Original Research Article International Journal of Periodontology and Implantology, July-September 2017;2(3):87-90 87 Free gingival graft – a versatile treatment modality Vineeta Singal 1,* , Ritika Arora 2 , Anamika Sharma 3 1 PG Student, 2 Senior Lecturer, 3 Professor & HOD, Dept. of Periodontology, Subharti Dental College & Hospital, Meerut, Uttar Pradesh *Corresponding Author: Email: vineetankit@gmail.com Abstract Introduction: Attached gingiva is the part of gingiva which is firm, resilient and tightly bound to the underlying periosteum of alveolar bone or to the root surface. The width of the attached gingiva is genetically predetermined, varies in different areas of the dentition, and its dimensions can change throughout life. Presence of an ‘‘adequate’’ amount of gingiva has been considered a s a keystone for the maintenance of periodontal health. Free gingival graft (FGG) is a versatile treatment modality to create an adequate zone of attached gingiva. Objective: Evaluating FGG procured from different anatomical sites to increase the width of attached gingiva. Materials and Method: Three cases were selected with inadequate width of attached gingiva and treated with FGG obtained from different sites like palate, edentulous ridge and buccal attached gingiva. Cases were evaluated for gain in width of attached gingiva, colour matching of grafted soft tissue to adjacent areas and post-operative pain evaluation through visual analog scale. Result: There was an increase in width of attached gingiva with some coronal migration. FGG obtained from buccal attached gingiva and edentulous region had least pain post operatively with satisfactory colour matching as compared to FGG obtained from palate. Conclusion: FGG is a viable and effective modality for increasing the width of attached gingiva and can be procured from sites other than palate. Keywords: Free gingival graft, Attached gingiva, Visual analog scale Introduction The attached gingiva is defined as the tissue between the mucogingival junction and the projection on the external gingival surface of the most apical portion of the gingival sulcus or the periodontal pocket. (1) The width of the attached gingiva is genetically predetermined, varies in different areas of the dentition, and its dimensions can change throughout life. Presence of an ‘‘adequate’’ amount of gingiva has been considered as a keystone for the maintenance of periodontal health. (2) Inadequate zone of attached gingiva facilitate subgingival plaque formation, increases movability of the marginal tissue, favours attachment loss and soft tissue recession and impedes proper oral hygiene. According to Friedman, Surgical procedures are designed to preserve gingiva, remove aberrant frenulum or muscle attachments, and increase the depth of the vestibule. (3) Vestibular extension operations given by Bohannan were aimed at extending the depth of the vestibular sulcus. (4) It can be done by Denudation technique with the risk of exposure of alveolar bone and severe bone resorption. (5) Split flap procedure/ periosteal retention procedure showed less severe bone resorption but loss of crestal bone height was observed. (6) Apically repositioned flap showed predictable increase in the width of the attached gingiva with the risk for extensive bone resorption. (7) FGG from the palate has been used most commonly for gingival augmentation. Gingival and palatal soft tissue grafts have the property of maintaining their original characteristics after transplantation to the recipient site. (8) Materials and Method Three cases were selected from the Out Patient Department of Department of Periodontology, Subharti Dental College and Hospital, Meerut having problem in maintaining a good oral hygiene or gingival recession. On examination inadequate width of attached gingiva was observed with respect to lower anterior teeth. They were treated with FGG obtained from different sites like palate, edentulous ridge and buccal attached gingiva. Cases were evaluated after 21 days for gain in width of attached gingiva, colour matching of grafted soft tissue with adjacent areas and post-operative pain evaluation using visual analog scale. Case 1 After administering local anaesthesia recipient site in relation to 31, 41 was prepared by giving a horizontal incision along the mucogingival junction using no.15 blade. The keratinized tissue was de-epithelialized to expose the underlying connective tissue and create a trapezoidal recipient bed (Fig. 1a). FGG of appropriate size (1.5 x 16 x 7 mm) was harvested from the palate extending from the distal aspect of first premolar to the mesial aspect of first molar (Fig. 1b, 1c). FGG was contoured, adapted, and sutured on to the recipient bed (Fig. 1d). After suturing pressure was exerted against the graft for 5 minutes in order to eliminate the blood and exudate from between the graft and the recipient bed.