Sigara kullanımı, posterior dental implantlar çevresindeki serbest dişeti grefti (FGG) büzülmesini etkiler: Prospektif klinik çalışma

Year 2025, Volume: 26 Issue: 3, 278 - 288, 22.09.2025

Ceren Okur Oya Turkoglu , Alpdogan Kantarci

https://doi.org/10.69601/meandrosmdj.1643557

Abstract

Amaç: Bu çalışmanın amacı sigaranın implant çevresinde uygulanan serbest dişeti grefti (SDG) işlemi sonrasında serbest dişeti grefti boyutlarına, keratinize mukoza genişliğine (KMG) ve vestibül sulkus derinliği üzerine etkisini değerlendirmektir.
Yöntem: Yirmi hastada bukkal tarafta KMG<2mm olan 20 adet implant araştırmaya dahil edildi. SDG’nin horizontal boyutu, KMG, SDG alanı, vestibül sulkus derinliği ve alıcı ve verici sahaların doku kalınlığı bireysel stentler yardımıyla 6 ay ölçüldü. İstatistiksel karşılaştırmalar için Brunner-Langer modeli kullanıldı.
Bulgular: Birinci ay KMG, vestibül sulkus derinliği ve alıcı bölgedeki doku kalınlığı başlangıca göre istatistiksel anlamlı oranda arttı (p<0.05), ancak 3 ve 6. aylarda daha fazla bir artış izlenmedi (p>0.05). Bu parametreler sigaradan etkilenmedi (p>0.05). SDG alanı ilk ay her iki grupta da azaldı (p>0.05). Sigara içmeyenlerde 3. ve 6. aylarda SDG alanında daha fazla azalma izlenmezken sigara içenlerde 6.ayda ilk aya kıyasla önemli azalma saptandı (p=0.0034). Sigara içenlerde SDG büzülmesi 6. ayda sigara içmeyenlere göre daha fazla bulundu (p= 0.004).
Sonuç: Sigara, implant çevresine yerleştirilen SDG işlemi sonrasında KMG ve vestibül sulkus derinliğindeki değişimleri etkilemese de SDG büzülmesi açısından kolaylaştırıcı bir faktör olabilir.

Keywords

dental implant , serbest dişeti grefti , graft

Smoking Effects the FGG Shrinkage Around Posterior Dental Implants: A Prospective Clinical Trial

Abstract

Objective: To evaluate the effect of smoking on free gingival graft (FGG) dimensions, keratinized mucosa width (KMW) and vestibule sulcus depth following FGG surgery around implants.
Methods: Twenty implants with KMW<2mm on buccal sites in twenty patients were included. Measurements of horizontal dimension of FGG, KMW, FGG area, vestibule sulcus depth, and tissue thickness of recipient and donor sites were performed using individual stents during 6 months. The Brunner-Langer model was used for statistical comparisons.
Results: KMW, vestibule sulcus depth and tissue thickness of recipient site significantly increased at first month compared to baseline (p<0.05), but no further change was observed at 3 and 6 months (p>0.05). These parameters were not affected by smoking (p>0.05). FGG area decreased at first month in both groups (p<0.05). While no further decrease in FGG area was observed at 3 and 6 months in non-smokers, a significant decrease was determined at 6 months compared to first month in smokers (p=0.0034). The smoker group had more shrinkage in FGG than non-smoker group at 6 months (p= 0.004).
Conclusion: Smoking might be a confounding factor for FGG shrinkage but KMW and vestibule sulcus depth do not seem to be affected by smoking following FGG around implants.

Keywords

dental implant , free gingival graft , smoking

References

• 1. Hall WB. Present status of soft tissue grafting. J Periodontol. 1977 Sep;48(9):587-97. doi: 10.1902/jop.1977.48.9.587. PMID: 333092.
• 2. Thoma DS, Gil A, Hämmerle CHF, Jung RE. Management and prevention of soft tissue complications in implant dentistry. Periodontol 2000. 2022 Feb;88(1):116-129. doi: 10.1111/prd.12415. PMID: 35103320; PMCID: PMC9306802.
• 3. Ravidà A, Arena C, Tattan M, Caponio VCA, Saleh MHA, Wang HL, Troiano G. The role of keratinized mucosa width as a risk factor for peri-implant disease: A systematic review, meta-analysis, and trial sequential analysis. Clin Implant Dent Relat Res. 2022 Jun;24(3):287-300. doi: 10.1111/cid.13080. Epub 2022 Mar 17. PMID: 35298862; PMCID: PMC9311272.
• 4. Sanz M, Schwarz F, Herrera D, McClain P, Figuero E, Molina A, Monje A, Montero E, Pascual A, Ramanauskaite A, Renouard F, Sader R, Schiegnitz E, Urban I, Heitz-Mayfield L. Importance of keratinized mucosa around dental implants: Consensus report of group 1 of the DGI/SEPA/Osteology Workshop. Clin Oral Implants Res. 2022 Jun;33 Suppl 23:47-55. doi: 10.1111/clr.13956. PMID: 35763021.
• 5. Novaes AB Jr, Palioto DB. Experimental and clinical studies on plastic periodontal procedures. Periodontol 2000. 2019 Feb;79(1):56-80. doi: 10.1111/prd.12247. PMID: 30892770.
• 6. Afshari Z, Yaghini J, Naseri R. LEVELS OF SMOKING AND PERI IMPLANT MARGINAL BONE LOSS: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Evid Based Dent Pract. 2022 Sep;22(3):101721. doi: 10.1016/j.jebdp.2022.101721. Epub 2022 Mar 18. PMID: 36162899.
• 7. Dwarakanath CD, Divya B, Sruthima GN, Penmetsa GS. Sub-epithelial connective tissue graft for root coverage in nonsmokers and smokers: A pilot comparative clinical study. J Indian Soc Periodontol. 2016 Jul-Aug;20(4):435-440. doi: 10.4103/0972-124X.184033. PMID: 28298827; PMCID: PMC5341320.
• 8. Namadmalian Esfahani N, Mohseni Salehi Monfared SH, Khorsand A, Shamshiri AR. Dimensional changes of keratinized mucosa after accordion versus conventional free gingival graft around dental implants: A randomized two-arm parallel clinical trial. Clin Oral Implants Res. 2022 May;33(5):472-481. doi: 10.1111/clr.13907. Epub 2022 Feb 28. PMID: 35191105.
• 9. Monje A, Blasi G, Amerio E, Sanz-Martin I, Nart J. Dimensional changes in free epithelialized gingival/mucosal grafts at tooth and implant sites: A prospective cohort study. J Periodontol. 2022 Jul;93(7):1014-1023. doi: 10.1002/JPER.21-0521. Epub 2022 Jan 25. PMID: 34970744.
• 10. Shah A, Kothiwale SV. Efficacy of free gingival graft in the augmentation of keratinized tissue around implants: A prospective clinical study. J Indian Soc Periodontol. 2021 Jul-Aug;25(4):330-334. doi: 10.4103/jisp.jisp_490_20. Epub 2021 Jul 1. PMID: 34393404; PMCID: PMC8336768.
• 11. Fu X, Wang Y, Chen B, Tian J, Lin Y, Zhang Y. Patient-reported outcome measures and clinical outcomes following peri-implant vestibuloplasty with a free gingival graft versus xenogeneic collagen matrix: a comparative prospective clinical study. Int J Implant Dent. 2021 Aug 2;7(1):69. doi: 10.1186/s40729-021-00356-5. PMID: 34337690; PMCID: PMC8326236.
• 12. Lin IP, Chen SH, Chang CC, Chang JZ, Sun JS, Chang CH. Morphology of Peri-Implant Tissues Around Permanent Prostheses With Various Emergence Angles Following Free Gingival Grafting. J Prosthodont. 2022 Oct;31(8):681-688. doi: 10.1111/jopr.13555. Epub 2022 Jul 9. PMID: 35770466.
• 13. Bouchard P, Malet J, Borghetti A. Decision-making in aesthetics: root coverage revisited. Periodontol 2000. 2001;27:97-120. doi: 10.1034/j.1600-0757.2001.027001097.x. PMID: 11551302.
• 14. Heitz-Mayfield LJA, Salvi GE. Peri-implant mucositis. J Periodontol. 2018 Jun;89 Suppl 1:S257-S266. doi: 10.1002/JPER.16-0488. PMID: 29926954.
• 15. Mombelli A, van Oosten MA, Schurch E Jr, Land NP. The microbiota associated with successful or failing osseointegrated titanium implants. Oral Microbiol Immunol. 1987 Dec;2(4):145-51. doi: 10.1111/j.1399-302x.1987.tb00298.x. PMID: 3507627.
• 16. Silva CO, Ribeiro Edel P, Sallum AW, Tatakis DN. Free gingival grafts: graft shrinkage and donor-site healing in smokers and non-smokers. J Periodontol. 2010 May;81(5):692-701. doi: 10.1902/jop.2010.090381. PMID: 20429648.
• 17. Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH, Flemmig TF, Garcia R, Giannobile WV, Graziani F, Greenwell H, Herrera D, Kao RT, Kebschull M, Kinane DF, Kirkwood KL, Kocher T, Kornman KS, Kumar PS, Loos BG, Machtei E, Meng H, Mombelli A, Needleman I, Offenbacher S, Seymour GJ, Teles R, Tonetti MS. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018 Jun;89 Suppl 1:S173-S182. doi: 10.1002/JPER.17-0721. PMID: 29926951.
• 18. Bouri A Jr, Bissada N, Al-Zahrani MS, Faddoul F, Nouneh I. Width of keratinized gingiva and the health status of the supporting tissues around dental implants. Int J Oral Maxillofac Implants. 2008 Mar-Apr;23(2):323-6. PMID: 18548930.
• 19. Orsini M, Orsini G, Benlloch D, Aranda JJ, Lázaro P, Sanz M. Esthetic and dimensional evaluation of free connective tissue grafts in prosthetically treated patients: a 1-year clinical study. J Periodontol. 2004 Mar;75(3):470-7. doi: 10.1902/jop.2004.75.3.470. PMID: 15088886.
• 20. Lindhe J, Wennstrom JL, Berglundh T. The Mucosa at teeth and implants. In: Lindhe J, Lang NP, Karring T, eds. Clinical Periodontology and Implant Dentistry, Oxford Blackwell Publishing Ltd, 2008, pp 69-85.
• 21. Gümüş P, Buduneli E. Graft stabilization with cyanoacrylate decreases shrinkage of free gingival grafts. Aust Dent J. 2014 Mar;59(1):57-64. doi: 10.1111/adj.12149. Epub 2014 Feb 4. PMID: 24494804.
• 22. Schmitt CM, Tudor C, Kiener K, Wehrhan F, Schmitt J, Eitner S, Agaimy A, Schlegel KA. Vestibuloplasty: porcine collagen matrix versus free gingival graft: a clinical and histologic study. J Periodontol. 2013 Jul;84(7):914-23. doi: 10.1902/jop.2012.120084. Epub 2012 Oct 2. PMID: 23030237.
• 23. Speroni S, Cicciu M, Maridati P, Grossi GB, Maiorana C. Clinical investigation of mucosal thickness stability after soft tissue grafting around implants: a 3-year retrospective study. Indian J Dent Res. 2010 Oct-Dec;21(4):474-9. doi: 10.4103/0970-9290.74208. PMID: 21187608.