The use of a free connective tissue graft to increase the width of attached gingiva

Various techniques have been employed for increasing the width of keratinized gingiva. In recent years free gingival grafting has been shown to produce more predictable results than previous methods. Wound-healing studies, however, have shown that the surface epithelium of free gingival grafts degenerates and re-epithelizes by cells proliferating from adjacent tissues. In addition, the donor site is left to heal by secondary intention and requires a dressing for 10 to 14 days. Most studies on epithelial-mesenchymal interactions support the concept that epithelium differentiates under the influence of stimuli from the underlying connective tissue. If this is so, then grafting of gingival connective tissue alone should induce keratinization in the proliferating epithelium. A case is presented which illustrates this principle. The graft effectively increased the width of keratinized gingiva. The donor site healed by primary intention, and no dressing was needed.