A Novel Dual Anchoring Technique for Keratinized Tissue Augmentation in Posterior Mandible: A Retrospective Case...

To evaluate the clinical efficacy of a dual anchoring technique (DAT) for keratinized tissue width (KTW) augmentation in the posterior mandible, utilising a dual fixation system (orthodontic anchor screws and membrane tacks) to improve soft tissue stability and reduce graft contraction.

This retrospective case series included 25 systemically healthy patients with KTW <2 mm after bone augmentation. Primary outcome was KTW change from baseline (T₀) to 12 months (T₅). Secondary outcomes included graft shrinkage, operative time, complications and postoperative patient-reported outcome measures (PROMs).

All 25 patients (49 implant sites) completed the 12-month follow-up. KTW increased from 0.67 ± 0.12 mm (T₀) to 11.00 ± 0.87 mm at 1 month, stabilising at 8.70 ± 0.84 mm at T₅ (net gain: 8.02 ± 0.82 mm; P < .001). Graft shrinkage was 17.48 ± 3.41% at T₅, with 85% occurring within the first 3 months. Mean operative time was 26.40 ± 1.9 min (single-site) and 33.31 ± 2.08 min (2-site). No complications occurred. VAS scores decreased to negligible levels by day 14.

Within the limitations of this retrospective study, DAT was associated with effective keratinized tissue augmentation in the posterior mandible and favourable dimensional stability over a 12-month period.

This study introduces DAT designed to reduce the contraction rate of free gingival grafts in the posterior mandible by enhancing their mechanical stability. This technique offers a reliable, practical and a simple surgical protocol for predictable keratinized tissue augmentation in this region.