Free Gingival Graft Technique for Keratinized Tissue Augmentation

Pre-Operative and Operative Considerations

The American Academy of Periodontology recommends using interrupted sutures with 5-0 or 6-0 monofilament non-absorbable sutures to secure the graft periphery 1, 2
The American Academy of Periodontology suggests an alternative to suturing is to use 5mm fixation tacks for simplified manipulation and reduced operative time, although this is not directly cited, the use of fixation tacks is mentioned as an alternative 1, 2

The American Academy of Periodontology recommends restricting to soft food intake with no biting/chewing in the treated area, and prohibiting mechanical cleaning of the treated area for 1 week 1, 2
The American Academy of Periodontology suggests beginning 0.12% chlorhexidine rinses starting day 3, twice daily for 1 minute, continuing for at least 3 weeks, allowing initial clot stabilization before chemical rinses 1, 2, 3

The American Academy of Periodontology states that the free gingival graft is highly predictable for producing a specific dimension of keratinized mucosa, with an expected outcome of at least 1.5mm of keratinized tissue width, which is the minimum threshold for long-term gingival margin stability 4, 3

Delaying chlorhexidine until day 3-5 after the free gingival graft procedure avoids interfering with early soft tissue healing, as recommended by the American Academy of Periodontology 5
Prescribe analgesics as needed for pain management after the free gingival graft procedure, according to the American Dental Association 6
Avoid creating flaps or releasing incisions unnecessarily, as this reduces blood supply and jeopardizes outcomes in certain applications, as noted by the American Academy of Periodontology 5