Free gingival grafts to increase keratinized tissue: A retrospective long-term evaluation (10 to 25 years) of outcomes

Background: Gingival augmentation procedures are indicated primarily to increase an insufficient amount of gingiva and sometimes to halt the progression of gingival recession. The aim of this retrospective long-term study was to evaluate changes in the amount of keratinized tissue (KT) and in the position of the gingival margin after free gingival graft procedures over a period of 10 to 25 years. Methods: One hundred three subjects presenting with 224 sites completely lacking attached gingiva associated with gingival recessions were treated in a private practice. The experimental sites were treated with gingival augmentation procedures (free gingival grafts). The grafts were positioned at the presurgical level of the gingival margin or in a submarginal position. Clinical variables, including recession depth, amount of KT, and probing depth (PD), were measured at baseline (T-0), 1 year after surgery (T-1), and at the end of the follow-up period (10 to 25 years) (T-2) and analyzed using descriptive statistics and multilevel models. Results: From T-0 to T-1, the gingival margin shifted coronally 0.8 mm, and KT increased 4.2 mm. From T-1 to T-2, the gingival margin shifted coronally 0.6 mm, and the overall KT decreased 0.7 mm. PD remained stable. Conclusion: Gingival augmentation procedures performed in sites with an absence of attached gingiva associated with recessions provide an increased amount of KT associated with recession reduction over a long period of time.