Abstract
The presence of a sufficient amount of keratinized tissue around dental implants is directly related to their success, facilitates the following restorative procedures, and obtains satisfactory cosmetic results. This study aims to investigate the effectiveness and predictability of different treatment modalities to gain keratinized tissue (KT) in partial edentulous jaws prior to dental implant placement; modified free gingival graft (MFGG), and connective tissue graft (CTG).
Materials and Methods: A total of 14 (age range between 25 and 58 years) partially edentulous patients (28 sites) with insufficient zones of keratinized tissue at the prospective implant positionswere included in this study, two treatment modalities were performed in the lower jaw: MFGG, and CTG. MFGG and CTG were applied in the premolar and molar positions randomly. Assessed outcomes up to 6 months postsurgery included changes in width and thickness of keratinized tissue.
Results: After 6 months of follow-up,changes in keratinized tissue width demonstrated an increase of 2.29 ± 1.6 mm in connective tissue graft, whereas modified free gingival graft showed an increase of 3.95 ± 1.25 mm, on the other hand changes in keratinized tissue thickness demonstrated an increase of 0.85 ± 0.5 mm in connective tissue graft, whereas modified free gingival graft showed an increase of 0.71 ± 0.4 mm.
Conclusion: The two methods were suitable to increase the width and thickness of KT over a 6-month period, although CTG alone rendered roughly 34% less gain at KT width compared to MFGG.Keywords: Modified Free Gingival Graft; Augmentation; Keratinized Tissue; De-Epithelialization; Keratinized Gingiva; Connective Tissue Graft.
Introduction
The absence of an adequate amount of keratinized mucosa is directly associated with inflammatory gingival manifestations, bleeding on probing, and bacterial plaque aggregation, in addition o poor cosmetic appearance. Previous studies concluded that dental implants placed within sites with a minimum amount of keratinized tissues(<2mm) are more susceptible to inflammatory manifestations and the accumulation of bacterial plaque compared to dental implants placed within sites with sufficient keratinized tissues (KT>2mm)[4].
Moreover, the presence of sufficient vertical thickness of soft tissue around the implants prevents the occurrence of resorption of the crestal bone, which can be witnessed with the presence of thin mucous around the implants [5].
Therefore, careful management of the soft tissues around the implants is an important and essential factor for obtaining satisfactory aesthetic and functional results in the long term [6].Several previous studies have shown that the presence of a sufficient amount of keratinized tissue around dental implants is directly related to the success of the osseointegrated of dental implants, which facilitates the following restorative procedures and obtains satisfactory cosmetic results, and also allows maintaining the health of the tissues around the implants [3, 7].
Many different and useful surgical techniques are used to improve soft tissues, including pedicle flaps and soft tissue grafts [6].From the beginning of the second half of the last century [1] free gingival grafts were the main technique to increase both the width of the keratinized tissue and the vestibular extension.
That indicates the reliability of this clinical procedure [2, 3, 7-10].The aim of the present study was, therefore, to evaluate two treatment modalities, modified free gingival graft (MFGG), and connective tissue graft (CTG), to gain vertical and horizontal soft-tissue growth in the posterior region of the mandible before installation of a dental implant. In addition, to report outcomes 6 months following the surgical interventions.
