Title: Free gingival graft: Contribution to pre implant tissue preparation
Abstract:
Introduction: The presence of keratinized tissue around dental implants, as around natural teeth, has long been a topic of debate in both implantology and periodontology. This tissue plays a fundamental role in protecting peri-implant tissues, maintaining mucosal stability, and controlling inflammation. Adequate keratinized mucosa contributes to patient comfort, facilitates oral hygiene, and reduces plaque accumulation and soft tissue inflammation around implants. Among the different mucogingival surgical techniques designed to create or increase the amount of keratinized tissue, the epithelial–connective tissue graft, also known as the free gingival graft, is still considered the gold standard because of its reliability and predictable clinical outcomes.
Objective: The main objective of this work is to highlight the clinical relevance and therapeutic value of the free gingival graft in the management of peri-implant soft tissues before implant placement, based on a representative clinical case.
Patient and Methods: The reported patient is a 58-year-old woman who was referred for soft tissue preparation prior to implant-supported prosthetic rehabilitation in the mandibular left posterior region, at sites 36 and 37. Clinical examination revealed an insufficient height of keratinized mucosa associated with a shallow vestibule, a condition known to be unfavorable for long-term implant stability and peri-implant tissue health. In response to these unfavorable conditions, a vestibular deepening procedure was performed and combined with the placement of a free gingival graft in order to increase both the quantity and the quality of keratinized tissue. Post-surgical outcomes demonstrated a significant increase in vestibular depth and a marked improvement in the soft tissue environment surrounding the future implant sites.
Discussion: Scientific literature consistently emphasizes that a band of keratinized tissue greater than 2 mm around implants is essential for maintaining peri-implant tissue stability, minimizing inflammation, and reducing bacterial plaque accumulation. Nevertheless, performing a free gingival graft in the posterior mandible remains technically demanding, particularly when the vestibule is shallow.
Conclusion: In conclusion, the free gingival graft remains a reliable and effective therapeutic option for optimizing the mucogingival environment around dental implants, thereby improving their prognosis, long-term stability, and overall clinical success.
