Comparison of Microsurgical and Conventional Techniques for Augmentation of Keratinized Mucosa Around Dental İmplants

Yıl 2024, Cilt: 25 Sayı: 2, 119 - 132

Gamze Solakoğlu , Meltem Hendek , Ebru Olgun

https://doi.org/10.69601/meandrosmdj.1532054

Öz

Objective: This study aims to compare the clinical outcomes of periodontal microsurgery with conventional periodontal surgery in keratinized mucosa augmentation around the implant.
Materials and Methods: Ten patients with at least 2 implants with a keratinized mucosal width of < 2 mm were included. Free gingival graft (FGG) was applied in the test group with the microsurgery technique whereas in the control group with the conventional periodontal surgery technique. Keratinized mucosa width (KMW) and palatal mucosal thickness (MT) were measured at baseline and 3rd month. Graft shrinkage(GS) was evaluated at the 3rd month. Donor site wound healing was evaluated at the 10th day and 3rd month. Feedback forms were collected on the 10th day.
Results: KMW values increased significantly in both groups at 3rd month compared to baseline. The percentage of GS was lower in the test group at 3rd month, but this difference was not significant. MT values in the test group were closer to the baseline values at 3rd month compared to the control group. Wound healing scores were similar in both groups at the 10th day and 3rd month. Postoperative pain levels decreased more rapidly in the test group.
Conclusion: The microsurgical technique provides a faster increase in palatal mucosal thickness and lower graft shrinkage during the healing period and an earlier reduction in postoperative pain levels.

Anahtar Kelimeler

dental implant,, free gingival graft, grift shrinkage, keratinized mucosa width, microsurgery

Etik Beyan

it was approved by Kirikkale University Clinical Research Ethics Committee (No: 16/08 Date: 01.08.2019).

Kaynakça

• 1. Chapple ILC, Mealey BL, Van Dyke TE, Bartold PM, Dommisch H, Eickholz P, Geisinger ML, Genco RJ, Glogauer M, Goldstein M, Griffin TJ, Holmstrup P, Johnson GK, Kapila Y, Lang NP, Meyle J, Murakami S, Plemons J, Romito GA, Shapira L, Tatakis DN, Teughels W, Trombelli L, Walter C, Wimmer G, Xenoudi P, Yoshie H. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018 Jun;89 Suppl 1:S74-S84. doi: 10.1002/JPER.17-0719. PMID: 29926944.
• 2. Cairo F, Pagliaro U, Nieri M. Soft tissue management at implant sites. J Clin Periodontol. 2008 Sep;35(8 Suppl):163-7. doi: 10.1111/j.1600-051X.2008.01266.x. PMID: 18724848.
• 3. Liao TH, Hsu MH, Liao YT, Chang YC. The perspectives of a novel operative procedure for free gingival graft. J Dent Sci. 2023 Jul;18(3):1368-1371. doi: 10.1016/j.jds.2023.05.013. Epub 2023 May 17. PMID: 37404611; PMCID: PMC10316494.
• 4. Fickl S, Thalmair T, Kebschull M, Böhm S, Wachtel H. Microsurgical access flap in conjunction with enamel matrix derivative for the treatment of intra-bony defects: a controlled clinical trial. J Clin Periodontol. 2009 Sep;36(9):784-90. doi: 10.1111/j.1600-051X.2009.01451.x. Epub 2009 Jul 14. PMID: 19614721.
• 5. Francetti L, Del Fabbro M, Calace S, Testori T, Weinstein RL. Microsurgical treatment of gingival recession: a controlled clinical study. Int J Periodontics Restorative Dent. 2005 Apr;25(2):181-8. PMID: 15839595.
• 6. Mingdeng R, Yanhong H, Haibin L, Gelin X, Shaobing L, Yuan S, Pei C, Pan J, Xueyang Z. [Application of periodontal microsurgery in the augmentation of attached gingiva around an implant]. Hua Xi Kou Qiang Yi Xue Za Zhi. 2018 Feb 1;36(1):71-75. Chinese. doi: 10.7518/hxkq.2018.01.014. PMID: 29595000; PMCID: PMC7030165.
• 7. 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.
• 8. Apse P, Zarb GA, Schmitt A, Lewis DW. The longitudinal effectiveness of osseointegrated dental implants. The Toronto Study: peri-implant mucosal response. Int J Periodontics Restorative Dent. 1991;11(2):94-111. PMID: 1718917.
• 9. Landry RG, Turnbull RS, Howley T. Effectiveness of benzydamyne HCl in the treatment of periodontal post-surgical patients. Res Clin Forums. 1988;10:105-118.
• 10. Araujo MG, Lindhe J. Peri-implant health. J Periodontol. 2018 Jun;89 Suppl 1:S249-S256. doi: 10.1002/JPER.16-0424. PMID: 29926949.
• 11. Roccuzzo M, Grasso G, Dalmasso P. Keratinized mucosa around implants in partially edentulous posterior mandible: 10-year results of a prospective comparative study. Clin Oral Implants Res. 2016 Apr;27(4):491-6. doi: 10.1111/clr.12563. Epub 2015 Feb 23. PMID: 25706508.
• 12. Boynueğri D, Nemli SK, Kasko YA. Significance of keratinized mucosa around dental implants: a prospective comparative study. Clin Oral Implants Res. 2013 Aug;24(8):928-33. doi: 10.1111/j.1600-0501.2012.02475.x. Epub 2012 Apr 30. PMID: 22540356.
• 13. 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.
• 14. Buyukozdemir Askin S, Berker E, Akincibay H, Uysal S, Erman B, Tezcan İ, Karabulut E. Necessity of keratinized tissues for dental implants: a clinical, immunological, and radiographic study. Clin Implant Dent Relat Res. 2015 Feb;17(1):1-12. doi: 10.1111/cid.12079. Epub 2013 Apr 30. PMID: 23631746.
• 15. Zheng C, Wang S, Ye H, Liu Y, Hu W, Zhou Y. Effect of free gingival graft before implant placement on peri-implant health and soft tissue changes: a randomized controlled trial. BMC Oral Health. 2021 Oct 4;21(1):492. doi: 10.1186/s12903-021-01818-3. PMID: 34607597; PMCID: PMC8489082.
• 16. Egli U, Vollmer WH, Rateitschak KH. Follow-up studies of free gingival grafts. J Clin Periodontol. 1975 Apr;2(2):98-104. doi: 10.1111/j.1600-051x.1975.tb01730.x. PMID: 1055730.
• 17. Rateitschak KH, Egli U, Fringeli G. Recession: a 4-year longitudinal study after free gingival grafts. J Clin Periodontol. 1979 Jun;6(3):158-64. doi: 10.1111/j.1600-051x.1979.tb02195.x. PMID: 288747.
• 18. Golmayo P, Barallat L, Losada M, Valles C, Nart J, Pascual-La Rocca A. Keratinized tissue gain after free gingival graft augmentation procedures around teeth and dental implants: A prospective observational study. J Clin Periodontol. 2021 Feb;48(2):302-314. doi: 10.1111/jcpe.13394. Epub 2020 Nov 18. PMID: 33098670.
• 19. 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.
• 20. Barbosa FI, Corrêa DS, Zenóbio EG, Costa FO, Shibli JA. Dimensional changes between free gingival grafts fixed with ethyl cyanoacrylate and silk sutures. J Int Acad Periodontol. 2009 Apr;11(2):170-6. PMID: 19431956.
• 21. Parvini P, Galarraga-Vinueza ME, Obreja K, Magini RS, Sader R, Schwarz F. Prospective study assessing three-dimensional changes of mucosal healing following soft tissue augmentation using free gingival grafts. J Periodontol. 2021 Mar;92(3):400-408. doi: 10.1002/JPER.19-0640. Epub 2020 Aug 21. PMID: 33448379.
• 22. Yaman D, Aksu S, Dişçi R, Demirel K. Thickness of palatal masticatory mucosa and its relationship with different parameters in Turkish subjects. Int J Med Sci. 2014 Jul 20;11(10):1009-14. doi: 10.7150/ijms.9112. PMID: 25076847; PMCID: PMC4115240.
• 23. Keskiner I, Aydogdu A, Balli U, Kaleli AE. Quantitative changes in palatal donor site thickness after free gingival graft harvesting: a pilot study. J Clin Periodontol. 2016 Nov;43(11):976-984. doi: 10.1111/jcpe.12592. Epub 2016 Sep 9. PMID: 27330024.
• 24. Tibbetts LS, Shanelec DA. A review of the principles and practice of periodontal microsurgery. Tex Dent J. 2007 Feb;124(2):188-204. PMID: 17396709.