An Innovative Microsuturing Technique for Stabilization of a Free Gingival Graft: The 'Fishnet Suture'.

Abstract

The stability and vascular integration of a free gingival graft (FGG) are critical for achieving predictable outcomes. The success of the technique relies on precise recipient site preparation, meticulous graft handling, and an optimized suturing protocol to ensure firm adaptation and immobilization to prevent micro-movements that could compromise healing. This case report introduces the 'Fishnet suture,' a novel microsuturing technique designed to enhance graft stabilization and provide uniform tension distribution. The approach utilizes a continuous interlocking suture with both vertical and horizontal components, creating a mesh-like pattern that anchors the graft to the periosteal bed, eliminating dead spaces, and promoting revascularization. The technique was applied in three clinical cases: a patient with multiple adjacent gingival recession defects in the anterior region of the mandible, a patient presenting peri-implant soft tissue deficiencies, and a patient with an insufficient width of keratinized tissue at an edentulous ridge. Postoperative healing was uneventful throughout, resulting in significant increase in keratinized tissue width. We interpret the favourable outcomes to be a result of effective graft stabilisation, facilitated by this novel suturing approach.