• The Journal of the Korean dental association
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• v.55 no.1
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• pp.30-41
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• 2017

Inadequate keratinized mucosa around dental implants can lead to more plaque accumulation, tissue inflammation, marginal recession and attachment loss. We evaluated the effects of free gingival and extracellular matrix membrane grafts performed to increase the insufficient width of keratinized tissue around dental implants in the posterior mandible. A 47-year-old female patient presented with discomfort due to swelling of the lower right second premolar area. Due to severe destruction of alveolar bone, the tooth was extracted. After 3 months, a guided bone regeneration (GBR) procedure was performed and then a dental implant was placed 6 months later. During the second-stage implant surgery, free gingival grafting was performed to increase the width of the keratinized tissue. After 12 months, a clinical evaluation was performed. A 64-year-old female patient had a missing tooth area of bilateral lower molar region with narrow zone of keratinized gingiva and horizontal alveolar bone loss. Simultaneous implant placement and GBR were performed. Five months after the first-stage implant surgery, a gingival augmentation procedure was performed with an extracellular matrix membrane graft to improve the width of the keratinized tissue in the second-stage implant surgery. After 12 months, a clinical evaluation was performed. In these two clinical cases, 12 months of follow-up, revealed that the increased width of the keratinized tissue and the deepened oral vestibule was well maintained. A patient showed a good oral hygiene status. In conclusion, increased width of keratinized tissue around dental implants could improve oral hygiene and could have positive effects on the long-term stability and survival rate of dental implants. When planning a keratinized tissue augmentation procedure, clinicians should consider patient-reported outcomes.

• Journal of Periodontal and Implant Science
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• v.44 no.2
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• pp.94-99
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• 2014

Purpose: Various surgical techniques target achieving adequate keratinized tissue around dental implants; however, these techniques are usually performed before implant placement or upon the exposure of submerged implants. The aim of this case report is to describe a simultaneous placement of an interpositional free gingival graft (iFGG) with that of nonsubmerged implants in a patient lacking keratinized tissue and to assess the longterm outcome of this grafted gingiva. Methods: A wedge-shaped free gingnival graft (FGG), including an epithelium-connective tissue (E-C) portion and a connective-tissue-only (CT) portion, was harvested from the palate. The CT portion was inserted under the buccal flap, and the E-C portion was secured tightly around the implants and to the lingual flap. Results: At the 8-year follow-up, the gingival graft remained firmly attached and was well maintained, with no conspicuous shrinkage or reported discomfort during oral hygiene procedures. The use of an iFGG at a nonsubmerged implant placement minimizes the required number of surgical steps and patient discomfort while providing adequate buccal keratinized tissue. Conclusions: Therefore, the technique could be considered an alternative method in increasing the keratinized tissue for cases that have a minimal amount of keratinized tissue.

• Journal of Dental Rehabilitation and Applied Science
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• v.29 no.4
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• pp.407-417
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• 2013

The one of peri-implant soft tissue problems seen during the maintenance phase of implant therapy is an inadequate zone of keratinized tissue. Keratinized tissue plays a major role around teeth and dental implants, helping in maintaining and facilitating oral hygiene. A free gingival graft (FGG) is chosen to correct the soft tissue defects and provide optimal peri-implant health in order to increase the long-term prognosis of the implant reconstruction. However, the patient treated with FGG has pain and discomfort on donor site such as palate. It is also technically demanding, time consuming, and the color match of the tissue is often less than ideal. An apically positioned flap (APF) is selected for increasing the keratinized tissue simply while or after the second stage implant surgery. This case report shows successfully increasing the width of peri-implant kenratinized tissue through APF procedure on small site of dental implant instead of FGG.

• Journal of Periodontal and Implant Science
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• v.27 no.3
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• pp.561-573
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• 1997

The keratinized mucosa around the implant is an important key in health of soft tissue and hard tissue. The purpose of this study is showed that the keratinized mucosa is associated with the keratinized mucosa index, plaque index, gingival index, probing depth. which is investigated to observing the peri-implant mucosa of mandibular partial edentulous patuent using periodontal parameter by previously published paper. It was estimated 6 site with regard to 80 fixture for 28 person, and the average age is 46.8. Each estimation is the order of less trauma, that is, plaque index, keratinized mucosa index, gingival index and probing depth. In this study, statstically analyzed treatment is used for Spss V 7.0 for Windows(Spss Inc, USA). The Kruskal Walis Test is used to compare the amount of the keratinized mucosa is into the $0{\sim}3$ index, with plaque index, gingival index and probing depth. Mann-whitney Test is used to interpreate the relation of plaque index and probing depth, which is showed significant difference. The Result are as follows 1. The kertinized mucosa index 3 amounts to 47.7%, which is much higher than the other indices and the index order is followed 3, 1, 2 and O. 2. The plaque index 1 amounts to 61.7%, which is much higher than the other indices and the index order is followed 1, 2, 3 and O. The plaque index 0 is significant to each of index(P<0.05). The plaque index is decrease as the keratinized mucosa index is increased. 3. The probing depth for 2mm, 1mm, 3mm is 48.9%, 23.5%, 16.8% respectively, which is most occupied. The probing depth 2mm and 3mm for the keratinized mucosa index is significant(P<0.05). The probing index is decreased as the keratinized mucosa index is increased. 4. The gingival index 0 amounts to 58.0%, which is much higher than the other indices and the index order is followed 0, 1, 2 and 3.

• Journal of Periodontal and Implant Science
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• v.53 no.2
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• pp.145-156
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• 2023

Purpose: The significance of keratinized tissue for peri-implant health has been emphasized. However, there is an absence of clinical evidence for the use of a xenogeneic collagen matrix (XCM) to manage peri-implant mucositis and peri-implantitis. Therefore, the purpose of this study was to investigate outcomes after keratinized tissue augmentation using an XCM for the management of peri-implant diseases. Methods: Twelve implants (5 with peri-implant mucositis and 7 with peri-implantitis) in 10 patients were included in this study. Non-surgical treatments were first performed, but inflammation persisted in all implant sites. The implant sites all showed a lack of keratinized mucosa (KM) and vestibular depth (VD). Apically positioned flaps with XCM application were performed. Bone augmentation was simultaneously performed on peri-implantitis sites with an intrabony defect (>3 mm). The following clinical parameters were measured: the probing pocket depth (PPD), modified sulcular bleeding index (mSBI), suppuration (SUP), keratinized mucosal height (KMH), and VD. Results: There were no adverse healing events during the follow-up visits (18±4.6 months). The final KMHs and VDs were 4.34±0.86 mm and 8.0±4.05 mm, respectively, for the sites with peri-implant mucositis and 3.29±0.86 mm and 6.5±1.91 mm, respectively, for the sites with peri-implantitis. Additionally, the PPD and mSBI significantly decreased, and none of the implants presented with SUP. Conclusions: Keratinized tissue augmentation using an XCM for sites with peri-implant mucositis and peri-implantitis was effective for increasing the KMH and VD and decreasing peri-implant inflammation.

• Journal of Periodontal and Implant Science
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• v.41 no.4
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• pp.185-191
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• 2011

Purpose: The objective of this study was to compare and evaluate the inflammatory responses of three widely used suture materials in the keratinized gingiva and buccal mucosa of beagle dogs. Methods: Silk, polyglycolic acid, and nylon sutures were placed within the mandibular keratinized gingiva and maxillary buccal mucosa of four male beagle dogs. Biopsies were taken 3, 7, and 14 days after suturing. Specimens were prepared with hematoxylineosin stain for evaluation under a light microscope. Results: The suture materials placed in the oral mucosa elicited more inflammatory reactions than did those placed in the keratinized gingiva. The multifilament suture materials caused more inflammatory tissue reactions than did the monofilament suture materials in the oral mucosa. Conclusions: If oral hygiene is well maintained and suture materials are placed in the keratinized gingiva, silk, nylon, and polyglycolic acid are considered to be proper suture materials for oral surgery. However, it is advisable to use monofilament suture materials if the suture site is within the oral mucosa.

• Journal of Periodontal and Implant Science
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• v.40 no.2
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• pp.96-101
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• 2010

Purpose: The purpose of this study was to evaluate the effect of collagen matrix with apically positioned flap (APF) on the width of keratinized gingiva, comparing to the results of APF only and APF combined with free gingival graft (FGG) at the second implant surgery. Methods: Nine patients were selected from those who had received treatments at the Department of Periodontics, Chosun University Dental Hospital, Gwangju, Korea. We performed APF, APF combined with FGG, and APF combined with collagen matrix coverage respectively. Clinical evaluation of keratinized gingival was performed by measuring the distance from the gingival crest to the mucogingival junction at the mid-buccal point, using a periodontal probe before and after the surgery. Results: The ratio of an increase was 0.3, 0.6, and 0.6 for the three subjects in the APF cases, 3, 5, and 7 for the three in the APF combined with FGG case, and 1.5, 0.5, and 3 for the three in the APF combined with collagen matrix coverage case. Conclusions: This study suggests that the collagen matrix when used as a soft tissue substitute with the aim of increasing the width of keratinized tissue or mucosa, was as effective and predictable as the FGG.

• The Journal of the Korean dental association
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• v.55 no.3
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• pp.240-248
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• 2017

A keratinized gingiva is important to the natural teeth and it is more essential to the health of the peri-implant mucosa of the implants. There are various surgical methods to restore a keratinized gingiva. First, a clinician could utilize apically positioned flap operation. This flap operation technique could be used as a full or partial thickness. If there is little keratinized gingival tissue available for the apically positioned flap operation, free gingival grafting should be used. Its technique sensitivity is relatively high, but using various surgical techniques and disciplines makes it simple and have the good predictability. There have been many considerations for those surgical techniques. Clinicians who treat for periodontitis or operate implant surgeries have to know the considerations and surgical methods.

• Journal of Periodontal and Implant Science
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• v.30 no.3
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• pp.651-661
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• 2000

A mucogingival grafting procedure has been developed to cover denuded root surface. The subepithelial connective tissue graft technique is very predictable and allows for a good esthetic results and minimum patient discomfort on the palate. However, in areas where there is a lack of vestibular depth and keratinized attached tissue, the presence of frena or heavy muscle attachment, covering the connective tissue graft with a mucosal flap is very difficult. The purpose of this study is to evaluate an alternative technique of root coverage using the free connective tissue graft. The results were as follows: 1. Probing depths didn't seem to vary significantly from the preoperative to postoperative period. 2. The amount of keratinized tissue showed an increase of $5.9{\pm}0.97mm$ from the preoperative level. 3. Total clinical exposed root coverage increase 72.2% compare with preoperative level. 4. The shrinkage from gingival margin is $4.2{\pm}1.15mm$ and the mean shrinkage rate is 40.1%. 5. The depth of the vestibule increased with the average distance from cementoenamel junction to mucogingival junction being $7.4{\pm}1.65mm$.

• 대한치주과학회:학술대회논문집
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• 1997.11a
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• pp.100-100
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• 1997