The skirt-shaped free gingival graft technique for peri-implant keratinized mucosa augmentation: A report of two cases.

BACKGROUND: Free gingival grafting (FGG) is a well-established technique for peri-implant keratinized mucosa (KM) augmentation. However, recipient beds prepared following apically positioned flap surgery are often trapezoidal in shape, whereas palatal grafts are typically rectangular. This geometric mismatch may require graft trimming, reducing usable donor tissue for recipient-site coverage. The skirt-shaped free gingival graft (S-FGG) technique was developed to improve adaptation between the graft and recipient bed. By improving graft-recipient conformity while preserving graft continuity, the technique may increase the effective utilization of donor tissue and extend the coverage achievable from a given graft harvest. METHODS: Two patients with insufficient peri-implant KM at mandibular posterior implant sites were treated using the S-FGG technique. A palatal FGG was modified with vertical incisions to create a skirt-shaped configuration and adapted to the recipient site. RESULTS: Both grafts healed uneventfully and integrated successfully with the recipient bed. In Case 1, the postoperative buccal KM width (KMW) measured 6 mm at definitive prosthesis delivery and remained clinically stable during the subsequent 6-month follow-up. In Case 2, the buccal KMW measured approximately 4 mm at 4 weeks and stabilized at approximately 3 mm after tissue maturation. No major postoperative complications were observed. CONCLUSION: The S-FGG technique appears to be a feasible modification of conventional FGG for peri-implant KM augmentation. By improving graft-recipient conformity, the technique may enhance utilization of available donor tissue. Further clinical studies are needed to evaluate its long-term effectiveness. KEY POINTS: The skirt-shaped free gingival graft (S-FGG) technique addresses the geometric mismatch between rectangular palatal grafts and trapezoidal recipient beds, commonly encountered during peri-implant keratinized mucosa (KM) augmentation. By reshaping a conventional FGG while preserving tissue continuity, the S-FGG technique may improve graft-recipient conformity and potentially enhance the effective use of available donor tissue. Clinical application in two cases demonstrated successful graft integration, favorable healing, and stable peri-implant KM during follow-up. PLAIN LANGUAGE SUMMARY: The skirt-shaped free gingival graft (S-FGG) technique reshapes a conventional FGG to better match recipient-site geometry and may increase the effective coverage achievable from a harvested graft while preserving graft continuity.