| Objectives To compare the clinical outcomes of gingival augmentation with acellular dermal matrix(ADM)and free gingival graft(FGG)at implants sites where the width of keratinized tissue were less than 2mm.Methods From Jan.2019 to Dec.2020,40 patients with mucogingival defects(<2mm keratinized tissue width,KTW)around dental implants were selected and divided into two groups.One group with 20 patients underwent gingival augmentation procedure by means of ADM(ADM group),while another group underwent the same augmentation procedure with FGG(FGG group).Follow-up examination were performed at 2 weeks,3 months and 6 months after surgery.Results 1 week after surgery,the ADM grafts were firmly attached to the recipient area and covered with white or gray tissue layer.1 month after operation,the light gray or white tissue layer on the ADM disappeared,and the newly formed tissue had irregular surface with orange or red color.At 2 months after operation,the ADM were intergrated with the surrounding gingival tissue well,and the soft tissue surface was uniform,and the color was between pink and red.The color,texture and contour of the grafts were similar to those of the adjacent tissues.1 week after the FGG was transplanted,the white epithelium began to disappear.2 weeks after operation,the FGG showed inflammatory changes,with smooth surface and varying colors from pink to red.1 month after surgery,the inflammatory changes of FGG decreased,and the color was between pink and red.From 2 months to 6 months after operation,the FGG gradually matured,the color of the grafts were whiter than the surrounding soft tissue,and the texture was harder.Statistics analysis on observation of relevant indicators:(1)The initial KTW and width of the grafts were comparable between two groups,the results showed no statistically significant differences(P>0.05).(2)Analysis was performed on gender and age,the results showed no statistically significant difference(P>0.05),suggesting that there is no difference on gender and age between FGG group and ADM group.(3)The initial KTW and KTW at 6 months were compared in each group,the results revealed statistically significant difference(P<0.05),KTW at 6 months was more than initial KTW in both groups.(4)The contraction ratio of KTW at 3 months and 6 months between two groups were compared,the results revealed there were statistically significant differences between two groups in KTW contraction ratio in both 3 months and 6 months after surgery(P<0.05),there was more KTW contraction in ADM group than in FGG group in both 3 months and 6 months.(5)The analysis of modified plaque index in ADM group before and 6 months after surgery showed statistically significant difference(P<0.05).In ADM group,before surgery,there were 35% patients with modified plaque index scored “0” or “1”,while 6 months after surgery,there were 85% patients with modified plaque index scored “0” or “1”,suggesting gingival augmentation with ADM can significantly decrease the modified plaque index of the patients.(6)The modified plaque index of the FGG group patients before and 6 months after surgery were compared,the results revealed statistically significant difference(P<0.05).In FGG group,there were 50% patient with modified plaque index scored “0” or “1”.6 months after treatment,there were 100% patients with modified plaque index scored “0” or “1”,indicating gingival augmentation with FGG can decrease the modified plaque index significantly.(7)The analysis of modified bleeding index in ADM group before and 6 months after surgery showed statistically significant difference(P<0.05).In ADM group,before surgery,there were 50% patients with modified bleeding index scored “0” or “1”,while 6 months after surgery,there were 95% patients with modified bleeding index scored “0” or “1”,suggesting gingival augmentation with ADM can significantly decrease the modified plaque index of the patients.(8)The modified bleeding index of the FGG group patients before and 6 months after surgery were also compared,the results revealed statistically significant difference(P<0.05).In FGG group,there were 70% patient with modified bleeding index scored “0” or “1”.6 months after treatment,there were 100% patients with modified bleeding index scored “0” or “1”,indicating gingival augmentation with FGG can decrease the modified bleeding index significantly.(9)Analysis of the time spent in the surgical procedure between ADM group and FGG group,the results revealed statistically significant difference(P<0.05).The result suggested that gingival augmentation surgery with ADM consumes less time than gingival augmentation with FGG.(10)Analysis of the patients’ perception of pain after treatment between the two groups showed statistically significant difference(P<0.001).There were 15% patients presented of the ‘very painful’ in the ADM group and 85% patients showed the ‘very painful’ in the FGG group,suggesting gingival augmentation surgery with ADM may cause less pain than with FGG.(11)Analysis of the patients;satisfaction to the final aesthetics of gingiva after treatment between the two groups revealed statistically significant difference(P<0.001).The percentage of ‘satisfactory’ was 70% in the ADM group and 30% in the FGG group.The result suggested that gingival augmentation with ADM may lead to a more satisfying aesthetic outcome than with FGG.Conclusions Keratinized gingival width can be increased when it is insufficient,either with free gingiva grafts or with acellular dermal matrix.The shrinkage rate of the graft is much more in ADM group than in FGG group.ADM revealed advantages in terms of patients satisfaction to the aesthetic outcomes of gingiva,patient perception of pain,and surgical time.There were no significant differences two groups comparing postoperative modified plaque index or modified bleeding index.Figure 6;Table 8;Reference 103... |
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