Free gingival graft is a mucogingival surgical technique applied to increase keratinized
gingival width and reduce gingival recession. Free gingival graft is one of the most
widely used approaches in root closure treatments and in increasing the height of the
keratinized gingiva. The "creeping attachment" phenomenon draws attention in the
long-term success of root closure treatment in areas with gingival recession. "Creeping
attachment" is defined as the coronal movement of the gingiva in the area where free
gingival graft or connective tissue is applied in the postoperative period. The mean root
closure rate with the creeping attachment is approximately 1 mm and can be detected 1 to
36 days after graft surgery. In the literature, clinical studies that measured a creeping
attachment value between 0.12 and 3.5 mm in a 2-year period in free gingival grafts
applied to the marginal gingival level have been reported.
Systemically healthy and non-smoking patients older than 18 years of age who applied to
Kütahya Health Sciences University, Faculty of Dentistry, Department of Periodontology
and had gingival recession in mandibular anterior teeth and keratinized gingival
deficiency will be included in the study. Systemic and dental anamnesis will be taken
from the patient before the operation and clinical measurements will be recorded.
Patients will be divided into 2 main groups as free gingival grafts to be placed coronal
and apical to the gingival recession. They will be written as Group I and Group II in
sealed envelopes and apical and coronal positioning groups will be chosen randomly.
The operation date will be given after the patient is given oral hygiene training and 4
weeks after receiving Phase I routine periodontal treatment. The data to be obtained
preoperatively and postoperatively are as follows:
Clinical measurements
Plaque index (Löe&Silness): It is obtained by measuring with a periodontal probe
from 4 regions of a tooth (mesial, distal, buccal and lingual).
Gingival index (Silness&Löe): It is obtained by measuring with a periodontal probe
from 4 regions of a tooth (mesial, distal, buccal and lingual).
Attachment loss: It is the value of the distance between a tooth and the free
gingiva based on the enamel-cementum boundary measured using a periodontal sonde.
Bleeding index on probing (Ainamo & Bay): In this index, probing is performed by
gently walking around the pocket. As a result of probing, the evaluation is made by
looking at the presence or absence of bleeding in the gingiva. A positive value is
given if bleeding occurs within 10-15 seconds after probing in the mesial, distal,
buccal and lingual gingival parts of all teeth. The ratio of the bleeding area to
the examined area is expressed as %.
Pocket depth: It is the vertical distance measured between a standard periodontal
probe and the base of the periodontal sulcus and the gingival margin.
Keratinized gingival height: It is the distance from the free gingival margin to the
mucogingival junction line.
Keratinized gingival thickness: It is the distance measured between the gingival
surface and hard tissue with a standard periodontal probe inserted perpendicular to
the keratinized gingiva.
Gingival recession depth: It is obtained by measuring the distance between the
gingival margin in the midbuccal region and the enamel-cementum boundary.
Gingival recession width: It is the mesio-distal width of the recession from the
midpoint of the distance between the enamel cementum border and the gingival margin.
Gingival phenotype: Visibility of the periodontal tube in the sulcus
Vestibular sulcus depth: It is the distance measured from the gingival margin to the
base of the sulcus.
Sample Selection: Taking the effect size of 0.08 for the significance value in the G
Power analysis program as a reference to a previously presented study, 40 teeth were
planned to be taken for α= 0.05 and 80% power.
Statistical Analysis method:
All analyzes will be done with SPSS software. Intra-group temporal evaluations in test
and control groups will be evaluated using Pairedsample -T or Wilcoxon test according to
normal distribution values. For intergroup comparisons, according to the normal
distribution of data, Student-t test will be analyzed in parametric within-group
evaluations and Mann Withney U test in nonparametrics. The normal distribution of the
data will be evaluated with the Kolmogorov-Smirnov test. The significance value will be
taken as 0.05. Relationships between variables will be evaluated with Logistic Regression
Analysis or Multivariate Regression Analysis.