Epithelized Free Autograft-A Case Report Series with Different Healing Outcomes

The gain in gingival soft tissue volume for multifaceted dynamics requires long term stability of gingival margin and interdental papilla height. Four patients presented with Miller’s class II and III recession on mandibular incisors. Abundant plaque and calculus, an aberrant frenum and inadequate width of attached gingiva (AG) were localized in the area with complaint of difficulty in cleaning the root surface. Patients underwent epithelized free autograft (Free Gingival Graft) for gain in AG, vestibular deepening and root coverage using direct technique. Healing in 18 months to two years showed creation of thick wide zones of AG with partial root coverage. This provided room for plaque control and halted disease progression. There was greater patient satisfaction as soft tissue and its existence was more important than quantitative level of root coverage. Autografts were cost effective and offered long term predictability. However, esthetic results obtained were different in all four patients. Therefore, this case series addresses various factors that interplay in healing of graft. Further, it highlights that position of fully erupted teeth and inclination of roots along with vascularity of recipient bed are likely to play an essential role that requires further well controlled trials to aid in better esthetic outcome and case selection.