Free gingival grafts vs mucosal excision in increasing the amount of keratinized mucosa during exposure of submerged orthodontic implants: a comparative, split-mouth study

Objectives: The aim of the present study was to compare the clinical outcomes after using free gingival grafts (FGGs) and mucosal excision during exposure of submerged orthodontic implants. Method and materials: Bilateral sites in 28 subjects were divided into two groups: In the FGG group, FGG augmentation was performed around the orthodontic implants, and in the mucosal excision group, a periosteal bed was made after mucosal excision to promote attached mucosa with no additional soft-tissue augmentation. Outcomes measured during the course of the study were the width of attached mucosa, soft tissue regrowth, degree of inflammation, oral debris, and shrinkage of the attached mucosa around the orthodontic implants over a period of 3 months. Results: FGG was more effective in increasing the width of attached mucosa over simple excision of the mucosa alone (2.87 mm vs 1.5 mm; P = .001). In both the groups, there was minimal postoperative soft tissue regrowth over the orthodontic implants, with no statistical significance difference between them (P > .05). The AM in both the treatment modalities demonstrated significant shrinkage (44% in FGG group vs 68% in mucosal excision group; P = .001). However, sites receiving augmentation showed significantly less inflammation than sites treated with mucosal excision (0.63 vs 1.5; P = .001). There was no statistical difference in oral debri accumulation between both the treatment modalities (P = .43) at the end of study period. Conclusion: Over a simple mucosal excision, using a FGG results in an uninflamed and immobile band of attached mucosa around an orthodontic implant, which offers greater comfort and stability during its function.