Dimensional changes in free epithelialized gingival/mucosal grafts at tooth and implant sites: A prospective cohort study

Abstract

Background: A study was made of the dimensional changes in free epithelialized gingival/mucosal grafts (FEGs) used to augment keratinized tissue (KT) at tooth and implant sites, and of the confounders influencing the dynamic changes over 6 months of follow-up. Methods: A prospective cohort interventional study was made of implant and tooth sites needing KT augmentation by means of an apically positioned flap and FEG. Six intraoperative variables were recorded at baseline (T0). In addition, graft width (GW), graft length (GL), and graft dimension (GD) were assessed at 3 weeks (T1), 3 months (T2), and 6 months of follow-up (T3). Univariate and multivariate analyses were performed to explore associations between the demographic and intraoperative variables and the outcomes over the study period. Results: Based upon an a priori power sample size calculation, a total of 56 consecutive patients were recruited, of which 52 were available for assessment. A total of 73 graft units were included in 122 sites. At T3, the mean change in GD in FEG was 40.21%. In particular, the mean changes in GL and GW were 12.13% and 33.06%, respectively. Statistically significant changes in GD were recorded from T0 to T1 (P < 0.0005) and from T1 to T2 (P < 0.0005), but not from T2 to T3 (P = 0.13). The change in GD at T3 was 33.26% at tooth and 43.11% at implant site level (P = 0.01). Age and GW assessed at T0 proved to be related to the changes in GD and GW in the univariate and multivariate analyses. The univariate analysis showed the avascular area (AA) to be related to the changes in GD and GW at the implant sites, whereas graft thickness (GT) was associated to changes in GD and GW at the tooth sites in the univariate and multivariate analyses. Conclusion:Free epithelialized grafts are exposed to dimensional changes that result in a reduction of approximately 40% of the original graft dimension-the changes being approximately 10% greater at the implant sites than at the tooth sites (NCT04410614).

Three-dimensional changes of a porcine collagen matrix and free gingival grafts for soft tissue augmentation to increase the width of keratinized tissue around dental implants: a randomized controlled clinical study

“…Moreover, a higher KT reduction was observed within 1 to 3 months compared to the decrease measured between 3 and 6 months. The latter findings align with those of previous clinical analyses, suggesting a higher FGG shrinkage during the early healing phase (i.e., within the first 1 to 3 months; [ 22 , 23 ], and a tendency towards greater KT width shrinkage in the CM group compared to the FGG group [ 8 ]).…”

Importance of keratinized mucosa around dental implants: Consensus report of group 1 of the DGI/SEPA/Osteology Workshop

“…Based on four studies (Sanz et al, 2009;Monje et al, 2022;Urban et al, 2015Urban et al, , 2019 not included in the systematic review, the percentage of shrinkage of surface area in autogenous grafs or combination of autogenous and xenogeneic grafts ranged between 42.4%-60% from baseline up to 12 months.…”

Modified free gingival graft technique for treatment of gingival recession defects at mandibular incisors: A randomized clinical trial

“…24,25 Monje et al evaluated dimensional changes of free gingival grafts used to augment keratinized tissue at teeth and implants. 26 The authors reported a reduction of approximately 33% of the original graft dimension at tooth sites. In the present study, the mean vertical shrinkage noted for FGG was 28%, while significantly less graft contraction was observed at sites treated with ModFGG (12%).…”

“…Monje et al. evaluated dimensional changes of free gingival grafts used to augment keratinized tissue at teeth and implants 26 . The authors reported a reduction of approximately 33% of the original graft dimension at tooth sites.…”