Effectiveness of the Application of 980-nm Wavelength Laser Radiation in Vestibuloplasty in the Area of Installed Dental Implants

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BACKGROUND

In prosthodontic rehabilitation of patients with partial or complete edentulism, dental implants are increasingly used as supports for fixed and removable prosthetic restorations [1]. For many years, adequate bone volume was considered the sole determinant of long-term implant survival. In cases of insufficient bone at the implant site, bone augmentation with autogenous grafts or bone substitute materials is required [2]. Successful graft integration depends on its stable fixation and tension-free primary closure, which is commonly achieved through periosteal-releasing incisions for flap mobilization. However, such procedures may lead to scar formation, mucosal thinning, and shallow vestibular depth associated with pull syndrome [3].

Several studies have reported long-term implant survival even in cases where the vestibular cortical bone plate was absent, provided that there was sufficient gingival thickness and width of attached keratinized mucosa [4, 5]. In recent years, research focus has shifted toward the management of peri-implant soft tissues [6].

When restoring an edentulous area, clinicians often encounter a soft-tissue deficiency, because tooth extraction initiates not only alveolar ridge resorption but also remodeling of the surrounding soft-tissue complex.

The attached keratinized mucosa surrounding dental implants performs protective and barrier functions, preventing food impaction around the prosthetic margins. However, its anatomical structure differs substantially from that of the gingiva around natural teeth. First, the connective tissue fibers surrounding implants run parallel to the implant surface and generally do not attach to it, whereas dentogingival fibers are oriented perpendicularly and insert directly into the root cementum [7]. Second, peri-implant soft tissues are supplied solely by the periosteal blood vessels. Third, the junctional epithelium around implants is more permeable, and the connective tissue contains fewer fibroblasts and more dense collagen fibers. Consequently, due to both anatomic and physiologic differences, dental implants are more susceptible to inflammation and subsequent bone loss resulting from bacterial plaque accumulation [8, 9].

Bone loss around osseointegrated implants may also be exacerbated by muscle attachments. A shallow oral vestibule and high muscle attachments can mechanically irritate the peri-implant mucosal margin during speech and chewing, leading to chronic trauma-induced inflammation. Moreover, an insufficient width of keratinized mucosa makes effective oral hygiene difficult, perpetuating a vicious cycle of peri-implant bone resorption [10]. According to a systematic review by Ramanauskaite et al., the prevalence of a complete absence of attached keratinized mucosa around dental implants ranges from 46% to 74% [11].

The combination of these factors contributes to implant-related complications such as soft-tissue recession, peri-implant mucositis, and peri-implantitis. These not only result in aesthetic concerns—such as exposed implant threads, compromised oral hygiene, and disruption of “pink esthetics”—but also increase the risk of implant failure due to plaque accumulation and biofilm formation on the exposed rough titanium surface [12].

As reported by Monje et al., the minimum width of attached keratinized mucosa around implants should be at least 2 mm, and the oral vestibule should be sufficiently deep and free of high muscle insertions to ensure long-term peri-implant stability [13].

To create optimal peri-implant soft tissue conditions, various vestibuloplasty techniques have been proposed. During vestibuloplasty, epithelialization over the periosteum may occur either by secondary intention or through appositional healing of a free gingival graft (FGG) secured to the recipient site with sutures, a plastic stent, or mini-pins [14]. According to Meitner et al., performing vestibuloplasty with a FGG not only establishes a deeper vestibule and wider zone of attached keratinized mucosa, but also enhances the gingival biotype through an increase in mucosal thickness during the graft’s morphogenetic integration [15].

Vestibuloplasty can be performed using conventional surgical instruments (scalpel technique) or modern physical methods, particularly high-intensity laser radiation. According to Trunin et al., laser technology significantly reduces the duration of surgery and the patient’s postoperative recovery period, decreases the risk of intraoperative complications, creates aseptic conditions in the surgical field, and provides excellent visibility due to instant hemostasis [16].

AIM:

The work aimed to improve the effectiveness of surgical treatment for patients with a deficient width of attached keratinized mucosa around dental implants using a 980 nm diode laser.

METHODS

Study Design

A prospective, non-randomized, longitudinal, single-center, parallel-group study was conducted. In the scalpel group, vestibuloplasty using a FGG harvested from the palate was performed in the area of previously placed dental implants. In the laser group, an identical procedure was performed using a 980 nm diode laser (see Fig. 1).

Fig. 1. Study design.

Eligibility Criteria

Inclusion criteria:

8. a) Diagnosis of tooth loss due to trauma, extraction, or localized periodontitis (ICD-10 K08.1), in the maxilla or mandible;
9. b) Deficiency of attached keratinized mucosa in the peri-implant area;
10. c) Satisfactory oral hygiene;
11. d) Informed consent obtained from the patient.

Non-inclusion criteria:

1. a) Severe periodontitis;
2. b) Full edentulism rehabilitated according to the All-on-4 or All-on-6 protocols;
3. c) Decompensated systemic disease of any type;
4. d) Malignant neoplasms of any origin;
5. e) Acute respiratory viral infections;
6. f) Smoking more than 10 cigarettes per day;
7. g) Use of medications affecting blood rheology;
8. h) Pregnancy or lactation;
9. i) Age under 18 years.

Exclusion criteria:

1. a) Allergic reaction to medications used;
2. b) Noncompliance with physician instructions or violation of scheduled treatment and examination stages required for participation;
3. c) Pregnancy occurring during treatment or observation;
4. d) Withdrawal of consent.

Study Setting

All patients were examined and treated at the Department of Oral and Maxillofacial Surgery, E.V. Borovsky Institute of Dentistry, Sechenov University.

Study Duration

The study commenced on August 1, 2024. Over a two-month period, 35 patients underwent surgery, of whom 20 were included in the final analysis. Postoperative follow-up examinations were scheduled on days 1, 2, 3, 5, and 7. Sutures were removed after two weeks, and during the following month, implant-supported prosthetic restorations were fabricated for all patients. At three months post-surgery, a follow-up evaluation was conducted to measure the increase in the width of attached keratinized mucosa. Statistical analysis of the collected quantitative data was performed in December 2024.

Intervention

All patients presented with osseointegrated dental implants and healing abutments already in place. After obtaining written informed consent, the width of the attached keratinized mucosa was measured using a periodontal probe, and the values were recorded in a master chart. If a deficiency in the width of attached keratinized mucosa was identified, vestibuloplasty with a FGG harvested from the palate was performed.

Vestibuloplasty using a scalpel followed a standard protocol. After infiltration anesthesia with 1.7 mL of 0.00001% articaine solution, an incision was made along the mucogingival junction at 45° to the periosteum using a No. 15C scalpel blade, followed by partial-thickness flap dissection. The mucosal flap was apically repositioned 10–15 mm using a sharp–blunt dissection technique with a raspatory. Residual muscle attachments were excised with microsurgical scissors and a scalpel, and the repositioned flap was sutured to the periosteum at the new vestibular depth using simple interrupted sutures with non-resorbable monofilament polyvinylidene fluoride (PVDF) suture (ArmaPVDF 5-0, Armaline, Russia) and a 1/2-circle cutting needle (see Fig. 2).

Fig. 2. Apical repositioning of the mucoperiosteal flap and creation of a new vestibular depth.

FGG was harvested from the palatal mucosa in the region of teeth 13–17 (ISO/FDI designation). A No. 15C blade was used to make the first horizontal incision 3 mm apical to the gingival sulcus, angling the blade at 45° to a depth of 1.0–1.5 mm. Mesial and distal incisions were then made to define the graft borders, followed by split-thickness flap elevation. While gently holding the flap with tissue forceps, a parallel incision to the initial one was performed to determine the graft width. Glandular inclusions and residual adipose tissue were removed with a scalpel (see Fig. 3). The graft was then positioned onto the recipient bed and sutured to the periosteum using ArmaPVDF 5-0 sutures with a 3/8-circle cutting needle (see Fig. 4).

Fig. 3. Free gingival graft harvested from the palatal donor site.

Fig. 4. Postoperative appearance of the surgical site.

Vestibuloplasty using laser technology was performed according to the following standardized protocol. After infiltration anesthesia with 1.7 mL of 0.00001% articaine solution, a partial-thickness flap was created using a Doctor Smile Simpler diode laser (Lambda SpA, Italy) with a 980 nm wavelength. The incision was made with an activated optical fiber with a diameter of 300 µm in pulsed ablation mode, under light contact with the mucosal surface, at an adjustable power output of 1.2 W. The mucosal flap was then apically repositioned 10–15 mm, with simultaneous resection of muscle fiber attachments, and sutured to the periosteum at the new vestibular depth using simple interrupted sutures with non-resorbable monofilament PVDF (ArmaPVDF 5-0, Armaline, Russia) and a 1/2-circle cutting needle.

Under infiltration anesthesia with 0.7 mL of 0.00001% articaine solution, a FGG was harvested from the palatal mucosa using the same 980 nm diode laser in pulsed ablation mode at 1.2 W. The inner surface of the graft was treated by laser vaporization to remove adipose and glandular tissue inclusions, ensuring a uniform graft thickness. Next, with the fiber tip held 0.5–1.0 cm away from the donor site, a defocused laser beam was applied to create a coagulated surface layer, known as a “laser dressing,” which promotes hemostasis and sterile wound coverage on the palatal donor area. The prepared graft was positioned in the recipient bed and sutured to the periosteum using ArmaPVDF 5-0 suture material with a 3/8-circle cutting needle.

In the postoperative period, all patients were prescribed the following regimen: antiseptic mouth rinses with 0.05% chlorhexidine gluconate after each meal; Augmentin (amoxicillin/clavulanate 1000 mg), 1 tablet daily for 7 days; Nimesulide 100 mg, twice daily for 5 days.

Follow-up examinations were performed on postoperative days 1, 3, 5, and 7 to assess for signs of graft rejection, evaluate suture integrity, and monitor the healing progression. All findings were documented in the master chart. Sutures were removed on postoperative day 14 using surgical scissors. At 3 months post-surgery, the width of the attached keratinized mucosa was remeasured with a periodontal probe.

Main Study Outcome

The main outcome was the increase in the width of the attached keratinized mucosa and the improvement of peri-implant soft tissue condition following vestibuloplasty in the area of osseointegrated dental implants.

Additional Study Outcomes

Additional outcomes included assessment of pain intensity using a Visual Analog Scale (VAS) and evaluation of collateral edema and mucosal hyperemia in patients of both study groups.

Subgroup Analysis

Participants were randomized into two groups, each with an equal opportunity to undergo vestibuloplasty either using a scalpel or laser-assisted technique.

Outcomes Registration

The primary endpoint was the gain in the width of attached keratinized mucosa, measured before surgery and 90 days postoperatively using a periodontal probe, according to the “roll method” (see Fig. 5).

Fig. 5. Measurement of the width of keratinized mucosa using the “roll technique.”

The secondary endpoints included assessment of pain intensity, mucosal hyperemia, and collateral edema severity.

Pain levels were recorded on postoperative days 1, 3, 5, and 7 using a 10-point VAS, where 0 is no pain and 10 is unbearable pain. Patients were asked to select the number that best represented their perceived level of discomfort.

Collateral edema was graded on days 1, 3, and 5 using the MS Tonetti (2023) ordinal scale, where: 0, no edema; 1, mild edema; 2, moderate edema; 3, severe edema. Mucosal hyperemia was evaluated on days 1, 3, and 5 using a six-point grading scale: 0, no hyperemia; 1, mild; 2, moderate; 3, severe; 4, cyanosis; 5, ischemia [17].

Statistical Analysis

Sample size calculation: The sample size was not calculated in advance.

Data analysis methods: Statistical data were processed using Statistica 11.0 (StatSoft Inc., USA). Descriptive statistics were applied, including mean value (M), standard deviation (SD), median, and minimum and maximum values.

After testing for normality of distribution using the Kolmogorov–Smirnov test, intergroup comparisons of pain scores, collateral edema, and mucosal hyperemia were conducted using the parametric Student’s t-test. Results were considered significant at p < 0.05. To assess intragroup changes, a one-way analysis of variance (ANOVA) was performed. To evaluate the postoperative healing progression in the two groups, a two-way ANOVA was applied. When no significant differences were observed, pairwise comparisons were carried out at each time point using the t-test for independent samples (for normally distributed data) and the Mann–Whitney U test (for non-normally distributed data).

RESULTS

Participants

A total of 35 patients diagnosed with partial edentulism (ICD-10 code K08.1) were examined and surgically treated. During the initial comprehensive evaluation, including clinical and instrumental diagnostic methods, all participants were found to have a deficiency in the width of attached keratinized mucosa in the region of osseointegrated dental implants. Due to loss to follow-up, 3 patients withdrew early, 10 patients did not attend the 3-month postoperative evaluation, and 2 patients declined further participation. Ultimately, 20 patients (10 men and 10 women), aged 32 to 66 years, completed the study. The groups were comparable in terms of age and sex distribution. Two parallel groups were formed: the laser group (experimental group), which included 10 patients treated with the diode laser (980 nm) technique, and the scalpel group (comparison group), which included 10 patients treated with conventional scalpel-assisted vestibuloplasty. The mean age of participants was 47.3 years (51.50 ± 11.81 years and 43.10 ± 7.03 years, respectively).

Before surgery, the minimum width of attached keratinized mucosa in the comparison group was 0.4 mm, and the maximum was 2.4 mm (mean 1.530 ± 0.506 mm; median 1.6 mm). In the laser group, the minimum width was 0.2 mm and the maximum was 4.0 mm (mean 1.490 ± 0.942 mm; median 1.25 mm). According to the Student’s t-test, there were no significant differences between preoperative values in the two groups.

Primary Results

After surgery, the minimum width of attached keratinized mucosa in the comparison group was 2.0 mm, and the maximum was 5.4 mm (mean 3.770 ± 1.003 mm; median 4.0 mm). In the laser group, the minimum width was 3.0 mm and the maximum was 6.5 mm (mean 4.37 ± 0.89 mm; median 4.1 mm). Statistical analysis using the Student’s t-test showed a significant intergroup difference in the postoperative width of attached keratinized mucosa between the scalpel and laser groups (p < 0.0232) (see Fig. 6).

Fig. 6. Width of attached keratinized mucosa before and after surgery, mm.

The mean gain in the width of attached keratinized mucosa in the comparison group was 2.29 ± 1.10 mm (minimum 0.3 mm, maximum 3.6 mm; median 2.55 mm). In the laser group, the mean gain was 2.88 ± 1.12 mm (minimum 1.0 mm, maximum 5.4 mm; median 2.7 mm). According to the Student’s t-test, the increase in the width of attached keratinized mucosa was significantly greater in patients treated with the laser technique compared to the scalpel method (p < 0.0454) (see Fig. 7).

Fig. 7. Mean increase in attached keratinized mucosa width after surgery, mm

Secondary Results

Among patients who underwent scalpel surgery, postoperative pain levels on VAS were as follows. On postoperative day 1, VAS scores ranged from 2 to 6, with a mean of 3.60 ± 1.57. On day 2, scores ranged from 1 to 4, with a mean of 2.50 ± 0.97. On day 3, scores also ranged from 1 to 4, with a mean of 2.30 ± 0.95. On day 5, scores ranged from 0 to 3, with a mean of 1.40 ± 0.97. On day 7, scores ranged from 0 to 2, with a mean of 0.70 ± 0.95. A one-way ANOVA was applied for intragroup analysis. The F-value for patients treated with the scalpel was 9.93243 (p < 0.00001). According to the Tukey HSD post hoc test, the difference between postoperative days 1 and 5 was Q = 6.26 (p = 0.00055); between days 1 and 7, Q = 8.26 (p = 0.00001); and between days 2 and 7, Q = 5.13 (p = 0.00628), indicating a significant reduction in pain by postoperative day 5 in this group.

Among patients treated with the laser, postoperative pain levels on VAS were as follows. On postoperative say 1, VAS scores ranged from 0 to 6, with a mean of 1.20 ± 1.81. On day 2, scores ranged from 0 to 4, with a mean of 1.60 ± 1.07. On day 3, scores ranged from 0 to 3, with a mean of 1.20 ± 1.03. On day 5, scores ranged from 0 to 2, with a mean of 0.60 ± 0.67. By day 7, patients reported no pain (see Fig. 8). For patients in the laser group, one-way ANOVA revealed an F value of 3.27 (p = 0.0196). According to the Tukey HSD post hoc test, the comparison between postoperative days 2 and 7 yielded Q = 4.62 (p = 0.01697), indicating a significant reduction in pain by day 2 in this group.

Fig. 8. Pain intensity according to the Visual Analog Scale, points.

The two-way ANOVA revealed no significant relationship between surgical technique and postoperative day; however, pairwise comparisons using the Student’s t-test for independent samples identified significant differences at each time point: day 1 (p < 0.0027), day 2 (p < 0.0326), day 3 (p < 0.0116), day 5 (p < 0.0240), and day 7 (p < 0.0157). These findings indicate more severe pain in patients who underwent scalpel surgery.

Among patients who underwent scalpel surgery, collateral edema scores were as follows. On postoperative day 1, scores ranged from 2 to 3, with a mean of 2.60 ± 0.52. On day 3, scores again ranged from 2 to 3, with a mean of 2.60 ± 0.52. On day 5, scores ranged from 0 to 2, with a mean of 1.10 ± 0.74.

Among patients treated with the laser, collateral edema scores were as follows. On postoperative day 1, scores ranged from 0 to 1, with a mean of 0.60 ± 0.52. On day 3, scores ranged from 0 to 1, with a mean of 0.50 ± 0.52. By day 5, edema was absent (see Fig. 9).

Fig. 9. Collateral edema scores, points.

Intragroup analysis of collateral edema in the scalpel group using one-way ANOVA demonstrated a significant reduction in postoperative swelling over time (F = 20.87629; p < 0.00001). According to the Tukey HSD post hoc test, the comparison between postoperative days 1 and 3 yielded Q = 7.91 (p = 0.00002), and the comparison between days 3 and 5 also yielded Q = 7.91 (p = 0.00002). These data indicate a notable decrease in edema starting from postoperative day 3 in this group.

In the laser group, the F-value was 5.69388 (p = 0.008646). According to the Tukey HSD post hoc test, the comparison between postoperative days 1 and 5 yielded Q = 4.45 (p = 0.01073), and the comparison between days 3 and 5 yielded Q = 3.71 (p = 0.03642), indicating a mild edema on the days following surgery in this group.

Two-way ANOVA assessing collateral edema revealed no significant differences between the groups. However, pairwise comparisons using the independent-samples t-test showed significant differences at each time point—on postoperative day 1 (p < 0.00001), day 3 (p < 0.00001), and day 5 (p < 0.000086). These findings indicate more severe collateral edema in the control group during the first 5 postoperative days.

Among patients who underwent scalpel surgery, hyperemia scores were as follows. On postoperative day 1, scores ranged from 1 to 3, with a mean of 2.30 ± 0.67. On day 3, scores again ranged from 1 to 3, with a mean of 2.30 ± 0.67. By day 5, scores ranged from 0 to 2, with a mean of 0.80 ± 0.63.

Among patients treated with the laser, hyperemia scores were as follows. On postoperative day 1, scores ranged from 1 to 3, with a mean of 1.50 ± 0.70. On day 3, scores ranged from 0 to 4, with a mean of 1.10 ± 1.19. By day 5, scores again ranged from 0 to 4, with a mean of 0.80 ± 1.31 (see Fig. 10).

Fig. 10. Mucosal hyperemia scores, points.

To assess the degree of hyperemia in the control group, one-way ANOVA was also performed. The F value for patients in the control group was 17.16 (p = 0.000016). According to the Tukey HSD post hoc test, the comparison between postoperative days 1 and 5 yielded Q = 7.18 (p = 0.00007), and the comparison between days 3 and 5 also yielded Q = 7.18 (p = 0.00007). These findings indicate a reduction in hyperemia after postoperative day 3 in patients who underwent scalpel surgery.

The F value for the laser group was 1.01 (p = 0.377888).

Two-way ANOVA revealed no significant differences in mucosal hyperemia between the groups. However, pairwise comparisons using the independent-samples t-test demonstrated significant intergroup differences in hyperemia on postoperative day 1 (p < 0.009281) and day 3 (p < 0.006432). These findings suggest that patients in the scalpel group had more severe mucosal hyperemia.

Adverse Events

One patient experienced necrosis of FGG on postoperative day 3 due to noncompliance with postoperative wound care instructions.

DISCUSSION

Summary of Primary Results

This study presents a comparative clinical analysis of the effectiveness of scalpel-assisted versus diode laser-assisted vestibuloplasty (Doctor Smile Simpler, 980 nm) performed with FGG harvested from the palate. The clinical focus was directed toward the gain in the width of attached keratinized mucosa. Both surgical modalities resulted in a significant increase in attached keratinized mucosa width from baseline. The mean gain in the scalpel group was 2.29 ± 1.10 mm, whereas the laser group demonstrated a higher mean gain of 2.88 ± 1.12 mm.

Discussion of Primary Results

According to Rotundo et al., multiple methods have been proposed for augmenting peri-implant soft tissues, including autogenous grafts, allogeneic materials, and xenogeneic collagen membranes. However, the FGG harvested from the palatal mucosa remains the gold standard for increasing the width of attached keratinized mucosa [18]. The recipient bed for the graft can be prepared using conventional scalpel instrumentation or laser ablation techniques. The data obtained regarding the gain in attached keratinized mucosa width achieved with scalpel surgery are comparable to the findings reported by Grudyanov et al. [19] and Braylovskaya et al. [20]. The greater increase in width achieved with palatal free gingival grafting performed using laser technology may be associated with characteristics of laser irradiation such as brief, minimally traumatic exposure, stimulation of fibroblast proliferation, and a local immunomodulatory effect [21]. Studies by Morozova et al. [22] and Postnikov [23] have demonstrated a more comfortable postoperative course in patients undergoing laser-assisted soft tissue surgery, characterized by lower pain scores and reduced need for analgesics. Our results corroborate these findings. In the group treated with the Doctor Smile Simpler laser (980 nm), the peak postoperative VAS pain score was reported on day 2, with a mean of 1.60 ± 1.07; by day 7, patients reported no discomfort. Conversely, in the scalpel group, pain peaked on day 1, averaging 3.60 ± 1.57, and persisted for up to one week postoperatively. According to Eliseenko [24], activation of the body’s response to tissue injury requires an exposure time of at least 15 seconds, whereas the duration of a laser pulse is several orders of magnitude shorter. Harvesting a free gingival graft from the palate with a laser causes less postoperative discomfort during speech and chewing and does not require suturing of the donor site because of immediate hemostasis and formation of a coagulation layer—the so-called “laser bandage.” Moreover, the postoperative appearance of the palatal donor site on day 20 after laser harvesting is comparable to that observed on day 45 following scalpel surgery. By day 5, numerous vascularization loci become clearly visible on clinical examination. By day 7, no mucosal depression is observed, which may be attributed to early activation of fibroblastic cell populations and more rapid proliferation of granulation tissue following laser exposure and its immunostimulatory effect. Notably, the present study’s mean VAS pain values were substantially lower than those reported in the systematic review by Almeida et al., where patients rated postoperative pain at an average of 6 points [25].

The degree of collateral edema and mucosal hyperemia serves as an objective indicator of surgical trauma and tissue response following vestibuloplasty. In the present study, patients in the scalpel group exhibited a peak edema on postoperative day 3, with a mean score of 2.60 ± 0.52, which persisted until day 5. In contrast, patients in the laser group demonstrated a peak edema on the next day after surgery, with a mean of 0.60 ± 0.52, and no edema was observed by day 5. Similarly, mucosal hyperemia was more pronounced in the scalpel group, peaking on day 3 with a mean of 2.30 ± 0.67, whereas in the laser group, hyperemia peaked on day 1 with a mean of 1.50 ± 0.70. A distinguishing histophysiologic feature observed in laser-treated patients was the formation of a dense fibrinous layer covering the palatal wound surface, characteristic of laser-induced tissue ablation zones. However, in the laser group, marginal coagulation necrosis at the graft periphery was occasionally observed; importantly, this phenomenon did not adversely affect clinical outcomes.

Study Limitations

The main limitations of this study include the small sample size, the lack of randomization based on the patient’s gingival biotype with corresponding standardization of free gingival graft parameters, and the short postoperative follow-up period (3 months).

CONCLUSION

This study demonstrates increased efficacy of surgical management of insufficient peri-implant keratinized mucosa width when using a 980 nm diode laser compared with conventional vestibuloplasty performed with cutting instruments. Use of the laser is associated with a more favorable postoperative course and results in a greater gain in keratinized mucosa around dental implants.

ADDITIONAL INFORMATION

Author contributions: S.A. Kalinin: investigation, resources, writing— original draft, writing—review & editing; S.V. Tarasenko: supervision, resources, writing—original draft. All authors approved the final version of the manuscript for publication and agreed to be accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Ethics approval: This publication reports original research approved by the Local Ethics Committee of the Federal State Budgetary Educational Institution of Higher Education The First Sechenov Moscow State Medical University, Ministry of Health of the Russian Federation (Approval No. 28–24, November 21, 2024). All participants provided written informed consent prior to inclusion in the study. The study protocol was not registered.

Funding sources: No funding.

Disclosure of interests: The authors have no relationships, activities, or interests for the last three years related to for-profit or not-for-profit third parties whose interests may be affected by the content of the article.

Statement of originality: No previously published material (text, images, or data) was used in this work.

Data availability statement: All data generated or analyzed during this study are included in this article.

Generative AI: No generative artificial intelligence technologies were used to prepare this article.

Provenance and peer review: This paper was submitted unsolicited and reviewed following the standard procedure. The peer review process involved two external reviewers, a member of the editorial board, and the in-house scientific editor.

About the authors

Sergey A. Kalinin

Author for correspondence.
Email: medikas97@mail.ru
ORCID iD: 0000-0002-0310-1873
SPIN-code: 7930-3209
Russian Federation, Moscow

Svetlana V. Tarasenko

Email: prof_tarasenko@rambler.ru
ORCID iD: 0000-0001-8595-8864
SPIN-code: 3320-0052

MD, Dr. Sci. (Medicine), Professor

References

Supplementary files

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2. Fig. 2. Apical repositioning of the mucoperiosteal flap and creation of a new vestibular depth.

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3. Fig. 3. Free gingival graft harvested from the palatal donor site.

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4. Fig. 4. Postoperative appearance of the surgical site.

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5. Fig. 5. Measurement of the width of keratinized mucosa using the “roll technique.”

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6. Fig. 1. Study design.

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7. Fig. 6. Width of attached keratinized mucosa before and after surgery, mm.

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8. Fig. 7. Mean increase in attached keratinized mucosa width after surgery, mm

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9. Fig. 8. Pain intensity according to the Visual Analog Scale, points.

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10. Fig. 9. Collateral edema scores, points.

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11. Fig. 10. Mucosal hyperemia scores, points.

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