Clinical Outcomes of Free Gingival Graft Vs. Palatal Pedicle Graft in Peri-implant Soft Tissue Phenotype Modification: A Randomized Controlled Trial Comparing Patient Reports

Overview

Journal J Adv Periodontol Implant Dent

Specialty Dentistry

Date 2025 Jan 6

PMID 39758265

Authors

Hossein Khoshkhou

Siamak Yaghobee

Mohammadjavad Kharrazi Fard

Mahsa Etemadi

Seyed Hossein Mohseni Salehi Monfared

Affiliations

Soon will be listed here.

Abstract

Background: The importance of peri-implant soft tissues in maintaining tissue health and aesthetics has been recognized. A thickness of at least 2 mm is considered a protective factor against peri-implantitis. This study assessed clinical outcomes and complications at implant sites following soft tissue augmentation with either palatal free gingival graft (FGG) or palatal pedicle graft (PPG).

Methods: In this randomized controlled clinical trial, 42 patients with inadequate keratinized tissue width (KTW) were randomly assigned to two intervention groups: Group 1 received FGGs, while group 2 underwent PPGs. The KTW, vestibular depth, and surface shrinkage were recorded preoperatively and one and three months after the operation. Patient-reported outcome measurements were recorded at a two-week follow-up.

Results: Thirty-five patients completed the study (FGG group, n=17; PPG group, n=18). Group 2 demonstrated a higher increase in KTW and vestibular depth at 1 and 3 months (<0.05). The surface shrinkage differences were not statistically significant between the study groups at baseline and three-month follow-up (>0.05). The number of analgesics in each group was not significantly different two weeks after the operation; however, the Numeric Pain Rating Scale (NPRS) showed significantly higher pain scores on days 3 to 8 in group 1 patients.

Conclusion: The use of PPG in soft tissue augmentation demonstrated more KTW formation and less postoperative morbidity. There was no difference between the methods used to compare surface shrinkage.

References

Stefanini M, Tavelli L, Barootchi S, Sangiorgi M, Zucchelli G . Patient-reported outcome measures following soft-tissue grafting at implant sites: A systematic review. Clin Oral Implants Res. 2021; 32 Suppl 21:157-173. DOI: 10.1111/clr.13767. View

Guglielmoni P, Promsudthi A, Tatakis D, Trombelli L . Intra- and inter-examiner reproducibility in keratinized tissue width assessment with 3 methods for mucogingival junction determination. J Periodontol. 2001; 72(2):134-9. DOI: 10.1902/jop.2001.72.2.134. View

Roccuzzo M, Grasso G, Dalmasso P . Keratinized mucosa around implants in partially edentulous posterior mandible: 10-year results of a prospective comparative study. Clin Oral Implants Res. 2015; 27(4):491-6. DOI: 10.1111/clr.12563. View

Thoma D, Alshihri A, Fontolliet A, Hammerle C, Jung R, Benic G . Clinical and histologic evaluation of different approaches to gain keratinized tissue prior to implant placement in fully edentulous patients. Clin Oral Investig. 2017; 22(5):2111-2119. DOI: 10.1007/s00784-017-2319-4. View

Wiesner G, Esposito M, Worthington H, Schlee M . Connective tissue grafts for thickening peri-implant tissues at implant placement. One-year results from an explanatory split-mouth randomised controlled clinical trial. Eur J Oral Implantol. 2010; 3(1):27-35. View

Mormann W, Schaer F, Firestone A . The relationship between success of free gingival grafts and transplant thickness. Revascularization and shrinkage--a one year clinical study. J Periodontol. 1981; 52(2):74-80. DOI: 10.1902/jop.1981.52.2.74. View

Basegmez C, Karabuda Z, Demirel K, Yalcin S . The comparison of acellular dermal matrix allografts with free gingival grafts in the augmentation of peri-implant attached mucosa: a randomised controlled trial. Eur J Oral Implantol. 2013; 6(2):145-52. View

Basegmez C, Ersanli S, Demirel K, Bolukbasi N, Yalcin S . The comparison of two techniques to increase the amount of peri-implant attached mucosa: free gingival grafts versus vestibuloplasty. One-year results from a randomised controlled trial. Eur J Oral Implantol. 2012; 5(2):139-45. View

Thoma D, Benic G, Zwahlen M, Hammerle C, Jung R . A systematic review assessing soft tissue augmentation techniques. Clin Oral Implants Res. 2009; 20 Suppl 4:146-65. DOI: 10.1111/j.1600-0501.2009.01784.x. View

10.

Lorenzo R, Garcia V, Orsini M, Martin C, Sanz M . Clinical efficacy of a xenogeneic collagen matrix in augmenting keratinized mucosa around implants: a randomized controlled prospective clinical trial. Clin Oral Implants Res. 2011; 23(3):316-24. DOI: 10.1111/j.1600-0501.2011.02260.x. View

11.

Behneke A, Behneke N, dHoedt B . A 5-year longitudinal study of the clinical effectiveness of ITI solid-screw implants in the treatment of mandibular edentulism. Int J Oral Maxillofac Implants. 2003; 17(6):799-810. View

12.

Sculean A, Gruber R, Bosshardt D . Soft tissue wound healing around teeth and dental implants. J Clin Periodontol. 2014; 41 Suppl 15:S6-22. DOI: 10.1111/jcpe.12206. View

13.

Marin D, Rosa Perin Leite A, Nicoli L, Marcantonio C, Compagnoni M, Marcantonio Jr E . Free Gingival Graft to Increase Keratinized Mucosa after Placing of Mandibular Fixed Implant-Supported Prosthesis. Case Rep Dent. 2017; 2017:5796768. PMC: 5331288. DOI: 10.1155/2017/5796768. View

14.

Nemcovsky C, Moses O . Rotated palatal flap. A surgical approach to increase keratinized tissue width in maxillary implant uncovering: technique and clinical evaluation. Int J Periodontics Restorative Dent. 2003; 22(6):607-12. View

15.

Bassetti R, Stahli A, Bassetti M, Sculean A . Soft tissue augmentation around osseointegrated and uncovered dental implants: a systematic review. Clin Oral Investig. 2016; 21(1):53-70. DOI: 10.1007/s00784-016-2007-9. View

16.

Elkhaweldi A, Rincon Soler C, Cayarga R, Suzuki T, Kaufman Z . Various Techniques to Increase Keratinized Tissue for Implant Supported Overdentures: Retrospective Case Series. Int J Dent. 2015; 2015:104903. PMC: 4466381. DOI: 10.1155/2015/104903. View

17.

Karoussis I, Salvi G, Heitz-Mayfield L, Bragger U, Hammerle C, Lang N . Long-term implant prognosis in patients with and without a history of chronic periodontitis: a 10-year prospective cohort study of the ITI Dental Implant System. Clin Oral Implants Res. 2003; 14(3):329-39. DOI: 10.1034/j.1600-0501.000.00934.x. View

18.

Anner R, Better H, Chaushu G . The clinical effectiveness of 6 mm diameter implants. J Periodontol. 2005; 76(6):1013-5. DOI: 10.1902/jop.2005.76.6.1013. View

19.

Sanz M, Lorenzo R, Aranda J, Martin C, Orsini M . Clinical evaluation of a new collagen matrix (Mucograft prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: a randomized prospective clinical trial. J Clin Periodontol. 2009; 36(10):868-76. DOI: 10.1111/j.1600-051X.2009.01460.x. View

20.

Warreth A, Boggs S, Ibieyou N, El-Helali R, Hwang S . Peri-implant diseases: an overview. Dent Update. 2015; 42(2):166-8, 171-4, 177-80 passim. DOI: 10.12968/denu.2015.42.2.166. View