Volumetric Changes in Free Gingival Graft Procedures Taken With Different Techniques
Condition: Ndirectly Measuring the Difference Between the Free Gingival Graft and the Free Gingival Unit Via a Scanner
Study type: Interventional

Summary: 
      The primary aim of this study is to evaluate the clinical results of free gingival graft and
      gingival unit graft by indirect method.

      To evaluate the 6-month results linearly and volumetrically using an intraoral scanner
      (TRİOS, 3Shape, Copenhagen, Denmark) (using measurements and on a plaster model).
    

Detailed description: 
      Deficiency of keratinized tissue includes mucogingival problems among different clinical
      entities. (Silva et al., 2010) There is no consensus on the minimum amount of attached
      gingiva required to maintain the health of the gums. However, there are many clinical
      situations that demonstrate the necessity of keratinized tissue. (Cevallos et al., 2020)
      (Agarwal et al., 2015) For example, if the attached gingiva is thin, it becomes difficult to
      perform adequate oral hygiene procedures and plaque. Inflammation and attachment loss are
      observed due to accumulation. (Gümüş and Buduneli, 2014) (Raoofi et al., 2019) Keratinized
      tissue width expresses the distance between the coronal margin of the gingival sulcus and the
      mucogingival line. It is considered to be the main factor in the management and protection of
      tissue health around natural teeth. (Agudio et al., 2019) Gingival recession refers to the
      apical displacement of the soft tissue margin from the cemento-enamel border. Oral hygiene
      and plaque with tooth sensitivity, root caries, unaesthetic appearance as well as loss of
      periodontal attachment causes retention. (Arzouman et al., n.d.) (Chambrone and Tatakis,
      2015) In the treatment of gingival recession Many techniques have been described:
      Subepithelial connective tissue graft, stemmed grafts (coronally, laterally), free gingival
      graft (FGG), gingival unit graft (GUG). (Cevallos et al., 2020)(Sriwil et al., 2020).
      Although significant results are observed, there are different success rates between
      techniques. (Sriwil et al., 2020) FGG is used not only to cover the root surface but also to
      increase the width of keratinized tissue. It was first proposed by Nabers for this purpose.
      (Mörmann et al., 1981) Currently, the FGG's incompatible aesthetic and crude. It has many
      limitations due to its appearance. (Sriwil et al., 2020)

      Due to the limitations of the FGG, there was a need for a new perspective on such phenomena.
      The vascular characteristics of the graft are important in terms of rapid capillary
      anastomosis with impaired vascularity of the recipient site. (Sriwil et al., 2020) Gingival
      sulcus, where thin blood vessels form a network and capillaries show numerous anastomoses is
      the place. (Jenabian et al., 2016) The vascular plexus of the gingiva, in terms of horizontal
      anastomoses feeding the marginal zone marginal and interdental tissues to benefit from better
      blood perfusion of the recipient area can be used, thus increasing the chances of survival of
      the graft. (Sriwil et al., 2020) (Yıldırım, 2015) The supracrestal part of the gingiva, which
      includes the marginal and papillary tissues, is included in the soft tissue graft taken to
      nourish the avascular root surface.

      Studies have shown that the marginal, attached, and interdental gingival regions have
      significantly different vascular distributions. (Sriwil et al., 2020)

      Due to these advantages of marginal and interdental tissues, the technique defined as
      Gingival Unit Graft (GUG) containing marginal and interdental papilla has emerged as an
      alternative approach to FGG. (Yıldırım, 2015) Kuru and Yıldırım, in their randomized
      controlled study comparing FGG and GUG in terms of keratinized tissue gain and root surface
      coverage, reported that DÜG gave better clinical results. (Dry oath Yıldırım, 2013)

      G Power 3.1 (University Kiel, Germany) program was used to calculate the effect size. Effect
      size Free Gingival Graft in the study of Sriwil, Fakher (1) and an effect size of 2.12 d
      cohen was determined to be sufficient for significance. It was found that a total of 20
      samples, at least 10 for each study group, was sufficient with a type 1 error of 0.05 and 99%
      power.

      Free Gingival Graft was applied to 10 patients with keratinized mucosa deficiency, and
      Gingival Unit Graft was applied to 10 patients. Volumetric changes in the gingiva were
      measured both clinically and by scanner at the beginning and 6th months.
    

Intervention name(s): Free gingival unit, free gingival greft
Intervention type(s): Procedure
Intervention description(s): The free gingival graft and the free gingival unit taken from the upper jaw palatal mucosa were sutured to the lower jaw anterior region.
Allocation: Randomized
Intervention model: Sequential Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Free gingival greft; Free gingival unit; Scanner