Efficacy of different suturing techniques on gingival grafts: A scoping review.

Abstract

<h4>Background</h4>This review evaluated the efficacy of various suturing techniques in gingival graft stabilization to optimize clinical outcomes and minimize the need for revision surgeries.<h4>Methods</h4>This scoping review was conducted across Scopus, PubMed, Cochrane, Web of Science, and ProQuest (through April 2025) using PICO criteria: Population (gingival grafts around teeth), Intervention (different suturing techniques), Comparison (efficacy of various suturing techniques in gingival graft stabilization), and Outcomes (keratinized tissue width [KTW], keratinized tissue height [KTH], and root coverage [RC]). From 838 initial records, 73 studies met the inclusion criteria after dual-reviewer screening with arbitration by a third reviewer. Study quality was assessed using the Joanna Briggs Institute tools.<h4>Results</h4>For free gingival grafts (FGGs), primary stabilization methods included interrupted sutures (with/without periosteal fixation), sling sutures, and cyanoacrylate. Connective tissue grafts (CTGs) predominantly use sling sutures, often combined with cross-mattress or interrupted sutures, vertical/double-cross mattress techniques, or continuous sutures with coronally advanced/tunnel flaps. While 72% of FGG studies (23/32) reported significant KTW improvement with interrupted sutures (a mean gain of 2.1±0.8 mm), CTG studies demonstrated 96% RC success (43/45) with sling-based techniques. However, outcomes showed substantial heterogeneity due to variability in the Miller classification (33/67 studies focused on Class I only) and inconsistent reporting of suture material (only 5/67 specified size/type).<h4>Conclusion</h4>No single suturing technique demonstrated clear superiority in graft stabilization, likely due to study heterogeneity. While sling/mattress combinations showed optimal RC for CTGs and interrupted sutures/cyanoacrylate performed well for FGGs, standardized RCTs controlling for confounding variables are required to establish definitive protocols.