Title Free Gingival Grafts Yield Greater Keratinized Tissue Than Allografts; Allografts Are an Adequate Alternative When a Free Gingival Graft Is Contraindicated
Clinical Question For a patient with inadequate keratinized tissue, will an allograft compared to a free gingival graft (soft tissue autograft) result in a greater increased zone of keratinized tissue?
Clinical Bottom Line Free gingival grafts (soft tissue autografts) yield superior widths of keratinized tissue and less shrinkage after healing than allografts. However, esthetically, allografts provide better color and texture matches to surrounding gingiva than free gingival grafts.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
19663961Thoma/2009585 adult patients in 12 studiesSystematic review of randomized and nonrandomized trials
Key resultsFree gingival grafts (soft tissue autografts) yield superior widths of keratinized tissue (0.85 mm – weighted mean difference [WMD]) and less shrinkage (28.41% - WMD) after healing than allografts. Esthetically, allografts provide better color and texture matches to surrounding gingiva than free gingival grafts.
23926586Basegmez/201336 adult patients with peri-implant sites requiring soft tissue augmentationRandomized Controlled Trial
Key resultsFree gingival grafts provided significantly more (p < 0.001) mean width of attached mucosa (2.58 mm) than allografts (1.58 mm), with significantly less post-operative relapse (12 mo.) seen for the free gingival grafts (1.73 mm) versus allografts (2.69 mm).
10972645Wei/200012 adult patients with need for soft tissue graft on mandibular incisorsRandomized Controlled Trial
Key resultsFree gingival grafts yield significantly (p<0.01) greater gain of attached tissue (5.57 mm ± 0.44 mm) vs allografts (2.59 mm ± 0.92mm) with significantly (p<0.01) less shrinkage (16% ± 2%) than allografts (71% ± 10%).
Evidence Search (((free[All Fields] AND ("gingiva"[MeSH Terms] OR "gingiva"[All Fields] OR "gingival"[All Fields]) AND ("transplants"[MeSH Terms] OR "transplants"[All Fields] OR "graft"[All Fields])) OR (soft[All Fields] AND ("tissues"[MeSH Terms] OR "tissues"[All Fields] OR "tissue"[All Fields]) AND ("autografts"[MeSH Terms] OR "autografts"[All Fields] OR "autograft"[All Fields]))) AND ("allografts"[MeSH Terms] OR "allografts"[All Fields] OR "allograft"[All Fields])) AND (keratinized[All Fields] AND ("tissues"[MeSH Terms] OR "tissues"[All Fields] OR "tissue"[All Fields]))
Comments on
The Evidence
Validity: The systematic review of both RCTs and non-RCTs yielded 25 studies for review. There was significant heterogeneity amongst studies included, but their results were all similarly conclusive. Basegmez and Wei's studies were both RCTs with relatively small sample sizes. Both studies give a glimpse as to how the acellular dermal matrix allografts and free gingival graft tissue respond to both tooth and implant surface. Perspective: Futures studies with longer follow-up periods, as well as advancements in allograft materials, will supplement the knowledge base on material selection (autografts vs. allografts) for treating patients with a lack of keratinized tissue.
Applicability All patients were in need of keratinized tissue, and the traditional method to gain keratinized tissue is through free gingival grafts. However, free gingival grafts require a donor site, which may lead to morbidity at the site. For patients with medical or psychological contraindications for using a donor site, allografts provide an adequate alternative to free gingival grafts (soft tissue autografts).
Specialty (Periodontics)
Keywords Free gingival graft, soft tissue autograft, allograft, keratinized tissue
ID# 3272
Date of submission 12/12/2017
E-mail arzouman@uthscsa.edu
Author Akemi Arzouman, DMD
Co-author(s)
Co-author(s) e-mail
Faculty mentor
Faculty mentor e-mail
   
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)
None available