All ETDs from UAB

Advisory Committee Chair

Ramzi Abou-Arraj

Advisory Committee Members

Amjad Javed

Maria Geisinger

Maninder Kaur

Nico Geurs

Document Type

Thesis

Date of Award

2017

Degree Name by School

Master of Science in Dentistry (MScD) School of Dentistry

Abstract

A PROSPECTIVE RANDOMIZED CLINICAL TRIAL TO COMPARE FREE GINGIVAL GRAFTS AND CONNECTIVE TISSUE GRAFTS AROUND IMPLANTS WITH A LACK OF KERATINIZED MUCOSA JEFFREY T HSU PERIODONTOLOGY ABSTRACT Although evidence is equivocal regarding the need for keratinized mucosa around dental implants, the consensus among researchers and clinicians is that peri-implant keratinized mucosa is beneficial to the health and stability of the implant prosthesis. An adequate width of keratinized mucosa (WKM) provides a resistant barrier to bacterial infiltration, facilitates restorative procedures, improves esthetic outcomes, patient comfort, and ease of oral hygiene. Many surgical approaches have been used to increase WKM around dental implants; in particular, autogenous grafts have been considered the gold standard due to ample evidence for their superior results and predictability around natural dentition. However, there are no controlled studies that compare differing types of autogenous grafts around dental implants, and there is a paucity of literature on patient-centered outcomes in mucogingival regenerative procedures. This randomized clinical trial aims to compare the two main autogenous grafting techniques, epithelialized free gingival grafting (FGG) and connective tissue grafting plus gingivoplasty (CTG+GP), to augment WKM around dental implants at 6 months following surgical intervention at recipient sites. Thirteen patients, each presenting with at least one dental implant with a lack of keratinized mucosa (WKM <2mm), completed the study. Out of those thirteen patients, twenty-six implant sites were randomized to receive either FGG or CTG+GP to augment the peri-implant soft tissue. Clinical outcomes of width of keratinized mucosa (WKM), plaque index (PI), gingival index (GI), probing depth (PD), recession (R), tissue thickness (TT1 and TT2), esthetics and patient-centered outcomes (post-operative pain, bleeding, swelling, satisfaction and impact on daily activities) were evaluated between the treatment groups for the duration of this 6-month study. Six months postoperatively, GI, PD, R, and patient-centered outcomes were similar between the two groups. WKM increased on average by 3.54mm in the FGG group and 1.13mm in the CTG+GP group. Without gingivoplasty (GP), WKM had no significant change with CTG alone at 1 month. Despite GP, there was still a statistically significant difference between the two groups, favoring the FGG group. Conversely, TT1 increased .50mm and TT2 increased .57mm in the FGG group, while TT1 increased 1.33mm and TT2 increased 1.42mm in the CTG+GP group. The increase in TT2 was statistically significant and significantly greater in the CTG+GP group compared to the FGG group. In conclusion, this study demonstrates that the use of FGG to increase WKM around dental implants results in significantly greater gains when compared to the use of CTG+GP at 6 months. Although GP can increase KM in the CTG group, the results are not always consistent. If the goal is to gain KM around an implant, FGG is recommended. If the goal is to increase tissue thickness, CTG is recommended.

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