Efficacy of Gingival Grafts During the Implantation Process on the Peri-implant Mucosa

Study Overview
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Brief Summary
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This study aims to compare the changes in the peri-implant mucosa during the application of two soft tissue grafting methods, which are free gingival graft (FGG) and connective tissue graft (CTG) taken from the palatine in terms of the width of the keratinized mucosa and the thickness of the peri-implant soft tissues.

Detailed Description
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The presence of adequate width of the keratinized gingiva may be necessary in some special cases such as the presence of fixed prostheses on the teeth with sublingual margins or peri implants. There is an association between insufficiency of the keratinized tissues peri implants with greater plaque accumulation, signs of inflammation, soft tissue recession, and loss of attachment. The sample will consist of 33 dental implant sites and divide randomly into three groups: Group I (Experiential, n=11): FGG; Group II: (Experiential, n=11): CTG; and Group III: (Control, n=11): No procedure will be done to improve the quality of the peri-implant tissues. The width of the keratinized gingiva will be measured preoperative with a UNC-15 and the thickness of the peri-implant soft tissues will be measured clinically by direct transgingival propping method. These measurements will be repeated after 1 and 3 months.

Official Title
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Efficacy of Gingival Grafts During the Implantation Process in the Increasing of Peri-implant Keratinized Tissue Width and Soft Tissues Thickness

Conditions
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Dental Implants, Transplants

Intervention / Treatment
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* Other: Efficacy of free gingival grafts during in the increasing of peri-implant keratinized tissue width and soft tissues thickness
* Other: Efficacy of connective tissue grafts during in the increasing of peri-implant keratinized tissue width and soft tissues thickness
* Other: No types of grafts will be made to improve the quality of the peri-implant mucosa


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients who have lost posterior teeth (premolars or molars). A decrease in the amount of keratinized gingiva (less than 2 mm from the alveolar process to the mucogingival junction). good oral health (plaque index ≤1). Exclusion Criteria: heavy smokers (more than 10 cigarettes per day) uncontrolled diabetes or other systemic diseases.

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 83 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Free gingival graft<br>Free gingival graft will be applied and and followed for 3 months | Other: Efficacy of free gingival grafts during in the increasing of peri-implant keratinized tissue width and soft tissues thickness<br>* Two vertical incisions will be made in the previously elevated flap against the placed implant , where these two incisions will be 10 mm apart from each other, and the free graft to will be placed in this distance (10 x 10 mm). The graft will be obtained from the donor site (the hard palate), and will be thinned to obtain a regular graft with the required thickness. After that, the graft will be moved to its correct place accurately, while avoiding leaving a distance between the graft and the tissue underneath, and the graft will be sutured well to ensure its stability and correct placement.<br>|
| Experimental: Connective tissue graft<br>Connective tissue graft will be applied and and followed for 3 months | Other: Efficacy of connective tissue grafts during in the increasing of peri-implant keratinized tissue width and soft tissues thickness<br>* Vertical incisions will not be made in the previously elevated flap against the placed implant, where there is no need to suture the flap apically of the grafting place because the graft will be covered with it after fixing it in place. The area will be washed with the serum to remove the clot before fixing the graft.The graft will be obtained from the donor site according to the previously mentioned method. Then the epithelium will be removed to leave the connective tissue underneath, and then the graft will be moved to its place (buccally dental implant site) and the flap will be sutured over it.<br>|
| Other: No grafts will be applied.<br>No grafts of any types will be applied. | Other: No types of grafts will be made to improve the quality of the peri-implant mucosa<br>* The simple suturing of the two surgical incisions will be done after the completion of the dental implant process, with no procedure will be made to improve the quality of the peri-implant mucosa.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The width of the keratinized gingiva | The width of the keratinized gingiva will be measured using a UNC-15 probe from the middle of the alveolar process at the site studied to the mucogingival junction, which was determined by the rollover technique. | after 1 month and 3 months | 
| The thickness of the peri-implant soft tissues | The thickness of the peri-implant soft tissues will be measured clinically by the direct transgingival propping method. | after 1 month and 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Keratinized Mucosa, Connective Tissue Graft, Free Gingival Graft