Aslroosta Hoori, Tehrani Ghazal Morshedzadeh, Akbari Solmaz, Yaghobee Siamak
Department of Periodontics, Faculty of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
Department of Periodontics, Faculty of Dentistry, Qom University of Medical Sciences, Qom, Iran.
BMC Oral Health. 2025 Jul 26;25(1):1247. doi: 10.1186/s12903-025-06597-9.
The objective of the present study was to compare the conventional and micro-surgical techniques to increase the keratinized gingiva width (KGW) by free gingival grafting (FGG). The primary outcome was the percentage of graft shrinkage. Clinical and esthetics results, postoperative complications, and patient-related parameters were also evaluated as secondary outcomes.
This randomized controlled clinical trial was conducted on 22 patients (68% females, mean age of 43.40 ± 11.21 years) who required FGG to increase their KGW. The patients were randomly assigned to two groups (n = 11) of microsurgery and conventional surgery (control). In the microsurgery group, all surgical processes (except graft harvesting) were conducted under magnification (x4- x10) using a surgical microscope. The primary outcome was graft shrinkage, measured by comparing graft dimensions over 3 months. Secondary outcomes included KGW, operative time, color match, root coverage esthetic score (RCES), healing index (HI), postoperative pain, edema, bleeding, and patient satisfaction. Data were analyzed by independent t-test, repeated measures ANOVA, Bonferroni test, and Mann-Whitney test (α = 0.05).
Graft shrinkage at 3 months showed no statistically significant difference between the two groups (p > 0.05). KGW increase was similar in both groups (p > 0.05). The micro-surgery group had significantly better color match (p = 0.04), faster early healing (p = 0.009), and lower pain (first week, p = 0.04) and edema (p < 0.05 on days 4-5) than the conventional group. However, the micro-surgery group required significantly more operative time (100.82 ± 19.11 min versus 78.09 ± 3.67 min; p = 0.003).
Despite no significant difference in the primary outcome (graft shrinkage), the micro-surgical approach resulted in faster tissue healing, better color match, and reduced early postoperative pain and edema. Clinically, these advantages should be weighed against the longer operative time and equipment requirements.
Iranian Registry of Clinical Trials IRCT20211022052841N1 registered on [05/11/2021].
本研究的目的是比较采用游离龈瓣移植术（FGG）增加角化龈宽度（KGW）的传统技术和显微外科技术。主要结局是移植组织的收缩百分比。临床和美学结果、术后并发症以及与患者相关的参数也作为次要结局进行评估。
本随机对照临床试验纳入了22例需要进行游离龈瓣移植术以增加角化龈宽度的患者（68%为女性，平均年龄43.40±11.21岁）。患者被随机分为两组（n = 11），分别接受显微手术和传统手术（对照组）。在显微手术组中，所有手术操作（除了获取移植组织）均在手术显微镜下放大4 - 10倍进行。主要结局是移植组织收缩，通过比较3个月内移植组织的尺寸来测量。次要结局包括角化龈宽度、手术时间、颜色匹配度、牙根覆盖美学评分（RCES）、愈合指数（HI）、术后疼痛、水肿、出血以及患者满意度。数据采用独立t检验、重复测量方差分析、Bonferroni检验和Mann-Whitney检验进行分析（α = 0.05）。
两组在3个月时移植组织收缩情况无统计学显著差异（p > 0.05）。两组角化龈宽度增加情况相似（p > 0.05）。与传统组相比，显微手术组的颜色匹配度显著更好（p = 0.04），早期愈合更快（p = 0.009），疼痛（第一周，p = 0.04）和水肿（第4 - 5天，p < 0.05）更低。然而，显微手术组所需的手术时间显著更长（100.82±19.11分钟对78.09±3.67分钟；p = 0.003）。
尽管主要结局（移植组织收缩）无显著差异，但显微手术方法可使组织愈合更快、颜色匹配度更好，并减少术后早期疼痛和水肿。临床上，应权衡这些优势与更长的手术时间和设备需求。
伊朗临床试验注册中心IRCT20211022052841N1于[2021年11月5日]注册。
