Wound Healing: A Review of the Literature. Dermatol. Surg. 2008;34(9):1159-69.
  • Silva CO, Ribeiro ÉDP, Sallum AW, Tatakis DN. Free Gingival Grafts: Graft Shrinkage and Donor-Site Healing in Smokers and Non-Smokers. J. Periodontol. 2010;81(5):692-701.
  • Soehren SE, Allen AL, Cutright DE, Seibert JS. Clinical and histologic studies of donor tissues utilized for free grafts of masticatory mucosa. J. Periodontol. 1973;44(12):727-41.
  • Sullivan HC, Atkins JH. Free autogenous gingival grafts. I. Principles of successful grafting. Periodontics. 1968;6(3):121-9.
  • Tavelli L, Barootchi S, Stefanini M, Zucchelli G, Giannobile WV, Wang HL. Wound healing dynamics, morbidity, and complications of palatal soft‐tissue harvesting. Periodontol. 2000. 2022;92(1):90-119.
  • Wan W, Zhong H, Wang J. Creeping attachment: A literature review. J. Esthet. Restor. Dent. 2020;32(8):776-82.
  • Wennström J, Lindhe J. Role of attached gingiva for maintenance of periodontal health: healing following excisional and grafting procedures in dogs. J. Clin. Periodontol. 1983;10(2):206-21.
  • Wennström JL, Lindhe J, Sinclair F, Thilander B. Some periodontal tissue reactions to orthodontic tooth movement in monkeys. J. Clin. Periodontol. 1987;14(3):121-9.
  • Yildiz MS, Gunpinar S. Free gingival graft adjunct with low-level laser therapy: a randomized placebo-controlled parallel group study. Clin. Oral. Investig. 2018;23(4):1845-54.
  • Zingale JA. Observations on free gingival autografts. J. Periodontol. 1974;45(10):748-59.
  • Zorina A, Zorin V, Kudlay D, Kopnin P. Age-Related Changes in the Fibroblastic Differon of the Dermis: Role in Skin Aging. Int. J. Mol. Sci. 2022;23(11).
  • Zuhr O, Bäumer D, Hürzeler M. The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J. Clin. Periodontol. 2014;41(S15):S123-S142.

Genç ve yetişkin bireylerde serbest diş eti grefti iyileşmesinin kısa dönem klinik olarak değerlendirilmesi: pilot çalışma

Yıl 2025, Cilt: 9 Sayı: 1, 55 - 63, 30.04.2025

Selin Babalı , Başak Doğan , Leyla Kuru , Hatice Selin Güngörmek

Öz

Amaç: Yaşın ilerlemesi, yara iyileşmesini etkileyerek fibroblast aktivitesini, kolajen sentezini azaltarak yara kontraksiyonu ve epitelizasyonu yavaşlatır. Bu pilot çalışmada, serbest dişeti greftinin (SDG) erken dönem iyileşmesinde yaşın etkilerini klinik olarak değerlendirilmesi amaçlandı.
Gereç ve Yöntemler: Çalışmaya sistemik olarak sağlıklı, genç (20-35 yaş) grupta 5 hasta ve yetişkin (50-65 yaş) grupta 5 hasta olmak üzere mandibular anterior bölgede keratinize diş eti dikey boyutu (KDDB) ≤2 mm olan toplam 10 hasta dahil edildi. Mandibular anterior bölgede alıcı yatak açıldı. Palatinal bölgeden alınan SDG alıcı bölgeye 6/0 ipek dikiş ile dikildi. Bütün ağız plak ve gingival indeks, sondalamada kanama, sondalama derinliği ve klinik ataşman seviyesi (KAS) operasyon öncesinde ve 3 ay sonra ölçüldü. Ameliyat bölgesi KDDB, greftin dikey ve yatay boyutu (GYB) operasyon sırasında ve sonrası 3. ayda kaydedildi. Greft alanı (GA), standart fotoğraflar üzerinde Java tabanlı bir program ile başlangıçta, 2. hafta ve 3. ayda ölçüldü. Büzülme yüzdesi (BY), GA' daki azalma üzerinden hesaplandı.
Bulgular: Klinik ölçümler operasyon öncesi ve operasyon sonrası 3. ayda gruplar arası karşılaştırılması benzerdi (p>0,05), yalnızca KAS, 3. ayda yetişkin grupta daha yüksek olduğu saptandı (p<0,05). Her iki grupta da başlangıca göre 3. ayda KAS ve KDDB’de istatistiksel olarak anlamlı artış gözlendi (p<0,05). BY, tüm postoperatif ölçüm dönemlerinde genç gruba göre yetişkin grupta istatistiksel olarak anlamlı düşük bulundu (p<0,05). Yaş ve GYB ile BY arasında negatif korelasyon tespit edildi (p<0,05).
Sonuç: Bu çalışma, SDG’nin erken dönem iyileşmesinde yaşın greft büzülmesini etkileyebileceğini göstermektedir.

Anahtar Kelimeler

Diş Eti Doku Grefti Yara İyileşmesi

Etik Beyan

Çalışmayı Marmara Üniversitesi Tıp Fakültesi Klinik Araştırmalar Etik Kurulu, çalışmayı 02.06.2020 tarihinde 09.2020.660 numarasıyla onayladı.

Kaynakça

  • Agudio G, Nieri M, Rotundo R, Franceschi D, Cortellini P, Pini Prato GP. Periodontal Conditions of Sites Treated With Gingival‐Augmentation Surgery Compared to Untreated Contralateral Homologous Sites: A 10‐ to 27‐Year Long‐Term Study. J. Periodontol. 2009;80(9):1399-405.
  • Anderson K, Hamm RL. Factors That Impair Wound Healing. J. Am. Coll. Clin. Wound. Spec. 2012;4(4):84-91.
  • Andia DC, Martins AG, Casati MZ, Sallum EA, Nociti FH. Root coverage outcome may be affected by heavy smoking: a 2-year follow-up study. J. Periodontol. 2008;79(4):647-53.
  • Barbosa FI, Zenóbio EG, Costa FO, Shibli JA. Dimensional changes between free gingival grafts fixed with ethyl cyanoacrylate and silk sutures. J. Int. Acad. Periodontol. 2009;11(2):170-6.
  • Bjorn H. Free transplantation of gingival propria. Sven Tandlak Tidskr. 1968;22:684-9.
  • Brackett RC, Gargiulo AW. Free gingival grafts in humans. J. Periodontol. 1970;41(10):581-6.
  • Caffesse RG, Burgett FG, Nasjleti CE, Castelli WA. Healing of free gingival grafts with and without periosteum: part I. Histologic Evaluation. J. Periodontol.1979;50(11):586-94.
  • Calsina G, Ramón JM, Echeverría JJ. Effects of smoking on periodontal tissues. J. Clin. Periodontol. 2002;29(8):771-6.
  • Camargo PM, Melnick PR, Kenney EB. The use of free gingival grafts for aesthetic purposes. Periodontol. 2000. 2001;27(1):72-96.
  • Çifçibaşı E, Karabey V, Koyuncuoğlu C, Düzağaç E, Genceli E, Kasalı K, et al. Clinical Evaluation of Free Gingival Graft Shrinkage in Horizontal and Vertical Dimensions. J. Istanbul. Univ. Fac. Dent. 2015;49(3):105-112.
  • Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. J. Clin. Periodontol. 2018;45(S20):S190-S198.
  • Deo SD, Shetty SK, Kulloli A, Chavan R, Dholakia P, Ligade S, et al. Efficacy of free gingival graft in the treatment of Miller Class I and Class II localized gingival recessions: A systematic review. J. Indian. Soc. Periodontol. 2019;23(2):93-9.
  • Donoff RB. Biological basis for vestibuloplasty procedures. J. Oral. Surg. 1976;34(10):890-6.
  • Dorfman HS, Kennedy JE, Bird WC. Longitudinal evaluation of free autogenous gingival grafts. J. Clin. Periodontol. 1980;7(4):316-24.
  • Dreeskamp M, de Jacoby LF. Breadth of the gingiva propria in vestibuloplasty following gingiva transplantation. Dtsch. Zahnarztl. Z. 1973;28(2):192-7.
  • Edel A. Clinical evaluation of free connective tissue grafts used to increase the width of keratinised gingiva. J. Clin. Periodontol. 1974;1(4):185-96.
  • Egli U, Vollmer WH, Rateitschak KH. Follow-up studies of free gingival grafts. J. Clin. Periodontol. 1975;2(2):98-104.
  • Friedman N. Mucogingival Surgery: The Apically Repositioned Flap. J. Periodontol. 1962;33(4):328-40.
  • Gapski R, Parks CA, Wang HL. Acellular Dermal Matrix for Mucogingival Surgery: A Meta-Analysis. J. Periodontol. 2005;76(11):1814-22.
  • Gerstein AD, Rogers GS, Gilchrest BA. Wound healing and aging. Dermatol. Clin. 1993;11(4):749-57.
  • Goldman HM, Isenberg G, Shuman A. The gingival autograft and gingivectomy. J. Periodontol. 1976;47(10):586-9.
  • Gümüş P, Buduneli E. Graft stabilization with cyanoacrylate decreases shrinkage of free gingival grafts. Aust. Dent. J. 2014;59(1):57-64.
  • Güncü GN, Keçeli HG, Ercan E, Hatipoğlu H, İlhan D, Tözüm TF. Vertical and horizontal dimensional evaluation of sutureless free gingival grafts. Clin. Dentistry. Res. 2012;36:29–35.
  • Guo S, DiPietro LA. Factors Affecting Wound Healing. J Dent Res. 2010;89(3):219-29.
  • Hangorsky U, Bissada NF. Clinical assessment of free gingival graft effectiveness on the maintenance of periodontal health. J. Periodontol. 1980;51(5):274-8.
  • Hatipoğlu H, Keçeli HG, Güncü GN, Sengün D, Tözüm TF. Vertical and horizontal dimensional evaluation of free gingival grafts in the anterior mandible: a case report series. Clin. Oral. Investig. 2007;11(2):107-13.
  • James WC, McFall WT. Placement of free gingival grafts on denuded alveolar bone. Part I: clinical evaluations. J. Periodontol. 1978;49(6):283-90.
  • Karakış Akcan S, Güler B, Hatipoğlu H. The effect of different gingival phenotypes on dimensional stability of free gingival graft: A comparative 6‐month clinical study. J. Periodontol. 2019;90(7):709-17.
  • 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.
  • Lang NP, Löe H. The relationship between the width of keratinized gingiva and gingival health. J. Periodontol. 1972;43(10):623-7.
  • Löe H. The Gingival Index, the Plaque Index and the Retention Index Systems. J. Periodontol. 1967;38(6):Suppl:610-6.
  • Matter J, Cimasoni G. Creeping attachment after free gingival grafts. J. Periodontol. 1976;47(10):574-9.
  • Mörmann W, Schaer F, Firestone AR. The relationship between success of free gingival grafts and transplant thickness: revascularization and shrinkage—a one year clinical study. J. Periodontol. 1981;52(2):74-80.
  • Nabers JM. Free gingival grafts. Periodontics. 1966;4(5):243-5.
  • Oliver RC, Löe H, Karring T. Microscopic evaluation of the healing and revascularization of free gingival grafts. J. Periodontal. Res. 1968;3(2):84-95.
  • Prato GP, Clauser C, Cortellini P. Periodontal plastic and mucogingival surgery. Periodontol. 2000. 1995;9(1):90-105.
  • Rateitschak KH, Egli U, Fringeli G. Recession: a 4-year longitudinal study after free gingival grafts. J. Clin. Periodontol. 1979;6(3):158-64.
  • Richard C, Oliver HL, Karring T. Microscopic evaluation of the healing and revascularization of free gingival grafts. J. Periodontol. 1968:84-95.
  • Rodriguez PG, Felix FN, Woodley DT, Shim EK. The Role of Oxygen in Wound Healing: A Review of the Literature. Dermatol. Surg. 2008;34(9):1159-69.
  • Silva CO, Ribeiro ÉDP, Sallum AW, Tatakis DN. Free Gingival Grafts: Graft Shrinkage and Donor-Site Healing in Smokers and Non-Smokers. J. Periodontol. 2010;81(5):692-701.
  • Soehren SE, Allen AL, Cutright DE, Seibert JS. Clinical and histologic studies of donor tissues utilized for free grafts of masticatory mucosa. J. Periodontol. 1973;44(12):727-41.
  • Sullivan HC, Atkins JH. Free autogenous gingival grafts. I. Principles of successful grafting. Periodontics. 1968;6(3):121-9.
  • Tavelli L, Barootchi S, Stefanini M, Zucchelli G, Giannobile WV, Wang HL. Wound healing dynamics, morbidity, and complications of palatal soft‐tissue harvesting. Periodontol. 2000. 2022;92(1):90-119.
  • Wan W, Zhong H, Wang J. Creeping attachment: A literature review. J. Esthet. Restor. Dent. 2020;32(8):776-82.
  • Wennström J, Lindhe J. Role of attached gingiva for maintenance of periodontal health: healing following excisional and grafting procedures in dogs. J. Clin. Periodontol. 1983;10(2):206-21.
  • Wennström JL, Lindhe J, Sinclair F, Thilander B. Some periodontal tissue reactions to orthodontic tooth movement in monkeys. J. Clin. Periodontol. 1987;14(3):121-9.
  • Yildiz MS, Gunpinar S. Free gingival graft adjunct with low-level laser therapy: a randomized placebo-controlled parallel group study. Clin. Oral. Investig. 2018;23(4):1845-54.
  • Zingale JA. Observations on free gingival autografts. J. Periodontol. 1974;45(10):748-59.
  • Zorina A, Zorin V, Kudlay D, Kopnin P. Age-Related Changes in the Fibroblastic Differon of the Dermis: Role in Skin Aging. Int. J. Mol. Sci. 2022;23(11).
  • Zuhr O, Bäumer D, Hürzeler M. The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J. Clin. Periodontol. 2014;41(S15):S123-S142.
Toplam 50 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Periodontoloji
Bölüm Özgün Araştırmalar
Yazarlar

Selin Babalı 0000-0001-8211-4906

Başak Doğan 0000-0002-3602-4886

Leyla Kuru 0000-0002-7599-2409

Hatice Selin Güngörmek 0000-0001-5650-3107

Yayımlanma Tarihi 30 Nisan 2025
Gönderilme Tarihi 26 Mart 2025
Kabul Tarihi 14 Nisan 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 9 Sayı: 1

Kaynak Göster

APA Babalı, S., Doğan, B., Kuru, L., Güngörmek, H. S. (2025). Genç ve yetişkin bireylerde serbest diş eti grefti iyileşmesinin kısa dönem klinik olarak değerlendirilmesi: pilot çalışma. European Journal of Research in Dentistry, 9(1), 55-63.
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