Regeneration of keratinized tissue around teeth and implants following coronal repositioning of alveolar mucosa with and without a connective tissue graft: An experimental study in dogs: Fifty years after Karring's 71 landmark study

AIM: To compare clinical and histological keratinized tissue formation around teeth and implants following coronal repositioning of alveolar mucosa with or without a connective tissue graft (CTG). MATERIALS AND METHODS: In nine beagle dogs, the third and fourth premolars (P3 and P4) were extracted from one side of the maxilla. Three months after the tooth extraction, a full‐thickness buccal flap was raised and two implants were placed in those healed areas. On the contra‐lateral side, a buccal flap was also raised at the P3 and P4 areas. Before suturing, the dogs were randomly assigned to three study groups (control, non‐keratinized tissue [NKT], and non‐keratinized tissue CTG [NKT‐CTG]). In the control group, the buccal flaps were re‐positioned around the teeth (P3 and P4) on one side, and implants on the other side, presenting an adequate band of keratinized tissue (KT). For the NKT and NKT‐CTG groups, this buccal KT was then excised. In the NKT group, the buccal flap without KT (alveolar mucosa) was re‐positioned around the teeth and implants. In the NKT‐CTG group, a CTG taken from the excised KT was sutured to the buccal alveolar mucosa and then both were re‐positioned around the teeth and implants. The clinical height of the KT was measured at baseline and at 1, 2, and 3 months of healing. The animals were sacrificed at 3 months, at which point the KT height was measured histologically. RESULTS: The control group presented normal healing with a band of KT surrounding the teeth and implants. In the NKT and NKT‐CTG groups, a new KT band approximately 2 mm in height (measured clinically and histologically) spontaneously formed around all teeth, regardless of whether a CTG had been placed. In the NKT implant group, no new KT was observed (clinically or histologically). Around the implants in the NKT‐CTG group, a small amount of KT was formed in just two of the six implants. CONCLUSIONS: After surgical excision of KT, spontaneous KT is formed around teeth but not around implants, regardless of the placement of a CTG.