Study of the Month – July 2026: Free Gingival Grafts Around Ceramic Implants: A Sustainable Strategy for Long-Term Soft Tissue Stability
29.7.2026 · 9 min
Why Keratinized Tissue Matters Around Dental Implants
Modern implant dentistry increasingly recognizes the oral cavity as an immunologically active interface between local tissues and systemic health. While implant survival remains important, long-term success also depends on the quality and stability of the peri-implant soft tissues.
A growing body of evidence suggests that insufficient keratinized mucosa may be associated with increased plaque accumulation, mucositis, bleeding on probing, soft tissue instability and peri-implant complications. Even around materials such as zirconia, the quantity and quality of peri-implant soft tissue remain clinically relevant.
The July 2026 Study of the Month highlights a clinical case describing the use of a free gingival graft (FGG) to increase peri-implant keratinized tissue around ceramic implants and support favorable soft tissue conditions during follow-up.
The Clinical Challenge
The case involved a 55-year-old patient who had received two zirconia implants in regions 36 and 37 approximately ten years earlier. Over time, insufficient keratinized tissue developed around the implants, compromising the peri-implant soft tissue architecture.
The clinical objective was to establish a broader and functionally stable zone of keratinized mucosa with the aim of supporting peri-implant tissue health and reducing local inflammatory signs in this individual case.
Baseline conditions demonstrated a markedly reduced band of keratinized gingiva around the implants.
Treatment Concept
To improve the peri-implant soft tissue conditions, an autologous free gingival graft (FGG) harvested from the palate was placed around the existing zirconia implants.
The procedure was combined with a biologically oriented treatment protocol including:
• Free gingival grafting (FGG)
• Advanced Platelet-Rich Fibrin (A-PRF)
• Injectable Platelet-Rich Fibrin (i-PRF)
• Ozone-assisted disinfection
• Nutritional and supplementation support
According to the authors, this integrated approach was intended to support wound healing, soft tissue maturation and tissue stability in the presented clinical context.
Why This Case Was Published
The authors highlighted four key reasons why this case is clinically relevant:
1. Soft Tissue as an Immune Seal
A stable band of keratinized mucosa may contribute to a protective soft tissue interface around implants and may help reduce local inflammatory signs within peri-implant tissues.
2. The Oral–Systemic Connection
The case is presented in the context of the broader scientific discussion on potential associations between oral inflammation and systemic inflammatory burden, sometimes referred to as the “leaky gum” concept.
3. The Ceramic Implant Advantage
The authors note that zirconia implants have been discussed in the literature in relation to favorable soft tissue responses; however, direct comparative claims regarding osteoimmunological burden versus titanium should be interpreted cautiously and require supporting evidence.
4. A Systemic-Biological Treatment Workflow
The combination of FGG, PRF, ozone protocols and nutritional support was presented by the authors as a biologically oriented treatment workflow; broader reproducibility should be confirmed in further clinical studies.
Clinical Outcomes
The treatment was associated with an improvement of the peri-implant soft tissue environment in the presented case.
At follow-up, the authors reported:
• Reported resolution of mucositis
• No bleeding on probing
• Establishment of a broad zone of keratinized mucosa
• Stable peri-implant tissue conditions during the reported follow-up period
The soft tissues were reported to remain stable throughout the observation period, suggesting favorable graft integration and tissue maturation in this individual case.
CaviTau Ultrasound Assessment
To further evaluate treatment outcomes, the clinicians used CaviTau transalveolar ultrasound, a radiation-free imaging technology described as providing information on peri-implant bone density patterns.
The ultrasound evaluation compared baseline conditions with findings obtained after 14 months of prosthetic loading.
The follow-up images were interpreted by the authors as showing predominantly favorable bone density patterns and stable peri-implant conditions, in line with the reported soft tissue findings.
Clinical Relevance
Although zirconia implants are frequently discussed in relation to favorable soft tissue compatibility, this case reinforces an important clinical concept:
Implant material alone cannot compensate for insufficient peri-implant soft tissue.
A stable zone of keratinized mucosa appears to be a relevant component of peri-implant health and may contribute to a more resilient peri-implant soft tissue interface.
The authors suggest that free gingival grafting may represent a clinically useful option for improving keratinized tissue conditions around ceramic implants; however, conclusions regarding predictability and long-term stability should be supported by further clinical evidence.
Conclusion
This case report suggests that free gingival grafting around zirconia implants may be an effective approach for re-establishing a stable peri-implant soft tissue barrier in selected clinical situations.
By increasing the width of keratinized mucosa and improving local tissue conditions, this approach may support peri-implant health and tissue stability around ceramic implants; however, general conclusions should be drawn cautiously because the evidence presented is based on a single case report.
