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CC BY 4.0 · Eur J Dent
DOI: 10.1055/s-0045-1810015
Case Report

Apical Positioned Flap with a Combination of Mucograft and Fibro-Gide for Augmenting Keratinized Gingiva with Thin Gingival Phenotype: A Case Report

Xin-Rui Zhu
1   Department of Stomatology, Beijing Haidian Hospital, Beijing, People's Republic of China
2   Department of Periodontics, School of Stomatology, Capital Medical University, Beijing, People's Republic of China
,
Yi Liu
2   Department of Periodontics, School of Stomatology, Capital Medical University, Beijing, People's Republic of China
› Author Affiliations
Funding This work was supported by a general program grant from the Beijing Haidian Hospital (No. KYM2025003) and was partially supported by a key program grant from the Beijing Haidian Hospital (No. KYZ2025002).
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Abstract

The width and thickness of keratinized gingiva play a crucial role in the periodontal health and long-term stability of natural teeth. Noncrosslinked xenogeneic collagen matrix (Mucograft) has demonstrated favorable outcomes in augmenting keratinized gingival width (KGW), though its effect on increasing gingival thickness remains suboptimal. In contrast, crosslinked xenogeneic collagen matrix (Fibro-Gide) effectively enhances keratinized gingival thickness (KGT) but is unable to increase KGW. The aim of this study is to investigate the combined transplantation of Mucograft and Fibro-Gide in patients with thin gingival biotypes and insufficient KGW, evaluating whether this approach can simultaneously achieve both widening and thickening of the keratinized gingiva. This study selected a patient with a thin gingival biotype and insufficient KGW. A horizontal incision was made 0.5 mm above the mucogingival junction, and a partial-thickness flap was elevated and repositioned apically. Fibro-Gide was placed at the apical aspect of the surgical site, enveloped by the partial-thickness flap, while its coronal aspect was positioned in close contact with Mucograft, which was exposed in the surgical area. Both graft materials were securely sutured to the periosteum, ensuring partial contact with the keratinized gingiva. At the 12-month follow-up, the KGW increased from 1.5 to 3.5 mm and the KGT increased from 0.8 to 2.1 mm. For patients with a thin gingival biotype, the combined transplantation of Mucograft and Fibro-Gide can simultaneously augment the width of keratinized gingiva and increase gingival thickness.

Key Points

This technique has the following advantages:

  • Reduces the need of harvesting autologous soft tissue grafts.

  • Minimal postoperative discomfort for the patient.

  • Widens and thickens keratinized gingiva at the same time, and enhances the effect of XCM in patients with thin gingival phenotype.

Keywords

Mucograft - Fibro-Gide - keratinized gingiva - thin gingival phenotype - apical positioned flap

Ethical Approval and Consent to Participate

This study was conducted in accordance with the Declaration of Helsinki and approved by the Clinical Research Ethics Committee of the Beijing Haidian Hospital (IRB approval number: BHHMEC-XM-2022–21).


Consent for Publication

Written informed consent for publication was obtained from the patient to publish all clinical data and accompanying images.


Authors' Contributions

Y.L. conceived the experiments, and X.R.Z. has performed the surgery and collected the data.




Publication History

Article published online:
18 July 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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