COMPARATIVE EVALUATION OF FREE GINGIVAL GRAFT AND VESTIBULOPLASTY WITH PERIOSTEAL FENESTRATION ON MUCOGINGIVAL JUNCTION STABILITY AND POSITION: A RANDOMIZED CLINICAL TRIAL

Abstract

Background: Adequate attached gingiva and a stable mucogingival junction (MGJ) are essential for periodontal health, particularly in the mandibular anterior region where shallow vestibule is common. Free gingival graft (FGG) and vestibuloplasty are routinely performed to increase keratinized tissue and vestibular depth; however, their comparative influence on MGJ stability remains unclear. This randomized clinical trial aimed to compare vestibuloplasty and FGG in the mandibular anterior region, focusing on changes in MGJ position and stability. Materials and Methods: Thirty systemically healthy patients presenting with inadequate vestibular depth and/or insufficient attached gingiva in the mandibular anterior region were randomly allocated to either a vestibuloplasty group (n=15) or an FGG group (n=15). Clinical parameters including vestibular depth (VD), keratinized tissue width (KTW), and width of attached gingiva (WAG) were recorded at baseline, 3 months, and 6 months postoperatively. MGJ stability was assessed indirectly through the maintenance of postoperative gains in KTW and WAG and the absence of significant dimensional changes between 3 and 6 months. Results: At 3 and 6 months postoperatively, the FGG group showed significantly greater improvements in all evaluated parameters compared to the vestibuloplasty group (p < 0.001). Mean VD was higher in the FGG group at 3 months (17.52 ± 1.06 mm) and 6 months (17.56 ± 1.01 mm). Greater gains in KTW (7.10 ± 0.97 mm) and WAG (4.48 ± 0.50 mm) were also observed at both follow-up intervals. The FGG group exhibited superior MGJ stability, evidenced by greater and more sustained apical displacement of the MGJ and maintenance of keratinized and attached gingival dimensions throughout the observation period. Conclusion: Within the limitations of this study, both surgical approaches were effective, FGG resulted in significantly superior clinical outcomes in terms of vestibular depth, keratinized tissue width, and width of attached gingiva at postoperative follow-up. Therefore, FGG remains the preferred approach when long-term MGJ stability and mucogingival augmentation are primary treatment objectives.