Clinical evaluations of free gingival grafting before implant placement to increase keratinized tissue width in molar regions: A retrospective case series

Abstract

Objectives To evaluate the dimensional changes of the keratinized tissue width (KTW) in molar regions after augmentation by free gingival grafts (FGG) before implant placement. Material and Methods In seventeen patients, twenty implant sites in molar regions with KTW ≤3 mm at the buccal aspect received FGG 2 months before implant placement. KTW at the buccal aspect was measured before FGG (T0), immediately before implant placement (T1), at the time of impression taking for final prosthesis fabrication (T2), and at the end of the follow‐up period after loading (T3, 12–48 months). Changes in KTW before and after FGG, as well as the alterations during the follow‐up period after loading, were analyzed. Shapiro–Wilk test, paired Student's t test, and Wilcoxon signed‐rank test were used for the data analysis at α = 0.05. Results KTW at the buccal aspect of the alveolar ridge was observed with a significant gain of 5.9 ± 1.3 mm at T1 (p < .001). The shrinkage of KTW from T2 to T3 was 8.5%, which was limited but statistically significant (p = .008). KTW at the buccal aspect of implant restorations was 5.0 ± 1.5 mm at T3. Conclusions Within the limitations of the present study, our data suggest that using FGG to increase KTW in molar regions before implant placement had a predictable result. The buccal KTW had a limited reduction and was ≥3 mm with more than 12 months of follow‐up after loading.

Effect of botulinum toxin‐A injection applied to the mentalis muscle on free gingival graft operation: A retrospective study

“…It is reported that this may be due to the shallow vestibule depth in the molar region and the excessive pulling activity of the muscles. [31][32][33] Hassani et al applied a newly developed stent with the idea that immobilization of the FGG at the recipient site increases the success rate and survival rate. When the stents were removed, it was found that all grafts survived without necrosis.…”

Ridge preservation in periodontally compromised molar sockets with and without primary wound closure: A comparative controlled clinical trial

“…The width of the keratinized tissue was measured midfacially from the mucogingival junction to the gingival margin of the tooth before extraction and from the most coronal part of the edentulous crest to the mucogingival junction after 6 months. The intraclass correlation coefficient used to assess the intra‐examiner reliability of the KTW measurements was 0.958, as described in a previous study (Han et al., 2021). At the implant placement visit, supracrestal tissue height (STH) and vertical dimensions of the soft tissue were measured from the mucosal margin to the crestal bone (Avila‐Ortiz et al., 2020).…”

Peri-Implant Soft Tissue Augmentation

“…The FGG was introduced in 1966 [87]. Historically, FGG was used to expand the band of keratinized gingiva around teeth [32], cover exposed root surfaces [88], soft tissue augmentation of edentulous ridges [89,90], and expand the band of keratinized tissue around implants [91]. Since the esthetic appearance of the augmented tissue is poor due to inadequate color blending with the adjacent soft tissue and a "patch" like appearance, today FGG grafts are used mostly to increase the band of keratinized mucosa around implants in nonesthetic areas.…”