Long‐term evaluation of peri‐implant keratinized mucosa stability after free epithelialized graft and keratinized mucosa shifting procedures: A retrospective study up to 13 years.

Objectives: This study aimed to assess the risk of less than 2 mm keratinized mucosa (KM) width occurrence after free epithelialized graft (FEG) and keratinized mucosa shifting (KMS) procedures using survival analysis. In addition, KM dimensional changes were evaluated. Materials and Methods: This study included 76 implants in 36 patients with insufficient KM (<2 mm). The implants underwent either FEG or KMS procedures. The mid‐buccal KM width was measured from surgery to the end of a one 13‐year follow‐up period. Results: Mean follow‐up durations were 9.2 ± 3.9 years for FEG and 6.3 ± 4.2 years for KMS. Two implants in FEG and nine implants in KMS exhibited a KM width of less than 2 mm during follow‐up. The hazard ratios for KMS compared to FEG were 6.48 (crude) and 6.54 (adjusted), both statistically significant (p <.05). The incidence rate of KMS (4.06%) was higher than that of FEG (0.63%), with an average incidence time of 3.38 years for KMS and 8.82 years for FEG post‐surgery. FEG showed a significant shrinkage within 6 months (33% ± 22%), whereas KMS demonstrated a gradual decrease over 13 years (34% ± 25%). FEG exhibited significantly greater width change than KMS during a 5‐year follow‐up (p <.05). Conclusions: FEG and KMS enhanced PIKM but exhibited different long‐term reduction patterns. FEG demonstrated rapid shrinkage, while KMS displayed gradual and continuous reduction. Moreover, KMS presented a higher risk and incidence of KM width less than 2 mm compared to FEG. [ABSTRACT FROM AUTHOR]