Abstract
INTRODUCTION AND AIMS: Free gingival grafting (FGG) is a common procedure in periodontal and implant therapy to augment keratinized tissue and improve esthetic outcomes. However, the effects of graft dimensions and residual tissue thickness (RTT(1)) on palatal donor site healing remain poorly characterized, lacking standardized 3-dimensional analysis. This study aimed to quantify how these factors influence 3-dimensional tissue recovery over 6 months, with thickness recovery rate as the primary outcome. METHODS: Thirty-two FGG patients were divided into single-tooth (ST(2)) and multi-teeth (MT(3)) groups. Intraoral scans and CBCT quantified donor site thickness and volume changes at 1, 3, and 6 months post-surgery. Statistical analyses (t-tests, ANOVA) assessed graft size and RTT effects. RESULTS: At 1 month, the ST group showed significantly faster healing than the MT group, with higher thickness (91.01% vs 86.46%, P = .005) and volume recovery rates (73.19% vs 64.23%, P = .009). No intergroup differences emerged at 3 or 6 months. RTT≥2 mm consistently improved outcomes across all time points (P < .001), while RTT<2 mm required prolonged healing. CONCLUSION: Graft size affects early-phase healing but not long-term outcomes. Preserving ≥2 mm RTT is critical for optimal recovery and re-harvesting potential, guiding graft dimension selection in FGG. CLINICAL RELEVANCE: Understanding the impact of graft size and residual tissue thickness (RTT) on palatal donor site healing can provide valuable guidance for clinical decision-making in free gingival graft surgery. Smaller grafts facilitate quicker initial recovery, while maintaining RTT≥2 mm is essential for optimizing long-term healing. These insights can improve surgical planning, postoperative care, and re-harvesting feasibility, leading to better patient outcomes.