• Journal of Periodontal and Implant Science
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• v.39 no.4
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• pp.437-441
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• 2009

Purpose: The purpose of this report is to show three cases treated by an intergrated periodontal and restorative dentistry approach. Methods: Three patients with Miller Class Ⅰgingiva recessions associated with cervical lesions were enrolled for treatment. Two patients received a connective tissue graft and resin modified glass ionomer, and one patient was treated with a connective tissue graft, resin restoration. Keratinized gingiva and relative gingival recession were measured. Results: The mean reduction of relative gingival recession was 3.7 mm, and the mean keratinized gingiva increase was 2.5 mm. The percentage of root coverage was 80% in average. No signs of gingival inflammation or bleeding on probing were seen. The patients were satisfied with the final esthetics and had no more dentin hypersensitivity. Conclusions: This report indicates that teeth with Miller ClassⅠ gingival recession associated with cervical lesions can be successfully treated by a connective tissue graft combined with restorative dentistry. However, longitudinal randomized controlled clinical trials must be performed to support this approach.

• Journal of Periodontal and Implant Science
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• v.53 no.5
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• pp.362-375
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• 2023

Purpose: The aim of this study was to investigate the relationships between gingival thickness (GT) and keratinized gingiva width (KGW), papilla height (PH), and crown ratio (CR) by employing transgingival probing and an intraoral scanner (IOS). Methods: This cross-sectional study examined 360 maxillary anterior teeth from 60 patients. GT was assessed using transgingival probing with an endodontic spreader. KGW, CR, and PH were measured using an IOS. One-way analysis of variance, the Student's t-test, and Spearman correlation coefficients were employed for statistical analysis. Results: Higher GT was significantly associated with thinner KGW in the central region (P=0.019). There was no statistically significant difference in GT between teeth (P=0.06). PH was lower in lateral teeth than in canines (P=0.047), with a PH of 2.99 mm in lateral teeth. The KGW was narrower in canines than in central teeth (P=0.007). A moderate correlation was observed between KGW and PH in the central region (P=0.01), while a weak negative correlation was found between KGW and CR (P=0.043). Conclusions: A moderate negative correlation was found between GT and KGW, as well as between PH and KGW in central teeth. In contrast, a weak negative correlation existed between CR and KGW. The PH (2.99 mm) was lower in lateral teeth than in canines. The traditional paradigm, which suggests a positive correlation between KGW and GT, was reevaluated by measuring KGW using an IOS.

• The Journal of the Korean dental association
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• v.38 no.7 s.374
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• pp.672-678
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• 2000

• The Journal of the Korean dental association
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• v.55 no.1
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• pp.30-41
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• 2017

Inadequate keratinized mucosa around dental implants can lead to more plaque accumulation, tissue inflammation, marginal recession and attachment loss. We evaluated the effects of free gingival and extracellular matrix membrane grafts performed to increase the insufficient width of keratinized tissue around dental implants in the posterior mandible. A 47-year-old female patient presented with discomfort due to swelling of the lower right second premolar area. Due to severe destruction of alveolar bone, the tooth was extracted. After 3 months, a guided bone regeneration (GBR) procedure was performed and then a dental implant was placed 6 months later. During the second-stage implant surgery, free gingival grafting was performed to increase the width of the keratinized tissue. After 12 months, a clinical evaluation was performed. A 64-year-old female patient had a missing tooth area of bilateral lower molar region with narrow zone of keratinized gingiva and horizontal alveolar bone loss. Simultaneous implant placement and GBR were performed. Five months after the first-stage implant surgery, a gingival augmentation procedure was performed with an extracellular matrix membrane graft to improve the width of the keratinized tissue in the second-stage implant surgery. After 12 months, a clinical evaluation was performed. In these two clinical cases, 12 months of follow-up, revealed that the increased width of the keratinized tissue and the deepened oral vestibule was well maintained. A patient showed a good oral hygiene status. In conclusion, increased width of keratinized tissue around dental implants could improve oral hygiene and could have positive effects on the long-term stability and survival rate of dental implants. When planning a keratinized tissue augmentation procedure, clinicians should consider patient-reported outcomes.

• The Journal of the Korean dental association
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• v.54 no.4
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• pp.296-305
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• 2016

Narrow zone of attached gingiva and shallow vestibule around the implants might contribute to difficulty of cleasing, periimplant mucositis caused by incomplete cleansing and further peri-implantitis. The aim of this case report is to present modification of soft tissue biotype around the implants by free gingival grafts according to timing of surgical intervention and shape of free gingiva. A 44 year-old male patient had a missing area on lower right second molar area with 1 to 2 mm of narrow attached gingiva zone and wanted to be treated by implant placement. In radiographic analysis, there was enough alveolar bone to install an implant, free gingiva from hard palate was grafted following implant placement using double layer flap. The width of attached gingival was increased to 4 to 5mm and well maintained during 5 months of follow up. A 69 year-old female patient also had a missing area on lower right first and second molar area with 1 to 2 mm narrow attached gingiva. Since she had systematically angina pectoris and dental phobia, minimal invasive free gingival graft after implants placement was planned. After 2 months of implant surgery, free gingival graft surgery was performed with healing abutments connection. The grafted gingiva was composed of two strip shaped free gingiva, and they were immobilized by periodontal pack. The width of attached gingival was increased to 4 to 5mm and well maintained during 10 months of follow up. With prosthesis delivery, the patients recovered ideal periodontal environment around implants and masticatory function. In conclusion, periodontal health and masticatory function could be achieved through implant placement and free gingival graft.

• Journal of the korean academy of Pediatric Dentistry
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• v.27 no.1
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• pp.122-134
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• 2000

The aim of this study is (1) to establish the baseline information concerning the width of keratinized gingiva, depth of gingival sulcus and width of attached gingiva on the buccal surface of the teeth: and (2) to determine the relationship between the above values and tooth eruption: and (3) to estimate the frequency of mucogingival problems. The results were as follows; 1. The mean width of attached gingiva of the children aged $6\sim12$ proved to be wider in the maxilla than in the mandible. Of the primary teeth, the widest width was found in the areas of maxillary primary lateral incisors and maxillary primary canines(3.50mm and 3.55mm). The narrowest was noted in the area of mandibular first primary molars(1.34mm) In the permanent dentition, the greatest width was found in the areas of maxillary permanent lateral incisors (3.00mm). The narrowest was noted in the area of mandibular first premolars(0.55mm). 2. In the primary dentition, the width of attached gingiva of primary canines and first and second primary molars became wider from the age of six as the age increased. In the permanent dentition of the boys, only mandibular central incisors and maxillary first molars showed the tendency towards increase in the width of attached gingiva with increasing age. In the permanent dentition of girls, central and lateral incisors of both jaws and maxillary first molars showed statistically significant increase in the width of attached gingiva with increasing age(p<0.05). 3. At the age of tooth change, the attached gingiva of primary teeth were almost wider than those of successive permanent teeth (p<0.05). 4. During the period of 6 to 12 years of age, the width of keratinized gingiva and the depth of gingival sulcus of permanent tooth at the age of twelve were larger than those of primary tooth at the age of six (p<0.05). 5. The maximum in the frequency of mucogingival problems was found in the areas of upper and lower first primary molars of primary dentition, and in the upper and lower first premolars of permanent dentition regardless of sex. The frequency was higher in primary teeth than in the corresponding successive permanent teeth These teeth showed tendency towards increase in mucogingival problems with age.

• Journal of Periodontal and Implant Science
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• v.30 no.3
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• pp.639-650
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• 2000

The purpose of this study was to evaluate clinical changes in graft size after treatment with connective tissue autograft in human. 40 premolar teeth in 23 patients having the following mucogingival problemswere selected. The width of extension, attached gingiva including free marginal gingiva, width of transplant and clinical sulcus depth were measured at the initial examination, 2, 12 and 24 weeks following the connective tissue autograft and free gingival autograft. The change of width of extension, attached gingiva including free marginal gingiva, width of transplant and clinical sulcus depth according to healing process in both graft procedures was statistically analyzed by ANOVA test and independent ttest using SPSS program. The results were as follows : 1. The change of keratinized gingiva in both grafting procedures was increased significantly at 24 weeks post-op. 2. The clinical sulcus depth exhibited no marked changes throughoutthe entire investigation in both grafting procedures. 3 . After 12 weeks, no dimensional variation was seen in graft size in both grafting procedures. 4. Shrinkage differs significantly in both grafting procedures. From the day of graft to 24 weeks after surgery the percentages of shrinkage were connective tissue autograft 55% and free gingival autograft 29%.

• Journal of Periodontal and Implant Science
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• v.27 no.3
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• pp.549-559
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• 1997

The purpose of this study was to evaluate clinical changes in graft size after treatment with strip gingival autograft in human. 57 premolar teeth in 27 patients having the following mucogingival problems were selected. The width of extension, attached gingiva including free marginal gingiva, width of transplant and clinical sulcus depth were measured at the initial examination, 2, 12 and 24 weeks following the strip gingival autograft and free gingival autograft. The change of width of extension, attached gingiva including free marginal gingiva, width of transplant and clinical sulcus depth according to healing process in both graft procedures was statistically analyzed by repeated measure ANOVA test and independent t-test using SPSS program. The results were as follows : 1. The change of keratinized gingiva in both graft procedures was increased significantly at 24 weeks post-op. 2. The clinical sulcus depth exhibited no marked changes throughout the entire investigation in both graft procedures. 3. No dimensional variation was seen in graft size in both graft procedures. 4. Shrinkage did not differ significantly in both graft procedures. From the day of grafting to 24 weeks after surgery the percentages of shrinkage were : strip gingival autograft 28% and free gingival autograft 29%.

• Journal of Periodontal and Implant Science
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• v.30 no.1
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• pp.133-146
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• 2000

Histological studies indicate a tetracycline HCl similar to citric acid to induce connetive tissue repair in animals. When tetracycline HCl was used as a root conditioning agent in humans, there was a trend toward more connective tissue attachment than in root planing alone. The purpose of this study was to evaluate clinical effect of tetracycline HCl in the treatment of gingival recession. 44 teeth in 12 patients with bilaterally gingival recession & Miller classification I, II gingival recession were selected and 22 teeth were treated with 125mg/ml tetracycline HCl , the others was not treated with tetracycline HCl. Gingival recession, pocket depth, clinical attachment level, width of keratinized gingiva were observed at baseline, postoperative 4, 12, 20weeks. Both groups were statistically analyzed by Wilcoxon signed Ranks Test & Wilcoxon's rank sum test(Mann-whitney test) using SPSS program.(5% significance level) The results were as follows: 1........The change of gingival recession, clinical attachment level, keratinized gingiva in both groups were increased significantly at 4, 12, 20 weeks. 2.......The pocket depth exhibited no marked changes throughout the entire investigation in both groups. 3........The change of gingival recession in tetracycline group was increased significantly than control group at 4, 12, 20 weeks and the percentage of root coverage was 93% in tetracycline group and 83% in control group. 4........The change of clinical attachment level, pocket depth, keratinized tissue from baseline to 4, 12, 20 weeks was not differ significanltly in both group.

• Journal of Periodontal and Implant Science
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• v.44 no.2
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• pp.94-99
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• 2014

Purpose: Various surgical techniques target achieving adequate keratinized tissue around dental implants; however, these techniques are usually performed before implant placement or upon the exposure of submerged implants. The aim of this case report is to describe a simultaneous placement of an interpositional free gingival graft (iFGG) with that of nonsubmerged implants in a patient lacking keratinized tissue and to assess the longterm outcome of this grafted gingiva. Methods: A wedge-shaped free gingnival graft (FGG), including an epithelium-connective tissue (E-C) portion and a connective-tissue-only (CT) portion, was harvested from the palate. The CT portion was inserted under the buccal flap, and the E-C portion was secured tightly around the implants and to the lingual flap. Results: At the 8-year follow-up, the gingival graft remained firmly attached and was well maintained, with no conspicuous shrinkage or reported discomfort during oral hygiene procedures. The use of an iFGG at a nonsubmerged implant placement minimizes the required number of surgical steps and patient discomfort while providing adequate buccal keratinized tissue. Conclusions: Therefore, the technique could be considered an alternative method in increasing the keratinized tissue for cases that have a minimal amount of keratinized tissue.