Comparative evaluation of gain in width of keratinized mucosa, post-operative pain and wound healing following vestibuloplasty procedure around implants using scalpel, electrocautery, diode laser and free gingival graft: A Clinical Study.

In dental implant success, an appropriate amount of keratinized mucosa around implant has become a well-established success factor. Lack of keratinized mucosa could result in shallow vestibular depth and compromises adequate plaque control. Vestibuloplasty aims at deepening of the vestibular trough and widening of the zone of keratinized mucosa.

40 subjects (both males and females), aged between 21- 60 years with inadequate vestibular depth and insufficient keratinized mucosa around implants which revealed by positive tension test were included in the study. They were categorized into four groups, 10 in each who underwent vestibular depth extension procedure by conventional technique, electrocautery, diode laser and free gingival graft (FGG) respectively. Clinical parameters assessed were Relative Attachment Level (RAL), Visual analogue scale (VAS) and Healing index (Landry, et al.) at baseline, 1-week and 1-month. Assessment and comparison of data was done by appropriate statistical analysis.

The results showed that intra-group comparison of gain in width of keratinized mucosa was greater at 1 week & 1month post-treatment across all groups in comparison with baseline values. There were statistically significant differences in the mean values of variables across all groups. (p<0.05). On inter-group comparison, the mean difference of gain in width of keratinized mucosa at 1 week & 1 month was greater in vestibuloplasty+free gingival group compared to other groups and found to be statistically significant (p<0.05).

Free gingival graft group was effective in increasing the width of keratinized mucosa and provided an improvement in maintaining the health of peri-implant tissues, which allows for better oral hygiene. It produces desired clinical outcomes, meets the esthetic demand of patients and can be implemented in treatment of shallow vestibule with deficient keratinized mucosa. Vestibuloplasty with FGG can be used to achieve the adequate amount of keratinized mucosa and vestibular depth without complications.