Minimally invasive free gingival graft technique prior-to orthodontic therapy: case report

Introduction: A gingival recession (GR) is an affection in which the gingiva displaces apical to the cement-enamel junction causing exposure of the root surface. A thin gingival phenotype can be associated to GR, especially when exposed to orthodontic movements. To solve this condition, several mucogingival techniques have been proposed. Free gingival grafts taken from the palate are the gold standard; however, they are related to poor esthetical results and postoperative complications. In order to reduce those disadvantages, a «Minimally Invasive Esthetic Free Gingival Graft» (MIEFGG) technique is proposed, which involves a donor site placed on the buccal aspect of upper molars to modify the phenotype or regain attachment in the recipient site. Aim: To describe a new graft technique, used in mucogingival surgery, which is both esthetic and minimally invasive. Material and methods: A 24-year-old female patient who requested a periodontal evaluation before orthodontic treatment. Diagnosis: Cairo’s RT3 along with thin phenotype, type II mobility, and extrusion associated to teeth 4.1 and 4.2. Treatment plan: thicken the gingival phenotype surrounding teeth 4.1 and 4.2 before orthodontic therapy. Since the patient expressed esthetical concerns, the MIEFGG technique was selected. Results: Postsurgical follow-ups were performed 7, 14, 30, and 150 days. Both the width and the height of the keratinized gingiva around teeth 4.1 and 4.2 increased by 1 mm. The esthetic outcome was satisfactory, according to the patient. No complications or postoperative pain was reported. Conclusion: MIEFGG is a technique that presents good results in terms of gingival augmentation, little discomfort to the patient, and esthetic results. Concerning the clinical case presented here, those advantages were achieved. However, more research is needed in order to prove its effectiveness.