A Simplified Sutureless Free Gingival Graft: A Case Series of Over 100 Consecutive Patients

Free gingival grafts (FGGs) are commonly utilized to increase the amount of keratinized tissue around both teeth and implants. Traditionally, autogenous grafts harvested from the palate are fixated to the recipient site utilizing a wide array of suturing techniques. In this paper a simplified sutureless method to free gingival grafting was demonstrated utilizing medical grade tissue adhesive, and Coe-Pak as a way to avoid sutures entirely, making the procedure simpler and faster to perform saving valuable chairside time for the clinician and patient. 111 consecutive patients in private practice were included in this case series. In all cases, free gingival grafts harvested from the palate were fixated to the recipient site utilizing medical grade cyanoacrylate and periodontal dressing alone after hydrating the grafts in liquid platelet-rich fibrin (liquid-PRF). The amount of keratinized tissue, recession, and attached tissue were recorded prior to treatment and at their follow-up. All clinical cases demonstrated successful graft integration with uneventful healing despite zero sutures being utilized. In 111 cases, a total of 348 teeth were grafted with an average gain of 3.98 + 2.36mm of keratinized tissue, 3.48 + 1.21mm of attached tissue, and a 0.15 + 0.54mm reduction in recession, with no failures. The simplified sutureless free gingival grafting technique is a predictable method to rapidly and confidently secure free gingival grafts around teeth and implants to increase the amount of keratinized and attached tissue. Further randomized comparative studies are necessary, specifically investigating the effects of liquid-PRF at the recipient site.