Procedimentos combinados Alguns casos de retração gengival localizada – que de Nesses casos, um procedimento adicional, como o enxerto gengival livre. Mar. Clinical. Tissue adhesive in free gingival graft. Adesivo tecidual no enxerto gengival livre. Title: Técnica modificada de enxerto gengival livre: uma série de casos. ( Portuguese); Alternate Title: Free gingival graft using a modified technique: a case.

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Literature analysis revealed numerous indications for this tissue adhesive in the medical field related to maxillofacial injuries. In dentistry, clinical reports, as well as controlled clinical studies conducted in humans and in animal models, using histological analysis described positive results for the use of different cyanoacrylate-based tissue adhesives.

These studies reported that the use of tissue adhesives reduced the surgical procedure time period, eliminated postoperative visits as well as the discomfort of suture removal and, in addition, did not interfere with the clinical repair process.

The success of periodontal surgery depends on the appropriate coaptation of the incised edges, elimination of empty spaces and reduction of the amount of coagulation. In free gingival graft surgery, stabilization of the graft, hemostasis and cleansing of the gemgival remain necessary 1. The suture is the most used and widespread technique for appropriate gengiival of the edges; however, new biomaterials and techniques are studied with the aim of uniting and maintaining the incised tissues stable and avoiding the penetration of foreign bodies.

This favors the stabilization of the coagulation and provides esthetics to the surgical site 2 3 4 – 5. The use of cyanoacrylate-based adhesives in periodontal surgery, including free gingival grafts, has demonstrated ease and efficiency, minimizing the problems generated by suturing thread, and showing minimal toxicity and low cost 6 – They used sutures for coaptation on enxedto side, and butyl-cyanoacrylate tissue adhesive on the other. They reported that the initial repair was faster using the adhesive, that the product was easy to apply, appropriate for setting the gingival flaps and that the histological exam showed no adverse effects.

Forrest 14in a longitudinal study, evaluated more than patients undergoing periodontal surgery, including free gingival grafts, laterally and apically positioned flaps, rhizectomies, endodontic and exodontic surgery, in which butyl-cyanoacrylate was used for the coaptation of the edges. The results were compared with edges set using sutures. The adhesive was reported to promote rapid hemostasis and clinical repair similar to the sutures, was well accepted by the patients and there were no reports of local or systemic reactions.

The application of gengiva material to the posterior region was considered difficult but, in general, the use of the adhesive was reported to reduce operating time considerably when compared with suturing techniques. The authors also reported that the tested adhesive is effective in closing lacerations, in addition to taking less time to apply and being less painful than suturing.

They observed that the time required for repair with sutures was approximately 4 times greater than with the adhesive. There was no incidence of dehiscence, hematoma or infection among the groups after one year; and, the esthetic results and patient satisfaction were superior in the 2-octyl-cyanoacryate group.


Probing depth, clinical attachment level, gingival recession, and dimensional changes of height and width were evaluated immediately post-operatively and at 15, 30, 45, and 90 days after surgery. They observed ejxerto dimensional changes related to the area of gingival graft were similar for both groups.

Gingival grafts, thinner than 1 mm, showed a greater average height at the end of the study and with genhival significant changes regarding the total area of the graft.

They conclude that the modality of gingival graft fixation did not present any significant influence over the clinical parameters evaluated. The patient, a year-old genguval with no systemic alterations, was referred to the Department of Periodontics of the authors.

Clinical examination revealed the absence of inserted keratinized mucosa in the region of enerto lower central incisors, the presence of inflammation and marginal edema and complaint of difficulty cleaning in the region.

Four weeks prior to the surgical procedure, the patient underwent professional plaque control to prepare the region for the procedure. During the initial evaluation, the following periodontal parameters were obtained: Pre-operative case probing depth.

Pre-operative case keratinized mucosa.

The following were used in the surgical procedure: A Bard Parker no. Muscle inserts that could interfere with the stability of the graft were eliminated, maintaining a thin, smooth layer of conjunctive tissue to facilitate genyival correct adaptation of the graft. A perpendicular incision was made at the base of the vestibule to fenestrate the periosteum.

A surgical guide having the same dimensions as the receiving area was created from sterile paper and placed in the region of hengival palate. Anesthesia was given by infiltration along the side of the guide, the incision was made around the guide and the graft was removed delicately.

Adipose tissue and irregularities in the connective tissue were removed from the graft. The donor site was sutured using 4. The contents were emptied into a sterile dappen dish, enxetto immediately collected using a clinical probe Figure 3 and taken to the surgical site, closing the edges of the gingival graft and the recipient site.

With the graft properly adapted and coopted enerto the recipient site, traction and tension lip movements were performed to verify if there were any interference from muscle inserts that enxerho cause movement in the graft Figure 4.

The patient received post-operative instructions related to careful cleaning of the region for 30 days with 0. Tissular adhesive Dermabond r. At seven days the graft showed normal healing and absence of movement.

The patient did not report, nor genggival there observed, any interference caused by the method of setting. At 15 days there was no edema and integration of the gingival graft with the adjacent tissues could be observed.

At 30 days, the graft appeared clinically completely healed. A significant increase in the keratinized mucosa and the width of the gingival margin could be seen. The clinical observations of this period were similar to those verified gengoval 90 and days Figures 5 and 6.

All surgical procedures and the care of the patient were performed following the ethical principals contained in the Helsinki Declarationin addition to following the ANVISA standards for biosecurity and control.

Final case 90 days. Final case days.

Técnica modificada de enxerto gengival livre: uma série de casos.

The appropriate coaptation of the surgical edges determines the success of the procedures. Suturing is the technique most used; however, new biomaterials have been studied and proposed for this purpose. They maintain all the advantages of conventional suturing, favoring the stabilization of the blood clot and providing esthetics to the surgical site 17 18 19 20 21 22 23 24 – The use of cyanoacrylate-based adhesives in periodontal surgery, including free gingival grafts, demonstrates ease and efficiency, minimizes the problems caused by suturing thread and shows minimal toxicity and low cost 6 7 8 9 – 10 The improvement of the periodontal clinical parameters, associated with the positive report of the patient as to the current ease of oral hygiene, reinforces the importance of the free gingival graft to increase the width of the gingival margin 26 from the area of the inserted gingiva 27 – 28 and for the maintenance of periodontal health.


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Dimensional changes between free gingival grafts fixed with ethyl cyanoacrylate and silk sutures. J Int Acad Periodontol. Longitudinal evaluation of free autogenous gingival grafts. A preliminary histologic study of the enxfrto healing of mucogingival flaps when secured with the cyanoacrylate tissue adhesives. Cyanoacrilates as a periodontal dressing.

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Tissue adhesive in free gingival graft

Lack of association between width of attached gingival and development of soft tissue recession-A 5-year longitudinal study. Periodontal status of mandibular central incisors after orthodontic proclination in adults.

Am J Orth Dentofac Orthop. Diagnosis and management of mucogingival problems in children. Dent Clin North Am. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Services on Demand Journal. Clinical Tissue adhesive in free gingival graft. Cyanoacrylates; Tissue adhesives; Transplants. Cianoacrilato; Adesivos teciduais; Transplantes. August 13, ; Revised: October 15, ; Accepted: How to cite this article.