Keratinised mucosa width enhancement around implants with a pedicle flap or free gingival graft: A non-randomised concurrent control study.

Abstract

Purpose: To investigate the effectiveness of keratinised mucosa width enhancement between an apically positioned flap with free gingival graft and the novel technique with a palatal/lingual pedicle flap by comparing the amount of keratinised mucosa width acquired and clinical outcomes related to peri-implant health.

Materials and methods: Patients requiring keratinised mucosa width enhancement (less than 2 mm) during uncovering surgery were included. Two surgical methods were compared: an apically positioned flap with free gingival graft (FGG group) and a palatal/lingual pedicle flap with collagen matrix (PPF group). The primary outcomes were amount of keratinised mucosa width and shrinkage rate at 2 weeks, 2 months after surgery, and 3 and 6 months after loading. Secondary outcomes included the intra- and intergroup comparison in mucosal recession, probing pocket depth, marginal bone level and restoration design.

Results: A total of 30 patients (FGG 15, PPF 15) with 39 implants were enrolled. Both surgical approaches enhanced keratinised mucosa width considerably, with the FGG group achieving significantly greater keratinised mucosa width at 2 weeks, and 3 months and 6 months after loading (P 0.05); however, there was no significant intergroup difference in the change in keratinised mucosa width over time. The shrinkage rate of acquired keratinised mucosa width was less than 30% from 2 weeks to 2 months, and this trend stabilised after loading. Both groups demonstrated favourable clinical outcomes. Although the PPF group exhibited more buccal mucosal recession with a convex restoration profile, the FGG group showed more buccal creeping effects and lingual mucosal recession over the follow-up period.

Conclusions: Both the free gingival graft and palatal/lingual pedicle flap techniques can effectively enhance keratinised mucosa width, maintaining an adequate amount of more than 2 mm after loading. Furthermore, comparable clinical outcomes between the methods indicate favourable peri-implant health regardless of the surgical technique, abutment type and restoration design.