Tissue Augmentation Technique Using Free Gingival Graft Simultaneous With Posterior Mandibular Implant

August 10, 2026 updated by: Ahmed Abo El Futtouh, Misr International University

Soft Tissue Augmentation Technique Using Free Gingival Graft Simultaneous With Implant Placement in Posterior Mandible: A 1-year Randomized Clinical Trial

Presence of keratinized tissue (KT) around dental implants, plays a crucial role in stability and health of peri-implant tissues. Several studies reported that, minimum of 2 mm keratinized tissue width is required to achieve long-term longevity. Insufficient keratinized mucosa leads to biofilm accumulation, soft tissue inflammation, eventually peri-implant mucositis and peri-implantitis. Hence, the aim of the present trial is to evaluate KTW gain, linear and volumetric changes in buccal soft tissue along with hard tissue alterations following implant restoration at sites treated either with delayed implant placement & simultaneous FGG or the conventional FGG protocol prior to implant placement.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

24

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Egypt
    • Cairo Governorate
      • Cairo, Cairo Governorate, Egypt, 11347
        • International Dental Continuing Education

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Adults at or above the age of 18.
  • Lower Posterior missing tooth/ teeth with minimal KT < 2mm

  • Sufficient alveolar ridge length minimum 13-15 mm to IAN

    •. Sufficient alveolar ridge width minimum of 6 mm

  • Patients able to tolerate surgical periodontal procedures.
  • Patients who provided an informed consent and accepted the one-year follow-up period.

Exclusion Criteria

  • Patients diagnosed with periodontal diseases (Caton et al., 2018).
  • Current or previous smokers.
  • Pregnant and lactating females.
  • Patients with medical conditions that would compromise the surgical procedures; uncontrolled diabetes mellitus, taking intravenous Bisphosphonates for treatment of osteoporosis.
  • Patients with active infection related to the site of implant.
  • Patients with parafunctional habits.
  • Patients with shallow vestibule

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: One Step Protocol
FGG simultaneous with delayed implant placement
Procedure: One Step Protocol
FGG will be done simultaneous with implant placement
Active Comparator: Two Steps protocol
Conventional FGG protocol, prior to implant placement
Procedure: Two Steps Protocol
Conventional FGG protocol, prior to implant placement

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Keratinized tissue width
Time Frame: 12 months
Optical scans using intraoral scanner (Runyes® Model V5) were obtained at baseline, 3, 6 and 12 months post-operative for each patient. All the optical scans in standard tessellation language (STL) format, were imported to the digital software (Exocad). The best-fit algorithm was used to superimpose digital surface models, when comparing each area of interest (AOI) throughout out the follow up period. KTW (mm) was measured from the preoperative MGJ to the new MGJ using distance measurement tool in the software. KTW measurements were taken at mesial, mid-buccal and distal sites on the buccal side of the implant, values at the three sites were then averaged. Difference between KTW baseline and KTW follow-up was then analyzed to present the changes in KTW
12 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Bucco-lingual width bone changes
Time Frame: 12 Months
Postoperative CBCT evaluation was performed to all the recruited patients after 1 year to assess bucco-lingual (BL) bone width changes at three levels; at implant platform, 2mm and 5mm below the implant platform. To perform radiographic measurements and comparisons and to ensure standardization and reproducibility of the CBCT images, superimposition of DICOM file sets of each patient were done using Fusion module software (OnDemand3D ver, 1.0.9, Cybermed), which allowed sub-voxel accuracy. On the fusion module, both initial and postoperative volumes were superimposed and loaded at the same time. To measure the bucco-lingual (BL) bone width changes, the lingual surface of the implant was used as a reference point. A reference line was constructed along the lingual surface of the implant on the cross-sectional cut of the postoperative CBCT volume. Then, both baseline and postoperative CBCT volumes we
12 Months
Survival Rate
Time Frame: 12 Months
Implant survival criteria were chosen according to Albrektsson et al. (1986). Surgical and prosthetic complications were also evaluated throughout the follow up timeline.
12 Months
Total volume Changes
Time Frame: 12 months
Total volume change (mm3) was calculated at 3 and 12 months postoperative via surface volume analysis within the AOI for each patient. The best-fit algorithm (iterative closet point algorithm) was used to superimpose digital surface models, when comparing each AOI throughout out the follow up periods. To measure the volume gain, the solid preoperative scans were subtracted from the follow-up scans using the Boolean operations software tool. This step will produce a new virtual object representing the volume gained. A three-dimensional (3D) inspection and metrology software (Geomagic Control X, 2022.1.0) was used to calculate the volume gain in mm3 using the measure volume tool.
12 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Misr International University

Collaborators

International Dental Contiuing Education

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

November 1, 2024

Primary Completion (Actual)

November 30, 2025

Study Completion (Actual)

December 30, 2025

Study Registration Dates

First Submitted

September 5, 2024

First Submitted That Met QC Criteria

October 15, 2024

First Posted (Actual)

October 17, 2024

Study Record Updates

Last Update Posted (Actual)

August 13, 2026

Last Update Submitted That Met QC Criteria

August 10, 2026

Last Verified

August 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • IDCE - 13

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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