The goal of this clinical trial is to learn whether titanium tacks can be used as an alternative to sutures for stabilization of free gingival grafts (FGG) around natural teeth. It will also evaluate the effect of each stabilization technique on patient comfort and clinical outcomes. The main questions it aims to answer are: * Does stabilization of free gingival grafts using titanium tacks reduce post-operative pain compared with conventional suturing? * Does stabilization of free gingival grafts using titanium tacks affect clinical outcomes such as keratinized tissue width, gingival thickness, graft dimensions, procedure time, plaque accumulation, and interference with daily activities? Researchers will compare free gingival graft stabilization using titanium tacks with the conventional suturing technique to determine whether titanium tacks provide comparable or improved outcomes. Participants will: * Receive a free gingival graft around natural teeth requiring augmentation of keratinized gingival tissue. * Be assigned to have the graft stabilized either with titanium tacks or with conventional resorbable sutures. * Attend scheduled follow-up visits for clinical examinations and measurements. * Report their post-operative pain levels using a Visual Analogue Scale (VAS). * Complete assessments related to daily life interference during the healing period. * Undergo evaluation of keratinized tissue width, gingival thickness, graft dimensions, plaque index, and procedure time.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
24
According to the graft size, 2 to 5 titanium tacks will be used to stabilize and secure the free gingival graft in place to the periosteum at the recipient bed as needed, through anchoring in inter-septal bone and avoiding teeth roots.
Stabilization of the free gingival autograft in place using a 5-0 or 6-0 resorbable Prolene suture using a combination of two interrupted sutures, anchoring the grafted tissue to the base of the anatomical papillae, and a horizontal mattress compression suture anchored to the periosteum apical to the bone dehiscence and suspended around the palatal or lingual cingulum of the tooth with the recession defect, allowing for intimate contact ensuring proper perfusion and consequent revascularization of the graft.
Faculty of Dentistry and Oral Medicine, Cairo University, Cairo.
Cairo, Cairo Governorate, Egypt
RECRUITINGPostoperative pain
Visual Analogue Scale (VAS) with numerical scale from 0 to 10 ('no pain' to 'worst pain imaginable') measured daily for the first 1 week postoperatively.
Time frame: Daily for the first 7 days post-surgery.
Keratinized tissue width (KTW)
Will be measured from the MGJ to the free gingival margin. The MGJ will be identified using the roll technique.
Time frame: Week 12, Week 24
Intra-operative/procedure time (PT)
Will be measured using a stopwatch from the beginning till the end of each procedure.
Time frame: During the free gingival graft stabilization procedure
Daily life interference
It is based on the level of interference of surgical procedure on the patient's normal daily life for the first week after surgery.
Time frame: Daily for the first 7 days post-surgery.
Gingival thickness
An endodontic file and a 3 mm diametersilicon disc stop will be used to measure gingival thickness 2mm apical to the gingival border. The file will be inserted into the soft tissue with mild pressure, perpendicular to the mucosal surface, until a firm surface is felt. The silicon disc stop will be then pressed against the soft tissue, with the coronal border covering the soft tissue boundary.
Time frame: Week 12, Weeks 24.
Post-operative Pain [Indirect]
It is based on the amount of analgesics patient consumes, only if needed, during the first week after surgery. This will be measured by the number of pills consumed by the patient after both the pretreatment and 6h post-treatment doses.
Time frame: Daily for the first 7 days post-surgery.
Plaque Index
* 0 No plaque in the gingival area. * 1 A film of plaque adhering to the free gingival margin and adjacent area of the tooth. The plaque may only be recognized by running a probe across the tooth surface. * 2 Moderate accumulation of soft deposits within the gingival pocket, on the gingival margin and/or adjacent tooth surface, which can be seen by the naked eye. * 3 Abundance of soft matter within the gingival pocket and/or on the gingival margin and adjacent tooth surface.
Time frame: Week 12, Week 24.
Graft dimensions
Will be measured from standardized images using "Image J Software" for standardization of measurements and readings.
Time frame: Week 12, Week 24.
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