The Expanded Slit Free Gingival Graft: A Novel Approach to Increase the Width of Keratinized Mucosa

Adequate keratinized mucosa width (KMW) is important for maintaining peri-implant health, mechanical stability, and patient comfort. Although the free gingival graft (FGG) remains the most predictable method for increasing KMW, harvesting large grafts is often limited by palatal donor-site anatomy and associated morbidity. The slit free gingival graft (slit-FGG) is a straightforward modification that enables controlled width expansion without compromising structural continuity, thereby reducing donor tissue requirements. In this technique, a single full-thickness longitudinal incision is made in the harvested graft, creating two juxtaposed ribbons connected by intact lateral platforms. These ribbons can be displaced unidirectionally or bidirectionally to achieve the desired expansion and adapted over an apically positioned mucosa on a prepared periosteal bed. Four systemically healthy patients with insufficient KMW in large edentulous areas were treated using the slit-FGG as part of staged implant therapy. All patients reported minimal postoperative discomfort, and at 6 months the augmented sites demonstrated stable vestibular depth and maintained increases in KMW. Within the limitations of this report, the slit-FGG appears to represent a practical graft-efficient alternative for peri-implant soft-tissue phenotype modification when donor tissue is limited or extensive coverage is required.