Graft stabilization with cyanoacrylate decreases shrinkage of free gingival grafts
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ABSTRACT
Background: The aim of this study was to comparatively evaluate three different stabilization methods with regards to the amount of shrinkage in free gingival graft.
Methods: Forty-five patients were included in three study groups: where stabilization was achieved with conventional technique, cyanoacrylate or microsurgery. In the conventional group standardized 5-0 sutures were used. In the microsurgery group grafts were stabilized with 7-0 sutures and loupe. In the third group, graft was stabilized with cyanoacrylate. Keratinized tissue width, graft area, gingival recession were calculated by a specific software on standard photographs at baseline, 1-, 3-, 6-month follow-ups. Duration of surgery was also recorded. Pain in recipient and donor sites was assessed using visual analogue scale within the first postoperative week.
Results: Change in keratinized tissue width was similar in the study groups at all times. Graft shrinkage was significantly less (p < 0.05) in the cyanoacrylate group than the other groups, whereas those in the conventional and microsurgery groups were similar. Significantly less pain in the recipient site was reported by the patients in the cyanoacrylate group (p < 0.05). Duration of surgery was significantly less in the cyanoacrylate group than the other groups (p < 0.05).
Conclusions: Less graft shrinkage in the free gingival graft, together with shorter surgery time and less pain in the recipient site obtained in the cyanoacrylate group, suggest that cyanoacrylate may be considered as an alternative for stabilization of free gingival grafts.
Keywords: Cyanoacrylates, gingiva, microsurgery, tissue grafts
INTRODUCTION
Insufficient width of attached gingiva is a major mucogingival problem when the existing attached gingiva does not enable effective patient plaque control. One sign of insufficient width of attached gingiva is gingival inflammation localized to the particular site despite overall satisfactory oral hygiene. Existing clinical and histological data suggest that any dimensions which enable maintenance of healthy periodontium can be regarded as adequate rather than a certain width in millimetres.1 Free gingival graft (FGG) is widely used to increase dimensions of attached gingiva.2 Its autogenous character, maintenance of keratinization, predictability of surgical outcomes, ease of technique together with the possibility of implementation in a group of teeth lead FGG to be accepted as the golden standard to increase attached gingiva dimensions.3 Various amounts of graft shrinkage during the healing period have been reported.4–6 Factors disrupting continuity of graft nutrition play a major role in graft shrinkage. According to Sullivan and Atkins,7 graft thickness, atraumatic surgical technique and quick stabilization of the graft are vital to protect graft vessels from damage and dehydration, thereby decreasing shrinkage. Suture technique is also highly important for minimizing trauma to the graft tissue. Accordingly, it is recommended to keep the number of sutures to a minimum since each suture forms a localized haematoma under the graft which affect graft shrinkage. Factors, which act during stabilization of FGG, affect ‘avascular plasmatic circulation’ and eventually graft shrinkage. Therefore, sutureless stabilization techniques may help to decrease or even prevent graft shrinkage and adhesives may be a method for reaching this goal.