Journal of Research in Dental
and Maxillofacial Sciences
Volume 11, Issue 1 (3-2026)
J Res Dent Maxillofac Sci 2026, 11(1): 8-21 |
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Shahbazpey S, Mohammadi M, Lashkarizadeh N. Comparative Efficacy of Acellular Dermal Matrix with and without Injectable Platelet-Rich Fibrin, and Free Gingival Graft for Enhancement of Peri-Implant Keratinized Gingiva Width: A Randomized Controlled Clinical Trial. J Res Dent Maxillofac Sci 2026; 11 (1) :8-21
URL: http://jrdms.dentaliau.ac.ir/article-1-1274-en.html
URL: http://jrdms.dentaliau.ac.ir/article-1-1274-en.html
1- Department of Periodontics, School of Dentistry, Kerman University of Medical Sciences, Shafa St, Kerman, Iran
2- Department of Periodontics, School of Dentistry, Kerman University of Medical Sciences, Shafa St, Kerman, 7616913555, Iran ,Mmohammadi28@yahoo.com
3- Department of Periodontics, School of Dentistry, Kerman University of Medical Sciences, Shafa St, Kerman, 7616913555, Iran
2- Department of Periodontics, School of Dentistry, Kerman University of Medical Sciences, Shafa St, Kerman, 7616913555, Iran ,
3- Department of Periodontics, School of Dentistry, Kerman University of Medical Sciences, Shafa St, Kerman, 7616913555, Iran
Abstract: (265 Views)
Abstract
Background and Aim: This study compared the efficacy of acellular dermal matrix (ADM) with and without injectable platelet-rich fibrin (iPRF) and free gingival graft (FGG) for the enhancement of peri-implant keratinized gingiva width (KGW).
Materials and Methods: In this randomized controlled clinical trial, 36 dental implants with KGW<2 mm were randomly assigned to 3 groups (n=12) for enhancement of KGW with FGG alone (control group), ADM alone (AlloDerm), and iPRF-impregnated ADM (AlloDerm). KGW, pain by using a visual analog scale (VAS), and graft shrinkage percentage (reduction in height and surface area of the graft) were assessed 3 months after surgery, and compared by one-way ANOVA and Sidak test (alpha=0.05).
Results: A significant increase in peri-implant KGW was observed after treatment in all three groups (P<0.001). FGG caused a significantly greater increase in KGW than the other two groups (P<0.001). Graft shrinkage was significantly lower in the FGG group than other groups (P<0.05). Postoperative pain was significantly lower in the ADM/iPRF than the FGG (P<0.001) and ADM (P=0.002) groups. Postoperative pain in the ADM group was significantly lower than that in the FGG group (P=0.008). No other significant differences were found (P>0.05).
Conclusion: All three tested methods significantly increased the peri-implant KGW. Although FGG was the most effective for the enhancement of KGW, it was associated with the highest postoperative pain level. IPRF-impregnated ADM may be considered as an acceptable, less invasive, and less painful approach for patients not consenting to FGG, although it had no significant difference with ADM alone.
Background and Aim: This study compared the efficacy of acellular dermal matrix (ADM) with and without injectable platelet-rich fibrin (iPRF) and free gingival graft (FGG) for the enhancement of peri-implant keratinized gingiva width (KGW).
Materials and Methods: In this randomized controlled clinical trial, 36 dental implants with KGW<2 mm were randomly assigned to 3 groups (n=12) for enhancement of KGW with FGG alone (control group), ADM alone (AlloDerm), and iPRF-impregnated ADM (AlloDerm). KGW, pain by using a visual analog scale (VAS), and graft shrinkage percentage (reduction in height and surface area of the graft) were assessed 3 months after surgery, and compared by one-way ANOVA and Sidak test (alpha=0.05).
Results: A significant increase in peri-implant KGW was observed after treatment in all three groups (P<0.001). FGG caused a significantly greater increase in KGW than the other two groups (P<0.001). Graft shrinkage was significantly lower in the FGG group than other groups (P<0.05). Postoperative pain was significantly lower in the ADM/iPRF than the FGG (P<0.001) and ADM (P=0.002) groups. Postoperative pain in the ADM group was significantly lower than that in the FGG group (P=0.008). No other significant differences were found (P>0.05).
Conclusion: All three tested methods significantly increased the peri-implant KGW. Although FGG was the most effective for the enhancement of KGW, it was associated with the highest postoperative pain level. IPRF-impregnated ADM may be considered as an acceptable, less invasive, and less painful approach for patients not consenting to FGG, although it had no significant difference with ADM alone.
Type of Study: Original article |
Subject:
Periodontology
References
1. Wang Q, Yu T, Wang F, Zhao Y, Huang X. The width of keratinized mucosa around dental implants and its influencing factors. Clin Implant Dent Relat Res. 2020 Jun;22(3):359-65. [DOI:10.1111/cid.12914] [PMID]
2. Arnoux JP, Papasotiriou A, Weisgold AS. A revised technique for stage-two surgery in the severely resorbed mandible: a technical note. Int J Oral Maxillofac Implants. 1998 Jul-Aug;13(4):563-6.
3. Zigdon H, Machtei EE. The dimensions of keratinized mucosa around implants affect clinical and immunological parameters. Clin Oral Implants Res. 2008 Apr;19(4):387-92. [DOI:10.1111/j.1600-0501.2007.01492.x] [PMID]
4. Chung DM, Oh TJ, Shotwell JL, Misch CE, Wang HL. Significance of keratinized mucosa in maintenance of dental implants with different surfaces. J Periodontol. 2006 Aug;77(8):1410-20. [DOI:10.1902/jop.2006.050393] [PMID]
5. Lee A, Fu JH, Wang HL. Soft tissue biotype affects implant success. Implant Dent. 2011 Jun;20(3):e38-47. [DOI:10.1097/ID.0b013e3182181d3d] [PMID] []
6. Boynueğri D, Nemli SK, Kasko YA. Significance of keratinized mucosa around dental implants: a prospective comparative study. Clin Oral Implants Res. 2013 Aug;24(8):928-33. [DOI:10.1111/j.1600-0501.2012.02475.x] [PMID]
7. Sanz M, Lorenzo R, Aranda JJ, Martin C, Orsini M. Importance of keratinized mucosa around dental implants: consensus report of group 1 of the DGI/SEPA/Osteology Workshop. Clin Oral Implants Res. 2022 Jun;33(Suppl 22):47-55. [DOI:10.1111/clr.13956] [PMID]
8. Thoma DS, Naenni N, Figuero E, Hämmerle CH, Schwarz F, Jung RE, et al. Effects of soft tissue augmentation procedures on peri-implant health or disease: a systematic review and meta-analysis. Clin Oral Implants Res. 2018 Mar;29(Suppl 15):32-49. [DOI:10.1111/clr.13114] [PMID]
9. Bassetti M, Schär A, Salvi GE, Sculean A. Soft tissue grafting to improve the attached mucosa at dental implants: a review of the literature and proposal of a decision tree. Quintessence Int. 2015 Jun;46(6):499-510.
10. Basegmez C, Yalcin S, Cehreli MC. The comparison of two techniques to increase the amount of peri-implant attached mucosa: free gingival grafts versus vestibuloplasty. Eur J Oral Implantol. 2012 Summer;5(2):139-47.
11. Sullivan HC, Atkins JH. Free autogenous gingival grafts. I. Principles of successful grafting. Periodontics. 1968 Jun;6(1):5-13.
12. Lim HC, An SC, Lee DW. A retrospective comparison of three modalities for vestibuloplasty in the posterior mandible: apically positioned flap only vs. free gingival graft vs. collagen matrix. Clin Oral Investig. 2018 Jun;22(5):2121-8. [DOI:10.1007/s00784-017-2320-y] [PMID]
13. Thoma DS, Mühlemann S, Jung RE. Critical soft-tissue dimensions with dental implants and treatment concepts. Periodontol 2000. 2014 Oct;66(1):106-18. [DOI:10.1111/prd.12045] [PMID]
14. Lorenzo R, García V, Orsini M, Martin C, Sanz M. Clinical efficacy of a xenogeneic collagen matrix in augmenting keratinized mucosa around implants: a randomized controlled prospective clinical trial. Clin Oral Implants Res. 2012 Mar;23(3):316-24. [DOI:10.1111/j.1600-0501.2011.02260.x] [PMID]
15. Sanz M, Martin C, Heuer D, Lorenzo R. Clinical evaluation of a new collagen matrix (Mucograft® prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: a randomized prospective clinical trial. J Clin Periodontol. 2009 Oct;36(10):868-76. [DOI:10.1111/j.1600-051X.2009.01460.x] [PMID]
16. Callan D, Silverstein L. Use of acellular dermal matrix for increasing keratinized tissue around teeth and implants. Pract Periodontics Aesthet Dent. 1998 Aug;10(6):731-4.
17. Achauer BM, Vander Kam VM, Celio AC, Albear P, Oseroff AR. Augmentation of facial soft-tissue defects with Alloderm dermal graft. Ann Plast Surg. 1998 Nov;41(5):503-7. [DOI:10.1097/00000637-199811000-00009] [PMID]
18. Wei PC, Laurell L, Lingen MW, Geivelis M. Acellular dermal matrix allografts to achieve increased attached gingiva. Part 1. A clinical study. J Periodontol. 2000 Aug;71(8):1297-305. [DOI:10.1902/jop.2000.71.8.1297] [PMID]
19. Harris RJ. Clinical evaluation of 3 techniques to augment keratinized tissue without root coverage. J Periodontol. 2001 Jul;72(7):932-8. [DOI:10.1902/jop.2001.72.7.932] [PMID]
20. Park J. Increasing the zone of keratinized mucosa in the implant-treated sites. J Korean Acad Oral Maxillofac Implant. 2003;9:111-5.
21. Park JB. Increasing the width of keratinized mucosa around endosseous implant using acellular dermal matrix allograft. Implant Dent. 2006 Sep;15(3):275-81. [DOI:10.1097/01.id.0000227078.70869.20] [PMID]
22. Miron RJ, Fujioka-Kobayashi M, Bishara M, Zhang Y, Hernandez M, Choukroun J. Injectable platelet rich fibrin (i-PRF): opportunities in regenerative dentistry? Clin Oral Investig. 2017 Nov;21(8):2619-27. [DOI:10.1007/s00784-017-2063-9] [PMID] []
23. Rao JD, Khanna R, Goyal N, Verma S, Sharma RK. A comparative evaluation of iliac crest bone graft with and without injectable and advanced platelet rich fibrin in secondary alveolar bone grafting. J Stomatol Oral Maxillofac Surg. 2021 Jun;122(3):241-7. [DOI:10.1016/j.jormas.2020.07.007] [PMID]
24. Sanz M, Vallcorba N, Fabregues S, Muller I, Herkströter F. Subgingival plaque reduction by scaling and root planing with or without adjunctive chlorhexidine rinsing. J Clin Periodontol. 1994 Jul;21(7):456-61. [DOI:10.1111/j.1600-051X.1994.tb00741.x] [PMID]
25. Herrera D, Sanz M, Jepsen S, Needleman I, Roldán S. A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients. J Clin Periodontol. 2002;29 Suppl 3:136-59; discussion 160-2. [DOI:10.1034/j.1600-051X.29.s3.8.x] [PMID]
26. Shiezadeh F, Moeintaghavi A, Moslehitabar Z, Khojaste M. Platelet-rich fibrin versus acellular dermal matrix for vertical soft tissue augmentation simultaneously with dental implantation: a 3-month randomized pilot clinical trial. BMC Oral Health. 2025 Jul 2;25(1):1060. [DOI:10.1186/s12903-025-06394-4] [PMID] []
27. Ramanauskaite A, Ratkauskiene V, Linkeviciute M, Turskaite A, Pozeraite Z, Malmstrom H. Three-dimensional changes of a porcine collagen matrix and free gingival grafts. Int J Implant Dent. 2023 Jun;9(1):13. [DOI:10.1186/s40729-023-00484-0] [PMID] []
28. Basegmez C, Gunay H, Baylas H, Tepe S, Demirer S. The comparison of ADM allografts with free gingival grafts. Eur J Oral Implantol. 2013 Summer;6(2):145-52.
29. Han Z, Zhang Y, Liao J, Zhuang L, Li M. Clinical evaluations of free gingival grafting before implant placement. Clin Oral Implants Res. 2021 Jul;32(7):799-807. [DOI:10.1111/clr.13748] [PMID]
30. Agarwal C, Kumar AT, Mehta DS. Comparative evaluation of free gingival graft and AlloDerm®. Contemp Clin Dent. 2015 Oct-Dec;6(4):483-8. [DOI:10.4103/0976-237X.169838] [PMID] []
31. Temmerman A, Dekeyser C, Jacquet W, Quirynen M, Teughels W. L-PRF for increasing keratinized mucosa width. J Periodontal Res. 2018 Oct;53(5):793-800. [DOI:10.1111/jre.12568] [PMID]
32. Giammarinaro E, Blasi A, Pisano M, Cortellini S, Rasperini G. Does platelet-rich fibrin enhance peri-implant soft tissues? BMC Oral Health. 2025 Apr;25(1):615. [DOI:10.1186/s12903-025-05922-6] [PMID] []
33. Zheng C, Su L, Zhou Y, Han X, Lin J. Effect of free gingival graft before implant placement: a systematic review and meta-analysis. BMC Oral Health. 2021 Oct;21(1):1-11. [DOI:10.1186/s12903-021-01818-3] [PMID] []
34. Papi P, Passarelli PC, Pompa G, Di Murro B, Pisano M, Pompa G. Peri-implant soft tissue augmentation using acellular dermal matrix: a cohort study. J Periodontol. 2021 Jun;92(6):803-13. [DOI:10.1002/JPER.20-0219] [PMID]
35. Deterville L, Lasserre JF, Toma S. Subgingival irrigation with injectable platelet-rich fibrin following non-surgical treatment of peri-implantitis: a pilot study. Front Dent Med. 2025 Jun;6:1568889. [DOI:10.3389/fdmed.2025.1568889] [PMID] []
36. da Silva MT, Cerqueira MT, Moura CC, de Oliveira AL, Silva-Junior MF. Effects of L-PRF on pain, healing, and cytokines after third molar extraction: a randomized controlled trial. Appl Sci. 2021 Feb;11(4):1666. [DOI:10.3390/app11041666]
37. Gupta N, Agarwal S. Advanced-PRF: clinical evaluation in impacted mandibular third molar sockets. J Stomatol Oral Maxillofac Surg. 2021 Feb;122(1):43-9. [DOI:10.1016/j.jormas.2020.04.008] [PMID]
38. Yang Z, Liu Y, Fu X, Zhang M, Li C. Efficacy of open flap debridement with enamel matrix derivative for periodontal defects: a randomized clinical trial. Oral Dis. 2024 Oct;30(7):4113-25.
39. Fu X, Yang Z, Liu Y, Li C, Xu F. Peri-implant vestibuloplasty: free gingival graft versus xenogeneic collagen matrix. Int J Implant Dent. 2021 Aug;7(1):69. [DOI:10.1186/s40729-021-00356-5] [PMID] []
40. Thoma DS, Matarazzo F, Hämmerle CHF, Jung RE. Minimal invasiveness in soft tissue augmentation: a systematic review. Periodontol 2000. 2023 Feb;91(1):182-98. [DOI:10.1111/prd.12465] [PMID]
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