Peri-implant Soft Tissue Phenotype Modification Using Free Gingival Graft and Apically Positioned Flap: A Case...

Area of Science:

• Periodontology
• Dental Implantology
• Oral Surgery

Background:

• Lack of keratinized mucosa (<2 mm) around implants correlates with plaque buildup, pain, and peri-implant disease.
• Modifying peri-implant phenotype is crucial for long-term implant success and patient comfort.
• Limited keratinized tissue poses a risk factor for peri-implant complications.

Purpose of the Study:

• To assess the efficacy of a free gingival graft combined with an apically positioned flap in augmenting peri-implant keratinized mucosa width (KMW).
• To evaluate the impact of this surgical technique on secondary outcomes including pocket probing depth, plaque index, gingival index, pain, and aesthetics.

Main Methods:

• A case series involving nine patients with 16 implants in areas lacking adequate keratinized mucosa (<2 mm).
• Surgical intervention included a free gingival graft and apically positioned flap after osseointegration and before prosthesis delivery.
• Follow-up assessments were conducted at 3, 6, and 12 months post-surgery.

Main Results:

• A statistically significant mean increase in KMW of 2.51 mm was observed at 12 months (p = 0.001).
• Significant reductions in plaque index and gingival index were noted.
• Patients reported high satisfaction with aesthetic outcomes and decreased pain during brushing.

Conclusions:

• The combined free gingival graft and apically positioned flap technique effectively increases peri-implant keratinized mucosa width.
• This approach enhances peri-implant soft tissue parameters and improves patient-reported outcomes, contributing to better peri-implant health.
• The findings suggest this technique is a viable option for managing insufficient keratinized mucosa around dental implants.