Creeping attachment after gingival augmentation using a free gingival graft. A case report

Introduction: Gingival recession presents an apical proliferation of the gingival margin to the cemento-enamel junction of the tooth and can be accompanied by aesthetics dissatisfaction and be associated with insufficient width of keratinized gingiva. Some surgical interventions are proposed for augmentation of gingival tissues when there is an insufficient width of keratinized gingival tissues. Such surgical approach is the use of a free gingival graft. This technique shows good results in gingival augmentation and treatment of shallow recessions with depth less than 3 mm. Aim: The aim of this case report is to demonstrate the creeping attachment of the gingival margin after use of a free gingival graft for augmentation of the width of keratinized gingival tissues on the vestibular side of the mandibular anterior area. Case Presentation: Lack of keratinized attached gingival tissues apically to the mandibular central incisors is established. A free gingival graft is used for augmentation of the width of the insufficient keratinized gingiva. Results : Three months after gingival augmentation with a free gingival graft, the reduction of the depth of gingival recessions was not significant. Compared to baseline, a significant increase in the width of keratinized attached gingiva was reported 6 months later. The depth of gingival recessions was reduced and gain of clinical attachment level was achieved on the vestibular side in both lower central incisors. Conclusion: The presented case report confirmed that, due to creeping attachment, a reduction of depth of gingival recessions and vestibular clinical attachment level gain were recorded after gingival augmentation with a free gingival graft.