Free gingival graft

​Free gingival grafts have high success rates in achieving:
1-increase in keratinised tissue
2-deepening of vestibule
3-increasing biotype
4- eliminating frenal attachments
They have limited efficacy when it comes to improving cosmetics or root coverage. If these two aims are the holygrail for mucogingival surgery, why do we still utilise free gingival grafts??
The answer is in the nature of the free gingival graft procedure.  It is considerably less complex than other grafting procedures with a very low risk of graft necrosis. This makes free gingival grafting the first option when it comes to extreme Miller class 3 or 4 cases particularly in the lower arch due to the limited working space resulting from a reduced sulcus depth (compared to uppers).  Moreover, gingival colour mismatch in the lower anterior region is more acceptable and less visible.
This patient was referred Frank Goulbourn who was quite rightly concerned about the prognosis of the LR1 LL1. These teeth had suffered:

1. advanced attachment loss combined with 5mm pocketing
2. loss of keratinised tissue
3. excessive plaque accumulation and erythema due to a mobile gingival margin with proximity to a frenal attachment

These teeth were surprisingly firm due to the patient’s anterior open bite. They were given a poor prognosis  and we set off trying to improve the situation with the aim of replacement with resin retained bridgework if they became mobile. We aimed to correct the problem list above with a free gingival graft which was very successful despite the heavy smoking status of the patient. The pictures below demonstrate a stable state approximately 18 months after treatment. They demonstrate gain in keratinised tissue, deepening of the sulcus and reduction in probing depths.
I would like to thank Frank for taking action and referring this patient quickly as soon as she presented. I would also like to thank Juliette Reeves for the fantastic post surgical maintenance and supportive therapy.