Abstract
Background: This review evaluates the efficacy of various suturing techniques in gingival graft stabilization to optimize clinical outcomes and reduce revision surgeries.Methods: 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 (KTW, KTH, RC). From 838 initial records, 73 studies met inclusion criteria after dual-reviewer screening with third-reviewer arbitration. Study quality was assessed using the Joanna Briggs Institute tools.Results: For free gingival grafts (FGGs), primary stabilization methods included interrupted sutures (with/without periosteal fixation), sling sutures, and cyanoacrylate. Connective tissue grafts (CTGs) predominantly utilize 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 (mean gain 2.1±0.8mm), CTG studies demonstrated 96% root coverage success (43/45) with sling-based techniques. However, outcomes showed substantial heterogeneity due to variability in Miller classification (33/67 studies focused on Class I only) and inconsistent suture material reporting (only 5/67 specified size/type). Conclusion: 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 needed to establish definitive protocols.