Effect of Free Gingival Graft Around Implants in Reconstructed Mandibles With Free Fibula Flaps or Iliac Bone Flaps

To compare the efficacy of free gingival graft (FGG) around implants in reconstructed mandibles with free fibula flaps (FFFs) or iliac bone flaps (IBFs). We included patients receiving mandibular reconstruction with FFFs or IBFs due to the removal of maxillofacial tumors who underwent implant and FGG placement prior to restoration. Clinical data were evaluated before (T0), immediately after (T1), 3 months after (T2), 6 months after (T3) and 1 year after (T4) FGG placement. We analyzed the keratinized mucosa width (KMW) gain and the shrinkage rate. A total of 30 patients were enrolled in this study, including 15 patients with 48 implants in the FFFs group and 15 patients with 52 implants in the IBFs group. The buccal KMW gain and shrinkage rate in the FFFs group were not statistically significant compared with the IBFs group at T4. In the IBFs group, the buccal KMW gain and shrinkage rate remained relatively stable after 6 months. The lingual KMW gain in the FFFs group was significantly greater than that in the IBFs group at T4 (2.1 ± 0.2 mm vs. 1.5 ± 0.2 mm, p < 0.05). The lingual shrinkage rate in the FFFs group was significantly smaller than that in the IBFs group at T4 (27.8% ± 5.5% vs. 47.3% ± 5.5%, p < 0.05). FGG can reconstruct the keratinized mucosa effectively in a reconstructed mandible. The keratinized mucosa width gain decreases over time.