Preimplant Free Graft: 5-Year Peri-Implant Stability

Insufficient attached gingiva (width <2 mm) is a critical risk factor for peri-implantitis due to plaque accumulation, mucosal recession, and compromised soft tissue stability. Preoperative soft tissue augmentation is essential for optimizing the peri-implant microenvironment in patients with thin gingival phenotypes. A 38-year-old female with inadequate keratinized gingiva (1 mm) at site 36 underwent pre-implant free gingival grafting (FGG). A partial-thickness flap was elevated, apically repositioned, and a palatal connective tissue graft sutured into the recipient bed. At 2 months post-FGG, keratinized width increased to 5 mm, enabling implant placement. Five-year follow-up revealed stable peri-implant probing depths (2–3 mm), 2 mm attached gingiva, and radiographically confirmed osseointegration without inflammation or bone loss. 1. Is soft tissue augmentation indicated for peri-implant keratinized gingiva deficiency? 2. Timing of soft tissue augmentation: Does pre-implant or pre-stage II surgery yield superior long-term stability? For thin phenotypes, the establishment of a keratinized zone of ≥2mm by FGG before implantation significantly reduced the risk of periimplantable inflammation within 5 years and enhanced soft tissue stability. This case provides a long-term clinical observation for preimplantation soft tissue reconstruction.