Gingival Unit Graft Versus Free Gingival Graft: 18-Month Digital Color Analysis

Clinical Outcomes and Digital Color Stability of Gingival Unit Graft Versus Free Gingival Graft: An 18-Month Comparative Digital Photographic Color Analysis Study

The purpose of this retrospective clinical study is to compare the long-term aesthetic integration and clinical outcomes of two periodontal plastic surgery techniques: Gingival Unit Grafting (GUG) and Free Gingival Grafting (FGG). The study evaluates the effectiveness of these procedures in increasing keratinized tissue width and assesses the color integration of the grafted tissues with the surrounding gingiva over an 18-month follow-up period using objective digital color analysis based on CIE Lab and RGB parameters.

This single-center retrospective study included patients treated with either Gingival Unit Grafts (GUG) or Free Gingival Grafts (FGG) for the management of Cairo Type 2 and Type 3 gingival recessions between March 2022 and December 2022. Clinical and photographic records obtained at baseline and during follow-up visits up to 18 months were retrospectively analyzed. The primary outcome was the evaluation of color integration of the grafted tissues using objective digital color analysis based on CIE Lab and RGB parameters. Secondary outcomes included changes in keratinized tissue width. The aim of the study was to compare the long-term aesthetic integration and clinical performance of GUG and FGG and to determine which technique provides superior color matching with the surrounding tissues.

Inclusion Criteria:

• Systemically healthy individuals aged between 18 and 65 years
• No systemic diseases contraindicating periodontal surgery
• Not taking medications known to exert adverse effects on periodontal tissues
• Presenting with Cairo Type 2 (RT2) or Type 3 (RT3) localized gingival recessions on mandibular incisors
• Presence of ≤1 mm of attached gingiva resulting in difficulty maintaining plaque control
• Full-mouth plaque and gingival index scores ≤1
• Bleeding on probing (BOP) <10%
• No history of prior soft tissue surgery in the designated area

Exclusion Criteria:

• Individuals who are pregnant or lactating.
• Presenting with gingival recession or prosthetic restorations at the donor site (maxillary premolar palatal region).
• Cases demonstrating caries, abrasions, or restorations on the root surfaces of the related teeth.
• Individuals with known allergies to dental impression materials.
• Periodontal pocket depth greater than 3 mm.
• Tooth malposition.
• Endodontic complications.