Effect of Suturing and Adhesive Fixation on Free Gingival Graft Stability: An Ex-Vivo Porcine-Model Study.

OBJECTIVES

Clinician expertise influences approach choices, amidst ongoing research on suturing techniques' biomechanical effects on graft stability. This study evaluated different suturing methods and cyanoacrylate adhesive for FGG fixation with a porcine mandible model.

MATERIAL AND

METHODS

Ninety-four FGG procedures were performed on juvenile pig mandibles. Eight fixation methods were evaluated: seven suturing techniques-Cross Compression (CC), Vertical Circumferential Compression (VCC), Horizontal (H), CC + H, VCC + H, Miller (MIL), Holbrook and Ochsenbein (Chan et al.)-and cyanoacrylate adhesive (GLU). Outcomes measured included marginal tension (vertical displacement force) and lateral tension (horizontal displacement) at the graft margin.

RESULTS

The HOC technique demonstrated the highest marginal stability (3.82 (SD 1.35 N) and compressive resistance (0.76 (SD 0.48 N). CC + H and VCC + H also showed significantly enhanced marginal stability. Compared to MIL, HOC exhibited superior compressive resistance (p = 0.001), while both HOC and CC + H achieved significantly greater marginal tension (p < 0.05). Graft dimensions influenced outcomes: greater graft height improved compressive resistance, while increased length reduced marginal stability with horizontal sutures. Mean suturing time was 4.84 min (SD 1.55); CC was faster than MIL (p = 0.03), whereas HOC, CC + H, and VCC + H required significantly more time (p < 0.01). GLU achieved marginal stability (3.45 (SD 3.2 N) comparable to HOC.

CONCLUSIONS

Within the limitations of this ex vivo study, suturing technique and graft dimensions significantly affect the FGG's biomechanical stability. Holbrook and Ochsenbein's suturing technique achieved the highest marginal stability and compressive resistance. Furthermore, tissue adhesive demonstrated comparable performance to conventional sutures, supporting its potential as an alternative fixation method.