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Updated: Mar 24, 2026
A Novel Approach to Monitoring Graft Neovascularization in the Human Gingiva
Published on: January 12, 2019
Free gingival graft-assisted regenerative therapy in a site with limited keratinized tissue: A case study
Eiichi Suzuki1,2, Akihiko Katayama3, Akiyoshi Funato4
1Private Practice, Suzuki Dental Clinic, Tokyo, Japan.
Background:
The width of keratinized tissue (KTW) is considered to be one of the factors contributing to successful regenerative outcomes in intrabony defects, as it helps establish a stable peri-defect soft tissue environment. Limited KTW and shallow vestibular depth may compromise wound healing and reduce the predictability of regenerative therapy. To address these anatomical limitations, a staged approach involving free gingival grafting (FGG) prior to regenerative procedures has been proposed as a viable strategy. This case study presents a periosteal flap approach that enables simultaneous regenerative therapy and FGG in a one-stage procedure. This technique facilitates stabilization of the blood clot and combined hard- and soft-tissue regeneration in defects with insufficient KTW width and shallow vestibular depth.
Methods:
A 48-year-old female patient presented with an intrabony defect on the buccal aspects of teeth #2 to #4, with a maximum probing pocket depth (PPD) of 8 mm and KTW of 0-3 mm. A one-stage regenerative therapy was performed using recombinant human fibroblast growth factor 2 and carbonate apatite in combination with FGG. The clinical course was monitored for 3 years.
Results:
At the 3-year follow-up, regenerative therapy resulted in improvements in PPD and clinical attachment level, with PPD reduced to ≤3 mm, accompanied by radiographic evidence of stable bone fill at the treated site. A marked increase in KTW was also observed, and a sufficiently deep vestibule was achieved. Stable soft tissue conditions were maintained throughout the entire observation period.
Conclusions:
A one-stage regenerative therapy combined with FGG achieved stable hard and soft tissue regeneration in an intrabony defect with limited KTW and shallow vestibular depth, with favorable outcomes maintained for 3 years.
Plain Language Summary:
When the gum is too thin and the area for treatment lacks firm tissue, long-term stability after regenerative surgery can be difficult to achieve. This report describes a technique that uses gum grafting and regeneration in a single surgery. Compared to the traditional step-by-step approach, which separates the gum graft and the regenerative procedure into two stages, this one-stage method may help shorten the overall treatment time and reduce the burden on the patient. However, it may not be suitable for every case, and careful evaluation is needed.
Key Points:
One-stage regenerative therapy combined with a free gingival graft can simultaneously address both soft tissue deficiency and intrabony defects, offering a practical alternative to traditional staged approaches. Preservation of the periosteum without vertical or periosteal-releasing incisions may promote vascular integrity and wound stability during periodontal regenerative procedures. This technique may reduce total treatment time and surgical burden while maintaining favorable clinical outcomes in select cases.
