# Peri-implant Soft Tissue Phenotype Modification Using Free Gingival Graft and Apically Positioned Flap: A Case Series

## TL;DR

This case series shows that a free gingival graft combined with an apically positioned flap can increase keratinized mucosa and improve implant health.

## Contribution

Demonstrates a surgical technique to modify peri-implant soft tissue phenotype in patients with insufficient keratinized mucosa.

## Key findings

- Mean keratinized mucosa width increased by 2.51 mm at 12 months.
- Plaque and gingival indices were reduced post-surgery.
- Patients reported improved aesthetics and less pain during brushing.

## Abstract

Background

The lack of peri-implant keratinized mucosa (<2 mm) is associated with plaque accumulation and pain during brushing, and consequently peri-implant disease. This case series aimed to evaluate the effectiveness of a free gingival graft in combination with an apically positioned flap to modify the peri-implant phenotype. The primary outcome was the change in keratinized mucosa width (KMW), and the secondary outcomes were pocket probing depth, plaque index, gingival index, pain upon brushing, and aesthetic appearance of the graft.

Methodology

A total of nine patients were treated with 16 implants placed in areas with a lack of KMW (<2 mm). After osseointegration and before the delivery of the final prosthesis, a free gingival graft in combination with an apically positioned flap was performed. All patients were followed up at 3, 6, and 12 months after surgery.

Results

The mean gain in KMW at 12 months was 2.51 mm. The change in KMW was statistically significant (p = 0.001). Plaque index and gingival index were reduced. Patients were satisfied with the aesthetic appearance and experienced less pain upon brushing.

Conclusions

Within the limitations of this case series, the use of a free gingival graft in combination with an apically positioned flap can modify the peri-implant phenotype by increasing the KMW and improving peri-implant health parameters.