(81) Free Gingival Grafts for Implants Exhibiting Minimal Keratinized Mucosa

Introduction: Over 3 million implants are placed each year in the United States. Given the number of implants placed, successfully maintaining implants long term is important. One important factor for promoting implant success is the environment in which an implant is placed. Contributing factors to peri-implant health include placement into systemically healthy individuals, accurate surgical management preoperatively and postoperatively, use of supportive implant restorations, adequate maintenance against plaque accumulation, and biological considerations like buccal bone thickness and keratinized mucosa width.
A review of the literature shows conflicting evidence for a minimal width for keratinized mucosa in relation to improved plaque indices or preventing bone loss. However, consensus can be made that patients have poor oral hygiene performance and experience discomfort when brushing implant sites with little to no keratinized mucosa. As a result, plaque may accumulate and resultant inflammation can begin to challenge peri-implant health. In this case report, free gingival graft was used to increase the width of keratinized mucosa around peri-implant tissue and promote improved oral hygiene.

Methods: A 69 year old female patient presented to the University of Pennsylvania Dental Medicine Graduate Periodontics clinic with the chief complaint of experiencing pain when brushing her mandibular implant supported fixed prosthesis. Mucosal recession and lack of keratinized mucosal width was noted around the buccal aspect of all four mandibular implants. Two 10x15 mm split thickness free gingival grafts were harvested from both sides of maxillary palate. The free gingival grafts were sutured with resorbable sutures to the recipient site for proper immobilization. Hemostasis was achieved on the donor sites. Patient was prescribed ibuprofen 600 mg and acetaminophen 500 mg for pain and 480 ml of 0.12% Chlorhexidine.

Results: At the 2 week follow up, donor site and the grafted site had healed with no sign of infection. At the 3 month follow up, patient presented with an increase of 9 mm keratinized mucosal height. Patient also presented with 2 mm increased keratinized mucosal thickness around implants. 3 out 4 implants achieved complete coverage and 1 achieved partial coverage. Patient reported no pain or discomfort around the implant supported fixed prosthesis when brushing and overall oral hygiene improved.

Conclusions: Free gingival graft was used to promote better oral hygiene around implants with peri-implant mucogingival defect.
Free gingival graft can be used to increase the width and thickness of keratinized mucosa around peri-implant tissue and promote improved oral hygiene.

Lead Author's Contributions to the Research Project. : The Lead Author was responsible for composition of abstract, assisting in treatment planning, and assisting in surgical intervention.