Free Gingival Graft for Mandibular Anterior Teeth: A Clinical Case Report

Free Gingival Graft (FGG) is a well-established surgical technique in mucogingival surgery, primarily used to increase the amount of Keratinized Tissue (KT) in deficient areas. This procedure has proven effective for the coverage of gingival recessions, especially in cases with insufficient attached gingiva. However, its application in deep recessions or for complete root coverage presents aesthetic and functional limitations. Recently, modifications to the traditional FGG technique have been proposed to improve its outcomes. A study introduced a modified FGG technique, which demonstrated greater recession coverage and a significant increase in KT height compared to the conventional FGG. This modification also resulted in higher patient satisfaction in terms of aesthetics. In addition, recent research has evaluated the use of mucoadhesive agents containing hyaluronic acid at the palatal donor site. Clinical Case: A 51-year-old female patient with a medical history of breast cancer, successfully treated five years ago with no signs of recurrence to date, presented for consultation seeking to improve periodontal esthetics and functionality through root coverage in the lower anterior region. Clinical examination revealed gingival recessions on teeth #31 and #41, classified as RT1 according to Cairo’s classification of recession types. Aberrant frenula were also noted, inserting at the mucogingival junction and causing excessive muscular traction on the gingival margin. The width of KT in the affected area was minimal-approximately 2 mm-compromising periodontal stability and complicating oral hygiene. The therapeutic approach involved performing a Free Gingival Graft (FGG) to increase the amount of KT and improve the periodontal environment in preparation for a potential future root coverage procedure. Additionally, muscle traction was addressed through the disinsertion of muscle fibers and removal of the aberrant frenula. The graft was harvested from the palate and adapted to the previously prepared recipient site. Postoperative evaluations revealed a significant gain in KT height and thickness, along with satisfactory integration of the graft in terms of color and texture, achieving esthetic harmony with the adjacent tissues. Despite the absence of mucoadhesive agents or dressings at the donor site, palatal healing was adequate and uneventful, with the patient reporting manageable pain levels. Conclusion: The free gingival graft remains a reliable and effective therapeutic option for increasing keratinized tissue in areas where it is minimal or absent. In this case, the technique not only improved the periodontal and esthetic conditions of the treated region but also established favorable conditions for possible future root coverage. The surgical intervention successfully modified the insertion of soft tissues, eliminating muscular tension that compromised gingival stability and improving the long-term prognosis of the involved teeth.