Analysis of the clinical efficacy of rootward repositioned flaps combined with free gingival grafts in the treatment of insufficient keratinized gingiva in the mandibular molar region among elderly patients prior to implant placement

LIANG Hong-ling; CHEN Zhi-min; MA Yu

doi:10.19749/j.cn.cjgd.1672-2973.2025.05.008

Abstract：Objective To analyze the application effect of apically positioned flap(APF)and free gingival graft(FGG)on in elderly patients with insufficient keratinized gingiva implantation in mandibular molar area.Methods A total of 104 elderly patients with insufficient keratinized gingiva in the mandibular molar region,who received treatment at the Department of Stomatology,Suzhou Jiulong Hospital between May 2020 and May 2024,were enrolled in this study and divided into the APF group(n=51)and the FGG group(n=53)based on the surgical procedure performed.The postoperative pain status[visual analogue scale(VAS)score]were recorded in the two groups.The patients were followed up for 6 months,and the differences in keratinized mucosa width(KMW),periodontal related clinical indexes[probing depth(PD),modified plaque index(mPLI)]before and after surgery were compared between the two groups.Results The VAS scores at 3 and 7 days after surgery in APF group were significantly lower than those in FGG group(P＜0.05).At 3 months and 6 months after surgery,KMW in both groups was significantly higher than that before surgery(P＜0.05).KMW values in FGG group at 3 months and 6 months after surgery were significantly higher than those in APF group(P＜0.05).At 3 months and 6 months after surgery,PD and mPLI were significantly lower in the two groups than those before surgery(P＜0.05).There were no significant differences in PD and mPLI between the two groups at 3 months and 6 months after surgery(P＞0.05).Conclusion Both the Apically Positioned Flap(APF)and Free Gingival Graft(FGG)demonstrate therapeutic efficacy in elderly patients with insufficient keratinized gingiva in the mandibular molar region prior to implant placement.APF has the advantages of milder postoperative pain,and it is more suitable for elderly patients with mild-to-moderate keratinized gingival insufficiency.FGG is more effective in increasing KMW,but has larger trauma.The two surgical methods have the same effect on improving periodontal health.Clinically,it is necessary to select appropriate surgical methods according to the specific conditions of patients.