| Objective To observe the clinical outcomes and patient-reported outcome measures(PROMs)of apically repositioned flap(ARF)combined with free gingival graft(FGG)on increasing keratinized mucosa around implants compared with conventional periodontal maintenance in periodontitis patients during a 6-month prospective study,and to provide clinical evidence for the role of keratinized mucosa in maintaining the stability of implants.Methods Thirty patients with chronic periodontitis during the periodontal maintenance period were selected from the Department of Periodontal Mucosa of our hospital from from January 2021 to June 2022,including 13 males and 17 females,aged 35-60 years,with an average age of 43.6 years.All the patients had completed implant restoration and the width of keratinized mucosa around the implant was insufficient(<2mm).They were randomly divided into FGG group and control group.Sixteen patients with 19 implants were included in the FGG group,and 14 patients with 19 implants were included in the control group.The two groups were followed up regularly at baseline,3months and 6 months.The intraoral images,imaging data,clinical parameters and visual analogue scale(VAS)were collected to analyze and compare the peri-implant soft and hard tissue parameters of the two groups.The clinical parameters included keratinized mucosa width(KMW),peri-implant probing depth(PPD),gingival index(GI),modification plaque index(m PLI),mucosal recession(MR)and marginal bone loss(MBL).And the patient-centered parameters included pain VAS and brushing discomfort VAS to evaluate the degree of pain in the surgical area within 2 weeks after surgery and the degree of discomfort caused by daily toothbrushing around the implant.The related index data of the two groups were recorded during follow-up,and SPSS 26.0 was used to compare and analyze the data within and between the groups.P<0.05 was considered statistically significant.Results 1.There were no significant differences in KMW,PPD,GI,m PLI,MR And MBL between the two groups at baseline(P>0.05).2.At 3 and 6 months of follow-up,the KMW of the FGG group was higher than that of the initial KMW(P<0.05);KWM in the FGG group was also greater than that in the control group(P<0.05).3.At the 6-month follow-up,the MR Of the FGG group decreased significantly compared with the baseline and the control group(P< 0.05).4.The MBL value of FGG group at 6 months was significantly lower than that of baseline and control group(P< 0.05).5.There was no significant difference in PPD between groups during the follow-up period(P< 0.05).The GI and m PLI of the FGG group were significantly improved at 3and 6 months compared with the baseline and control group,and the differences were statistically significant(P< 0.05).6.The VAS score of toothbrushing discomfort in the FGG group at 6 months was significantly lower than that before operation and in the control group(P< 0.05).The average VAS score of pain was 3.42 at 2 weeks after surgery,indicating that most patients had mild pain after surgery.Conclusion In this study,apically repositioned flap combined with free gingival graft increased the width of keratinized mucosa around the implant in patients with periodontitis.The keratinized mucosa maintained good stability during the follow-up period.The modified plaque index and gingival index around the implant were improved,and the marginal bone resorption around the implant was also delayed.The reconstruction of keratinized mucosa is helpful to improve the stability of implants in patients with periodontitis and prevent the occurrence of peri-implant diseases.However,the long-term stability of the surgical effect needs further follow-up. |
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