Novel Approaches for Augmentation of Peri-implant Keratinised Mucosa
Li Xinda
Clinical Medicine
Dr. Fekete Andrea
SE Semmelweis Szalon
2025-11-18 11:00:00
Dental Research
Dr. Varga Gábor
Dr. Windisch Péter
Dr. Szabó Balázs
Dr. Mikulás Krisztina
Dr. Joób-Fancsaly Árpád
Dr. Kivovics Márton
Dr. Sass Tamás
Peri-implant soft tissue augmentation is critical for maintaining long-term peri-implant health, preventing mucosal recession, and ensuring optimal functional and aesthetic outcomes. This doctoral research assessed the clinical effectiveness and dimensional stability of XDM-based techniques, used alone and in combination with a narrow ASG, for increasing PIKM-W.
The first study evaluated XDM alone in both the maxilla and mandible. XDM provided stable and clinically sufficient PIKM-W (>2 mm) in the maxilla at 12 months. However, mandibular applications showed marked contraction (87.4%) and variable outcomes, highlighting anatomical differences in graft behaviour and the necessity for region-specific strategies.
To address this drawback, a second study investigated the ASG+XDM technique in the mandible. This combination significantly enhanced mucosal stability, achieving a mean PIKM-W of 4.58 mm at 12 months with improved resistance to shrinkage. Importantly, PIKM-T in the mandible increased significantly from 1.36 ± 0.43 mm at baseline to 2.87 ± 0.82 mm at 1 month, remaining stable at 12 months (2.83 ± 0.65 mm, p = 0.91), indicating rapid integration and sustained volumetric stability of the ASG+XDM construct.
One key finding was the time-dependent remodelling pattern, with most dimensional changes occurring within the first three months postoperatively, followed by stabilisation from 6 to 12 months. This emphasises the need for extended follow-up in augmentation studies to avoid underestimating long-term outcomes. Importantly, the research quantified graft shrinkage across sites, reinforcing the clinical need for oversizing grafts at placement. The data support tailoring graft dimensions to anatomical location to achieve predictable results.
Clinically, this thesis work validates the use of XDM as a reliable alternative to autogenous grafts in the maxilla while supporting the ASG+XDM technique in the posterior mandible to ensure long-term peri-implant soft tissue stability. These findings inform evidence-based, anatomy-driven surgical protocols that enhance outcomes and reduce patient morbidity.
