Efficacy of different suturing techniques on gingival grafts: A scoping review

This review evaluated the efficacy of various suturing techniques in gingival graft stabilization to optimize clinical outcomes and minimize the need for revision surgeries.

This scoping review was conducted across Scopus, PubMed, Cochrane, Web of Science, and ProQuest (through April 2025) using PICO criteria: Population (gingival grafts around teeth), Intervention (different suturing techniques), Comparison (efficacy of various suturing techniques in gingival graft stabilization), and Outcomes (keratinized tissue width [KTW], keratinized tissue height [KTH], and root coverage [RC]). From 838 initial records, 73 studies met the inclusion criteria after dual-reviewer screening with arbitration by a third reviewer. Study quality was assessed using the Joanna Briggs Institute tools.

For free gingival grafts (FGGs), primary stabilization methods included interrupted sutures (with/without periosteal fixation), sling sutures, and cyanoacrylate. Connective tissue grafts (CTGs) predominantly use sling sutures, often combined with cross-mattress or interrupted sutures, vertical/double-cross mattress techniques, or continuous sutures with coronally advanced/tunnel flaps. While 72% of FGG studies (23/32) reported significant KTW improvement with interrupted sutures (a mean gain of 2.1±0.8 mm), CTG studies demonstrated 96% RC success (43/45) with sling-based techniques. However, outcomes showed substantial heterogeneity due to variability in the Miller classification (33/67 studies focused on Class I only) and inconsistent reporting of suture material (only 5/67 specified size/type).

No single suturing technique demonstrated clear superiority in graft stabilization, likely due to study heterogeneity. While sling/mattress combinations showed optimal RC for CTGs and interrupted sutures/cyanoacrylate performed well for FGGs, standardized RCTs controlling for confounding variables are required to establish definitive protocols.