Increase of keratinized gingiva in the 5th sextant

Clinical Cases Description: Case 1: Female patient, 42 years-old, healthy, with complaints of discomfort associated with the buccal gingiva of tooth 41. After clinical observation, a Miller class III gingival recession, with a narrow band of keratinized gingiva (KG) and a high insertion of the labial frenum was observed. Case 2: Female patient, 62 years-old, without relevant medical conditions, with complaints of discomfort associated with the buccal gingiva of tooth 41. After clinical observation, a Miller class II gingival recession, with a narrow band of KG and persistent inflammation was observed. In both cases, the proposed and performed treatment was mucogingival surgery to increase the width of KG, using a free gingival graft (FGG) from the palate. Discussion: The role played by KG in the maintenance of periodontal health is controversial. Some authors argue for a need of a minimum width of KG, while others suggest that there may be periodontal health even in areas where KG is absent, provided there is an adequate bacterial plaque control. However, when there is difficulty in maintaining good levels of oral hygiene, as in the presented cases, it should be considered the possibility of increasing the width of KG, in order to avoid the progression of inflammation and the consequent continuous loss of periodontal attachment. Conclusions: The FGG allowed to increase the band of KG and, therefore, to improve the periodontal health, creating conditions for its long-term maintenance. Thus, it can be concluded that, in both cases, the treatment fulfilled the proposed goals. Keywords: keratinized gingiva, gingival graft, free gingival graft, gingival recession, mucogingival defect, mucogingival surgery