Clinical evaluation of 3 techniques to augment keratinized gingival: standard and strip technique of free gingival and free connective tissue graft

Although keratinized gingiva is not necessary for the maintenance of periodontal and peri-implant tissue health if oral hygiene is adequate, its presence is generally advocated especially in some cases. In this study, 3 surgical procedures were compared in their ability to increase the width of keratinized tissue. Method & Materials: In this controlled randomized clinical trial, twenty-one cases with inadequate keratinized tissue were randomly assigned into 1 of the 3 study groups including standard free gingival graft (SFGG) and strip technique free gingival graft (STFGG), free connective tissue graft (CTG). All the cases were followed up for 1 to 6 months. The qualitative variables (e.g., color match, patient & periodontist's satisfaction, graft contour and need for recontouring) were compared by using the chi-square test. Furthermore, in order to comparison of the width of keratinized gingiva among the study groups, the Kruskal-Wallis test was used. All of the surgical procedures resulted in a statistically significant increase in the width of keratinized tissue (SFGG: 5.28mm, STFGG: 6.50mm, and CTG: 5.00mm). The results were improved six months later only for the first 2 techniques. The best results in esthetics were obtained in CTG and were significantly higher than the other groups (P<0.05). There was a significant difference between the success rates of the three surgical methods (P= 0.015). These rates were 100% for STFGG, 28.6% for CTG and 57.1% for SFGG. For selection the best technique in increasing the width of keratinized tissue: if the greatest amounts of keratinized tissue is considered, FGG or strip technique is advocated and if esthetic considerations is critical, FCTG and in considering both of them, strip technique may be the better choice.