Clinical Analysis of the Features of the Use of Soft Tissue Augmentation Techniques Taking into Account the Parameters of the Free Gingival Graft in the Area of ​​Implants of the Masticatory Group of Teeth

Abstract

Abstract: Currently, oral soft tissue surgery is an integral part of the rehabilitation process for patients with dental implants. In 46–62% of patients, soft tissue deficiency is observed at the initial visit stage, and in 28–52% of patients at the second stage of implantation. This requires mandatory correction, specifically in the form of creating a sufficient volume of keratinized (attached) gums around the implants to protect them from the “aggressive” environment of the oral cavity.
Goal: To determine the features of the application of free gingival graft techniques in two variations: one “large” (on one side of the jaw) and two “small” (on the other side of the jaw) in the same patient, in the area of ​​the implants of the chewing group of teeth. To investigate the relationship between the parameters of the free gingival graft and the results of soft tissue augmentation in the area of ​​the chewing group of teeth on the lower jaw.
Materials and methods: The study involved 14 patients aged 37 to 76 years (9 women and 5 men) who required restoration of the lower jaw’s chewing group of teeth using endosseous implants. Soft tissue volume augmentation techniques (free gingival graft) were used on gingival formers in two variations: group No. 1—one “large” (on one side of the jaw) and group No. 2—two “small” (on the other side of the jaw) of the same patient, in the area of the chewing group of teeth implants (in the area of teeth 3.5/3.7 or 3.5–3.7 and 4.5/4.7 or 4.5–4.7). The parameters of the “large” graft were 35×15×2 mm, and the two “small” grafts were 20×15×1.0 mm, respectively. Pain assessment in patients from each group was performed using a VAS (from 0 to 100, in mm) on days 3, 7, and 14. The state of healing of the postoperative wound was determined on days 3, 7, and 14 using the healing index, as described by Landry, Turnbull, and Howley. The assessment of the created width and height of the keratinized gums was determined in millimeters (mm) using a periodontal probe on day 35.
Results. Analysis of the obtained results indicates that on day 3, patients felt 31.66% “stronger” pain on the side where one “large” autograft was installed, which is explained by the increase in the wound surface area in the early postoperative period. The dynamics of wound healing indicate a significant difference between the groups throughout the entire study period (days 3, 7, and 14), p < 0.05. On day 3, wound healing on the side where “small” autografts were used was 59.24% faster than in the other group. On day 7, 36.02% faster than in the other group. The other group was 33.24% slower than the group on day 14. The results of the study indicate faster wound healing in patients on the side of the lower jaw where two “small” free gingival grafts were used. Additionally, a statistically significant difference was observed between the study groups, p < 0.05, in both the height and width of newly formed keratinized gums as of day 35. Accordingly, on the side of the jaw where one “large” autograft was used, the increase in keratinized gums in height was 21.84% faster than in the other group, and the increase in the width of keratinized gums was 10.12% faster than in the other group.
Conclusions. A correlation was found between the area thickness of the autograft and the volume of keratinized gingival growth within the intervention zone. The larger the area and thickness of the autograft inserted into the receiving bed, the greater the probability of wound healing by secondary tension. In our study, it was 64.29% (9 out of 14 patients). Faster wound healing occurred in patients on the side of the lower jaw where two “small” free gingival autografts were used. However, a greater increase in keratinized (attached) gingival growth in height and width occurred on the side of the lower jaw where one “large” free gingival autograft was used. Thus, the use of the free gingival graft technique in the masticatory segment of the lower jaw is a clinically justified, effective, and long-term stable method of soft tissue augmentation. Optimization of graft parameters, particularly their width, thickness, fixation method, and optimal timing of the intervention, significantly affects the treatment outcome. Free gingival grafts remain the most effective method for augmenting the attached mucosa, particularly in areas with high functional loads and aesthetic expectations from the patient. In the future, it is advisable to conduct randomized clinical trials with the assessment of both clinical and other patient-oriented indicators.