Efficacy of free gingival grafting to augment keratinized mucosa around dental implants in posterior regions after restorative procedures: A retrospective clinical study

Clinical Observations of Soft Tissue Dimensions Around Teeth and Implants After Free Gingival Graft

INTRODUCTION AND AIMS

The histological and morphological differences in soft tissue between natural teeth and peri-implant may result in different clinical effectiveness to free gingival graft (FGG). This research aims to investigate the different efficacy of FGG in augmenting keratinized tissue width (KTW) between tooth and implant sites while evaluating its medium-term stability over a 2- to 5-year follow-up.

METHODS

In this study, 29 patients underwent FGG to address insufficient clinical scenarios when KTW <2 mm at the buccal aspect, including 37 implant sites and 33 natural teeth sites both in posterior regions were included. The KTW and gingival margin position (GMP) of these sites was assessed by measuring the intra-oral photographs which were taken at 0 days (T0), 3-month (T1), 6-month (T2), 12-month post-surgery (T3), and 2 to 5 years follow-up (T4).

RESULTS

The results revealed that KTW increased significantly in both groups. However, the natural teeth group showed significantly less graft shrinkage (GS) than the implants group. (Teeth: 2.05 ± 0.51 mm and 25.42% ± 6.45%; Implants: 3.18 ± 0.65 mm and 38.92% ± 5.39%, P <.01). From T1 to T4. The gingival margin coronally advanced by 0.47 ± 0.51 mm and 0.18 ± 0.43 mm for the natural teeth and implants group, respectively (P<.05).

CONCLUSIONS

A greater KTW reduction after FGG was observed at implants versus natural teeth. And, the graft surrounding implants after crown restoration was stable for up to 2 to 5 years.

CLINICAL RELEVANCE

By comparing the changes in KTW around natural teeth and implants following FGG to investigate whether there are differences between them and the degree of differences. Additionally, this allows us to explore whether the restorations impact the effect of FGG. This research can assist clinicians in selecting an appropriate amount of soft tissue during surgery to achieve treatment goals, reduce postoperative discomfort for patients, and enhance predictability in clinicians' ability to increase keratinized tissue. Furthermore, by observing changes in the position of GMP around natural teeth and implants, the effectiveness of FGG in root coverage can be understood, thus improving the predictability of FGG for root coverage.

Effect of free gingival graft dimension on postsurgical shrinkage in posterior implant placement: A prospective parallel cohort study

STATEMENT OF PROBLEM

The impact of free gingival graft (FGG) dimensions on the postsurgical shrinkage of keratinized tissue width (KTW) and surface area in posterior implant sites is unclear. Standardized assessments of how graft dimensions influence KTW and surface area shrinkage rates over a 6-month period after FGG are lacking.

PURPOSE

The purpose of this prospective parallel cohort study was to examine the impact of the graft dimensions on the postsurgical shrinkage of KTW and surface area over a 6-month follow-up period after FGG in the posterior regions.

MATERIAL AND METHODS

Thirty partially edentulous participants with insufficient buccal KTW in the posterior regions were recruited. Before implant placement, participants received FGG procedures and were categorized into single-tooth and dual-tooth groups according to the range of recipient area. Intraoral scanning was performed before and after FGG and at subsequent follow-ups for 6 months. The KTW and surface area shrinkage rates of the grafted area were calculated and statistically analyzed by using the Student t test and ANOVA, and Bonferroni post hoc tests were performed to compare the shrinkage rate of KTW at various edentulous sites (α=.05).

RESULTS

The mean ±standard deviation KTW shrinkage rate was 18.84 ±5.11% over 6 months postoperatively, and the mean ±standard deviation SA shrinkage rate was 21.53 ±5.70%. The dual-tooth group had a statistically significantly higher KTW shrinkage rate (28.42 ±2.46%) when the second molar edentulous sites were involved (P<.05). Differences in surface area shrinkage rates between the single-tooth and dual-tooth groups over 6 months were statistically similar (P=.239). However, grafts in the second molar area exhibited significantly higher surface area shrinkage rates compared with those at the premolar and first molar areas (P<.001).

CONCLUSIONS

The dimension of free gingival graft tissues did not significantly affect surface area shrinkage rates, and a mean 25% shrinkage rate occurred in the second molar areas.

Effectiveness of keratinized mucosa augmentation procedures around dental implants based on risk assessment: A 5-year retrospective cohort study

PURPOSE

To compare the effectiveness of keratinized mucosa (KM) augmentation with different techniques for the treatment of dental implants based on risk assessment.

METHODS

Thirty-nine patients who underwent KM augmentation at implant sites in the posterior mandible were included. Three techniques were used based on anatomy-guided risk assessment: an apically positioned flap (APF) alone, an APF plus a free gingival graft (APF plus FGG), and an APF plus a collagen matrix (APF plus CM). Clinically effective KM augmentation was defined as remaining KM ≥ 2 mm after the intervention. The effective rate, implant/prosthesis survival rates, and bone/soft tissue parameters were analyzed. The correlation between local anatomical characteristics and different techniques was also determined. The associations between the effectiveness of KM augmentation and related factors were analyzed using a linear model.

RESULTS

Overall, 74 sites received KM augmentation in the posterior mandible, for an effective rate of 94.6% at the 1-year follow-up and 93.2% at the 5-year follow-up. The KM width in the APF plus FGG group (3.85 ± 1.22 mm) was greater than that in the APF alone (3.05 ± 0.90 mm) (P = 0.016) and APF plus CM (3.21 ± 1.17 mm) groups (P = 0.038) at 5 years post-surgery. There was no significant difference in the effective/ineffective outcomes at the 1-year or 5-year follow-up among the three groups.

CONCLUSIONS

Comparable effective outcomes were achieved with three KM augmentation techniques following the decision-making criterion based on risk assessment.

Enhancing Gingival Phenotype With Vestibuloplasty and Free Gingival Graft: Improving Maintenance of Regular Oral Hygiene

This case report describes Clark's technique of vestibuloplasty to treat shallow vestibule and, in addition, the use of free gingival autograft to augment attached gingiva to treat Miller's recession. Vestibuloplasty is performed to deepen a shallow vestibule. Different vestibuloplasty techniques are used to deepen the shallow vestibule by modifying the soft tissue attachment. A 29-year-old male presented to the Department of Periodontics and Oral Implantology, Regional Dental College, Guwahati, India with the chief complaint of bleeding from the lower anterior along with the gingival recession. Maintenance of regular oral hygiene was an added hindrance. The combined technique of vestibuloplasty and use of free gingival graft was performed to achieve dual benefits of increasing the vestibular depth and attainment of a thick gingival phenotype.