Techniques to Increase Gingival Thickness: A Systematic Review and Meta-analysis
Natasha Singh, Ruchi Pandey, Sakshi Kundu, Nipun Dhalla, Lipika GopalAbstract
Objective:
To evaluate and compare conventional surgical procedures with platelet-rich fibrin (PRF)-based therapies in increasing gingival thickness (GT).
Methods:
This systematic review was conducted according to preferred reporting items for systematic reviews and meta-analyses guidelines and registered in PROSPERO (CRD42024595878). A comprehensive search of PubMed, SCOPUS, EBSCO, Google Scholar, Embase, and Web of Science databases identified clinical studies published between 2015 and 2025. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool, and due to the heterogeneity, the results were synthesized narratively.
Results:
Twelve studies were included. Subepithelial connective tissue grafts (SCTG) and connective tissue graft (CTG) demonstrated the most consistent increase in GT, with a mean gain of 0.00–1.32 mm. PRF-based therapies showed moderate thickness gains of approximately −0.21 mm to 1.25 mm, with reduced surgical morbidity and improved early healing, though long-term stability remained inferior to that of autogenous grafts. Meta-analysis of the subgroup comparing GT gain using CTG/SCTG versus PRF showed significant greater GT gain with CTG/SCTG, with a mean difference of −0.26 mm.
Conclusion:
Overall, free gingival grafts and CTGs remain the gold standard, whereas PRF may serve as a minimally invasive alternative in selected cases. Further well-designed randomized controlled trials with standardized methodologies and long-term follow-up are required to validate the PRF in increasing the GT.