Clinical Prospective Study of a Modified Technique to Extend the Keratinized Gingiva Around Implants in Combination with Ridge Augmentation: One-Year Results

Purpose: The aim of this study was to evaluate the effectiveness of a modified surgical technique to extend the keratinized gingiva around implants in augmented mandibles and the stability of the technique after 1 year. Materials and Methods: Implants were inserted in mandibles in combination with ridge augmentation and extension of deficient buccal keratinized gingiva (BKT) with free gingival grafts (FGGs), in which the keratinized local gingiva (KLG) was transferred toward the lingual. In group 1, implants were placed simultaneous with ridge augmentation, and FGGs were performed at the time of uncovering the implants. In group 2, the implants were placed after ridge augmentation, and FGGs were performed at the time of implant placement with nonsubmerged healing. The width of KLG and FGG, as well as the width of the BKT and lingual keratinized gingiva (LKT), were measured 4 weeks, 3 months, and 1 year after soft tissue grafting. Results: Seventy implants (46 in group 1, 24 in group 2) were placed in 29 patients with a mean age of 54.4 years. The mean width of KLG was 2.90 mm preoperatively (3.00 mm for group 1, 2.75 mm for group 2). Mean FGG was 4.60 mm in group 1 and 4.70 mm in group 2. For group 1 the mean width of BKT was 3.70 mm after 1 year. In contrast, group 2 showed mean BKT of 3.30 mm after 1 year. The resultant overall gain in BKT was 3.50 mm at 1 year. The LKT exhibited significantly more atrophy in group 1 (0.35 mm at 1 year) than in group 2 (0.05 mm at 1 year). Conclusions: The combination of ridge augmentation with the presented modified surgical technique resulted in the stable extension of keratinized gingiva around implants for 1 year. Keywords: alveolar ridge management, dental implants, extension of keratinized gingiva, free gingival grafts, soft tissue management