Objective Peri-implant keratinized mucosa deficiency is a significant factor affecting implant success. Therefore, it is crucial to choose a suitable technique for increasing the width of the keratinized mucosa. This study aims to compare two different approaches of free gingival graft (FGG) application in the treatment of insufficient peri-implant keratinized mucosa and to determine the most effective and predictable technique.

Materials and Methods A total of 38 systemically healthy patients with ≤2 mm of keratinized mucosa in the mandibular anterior region (teeth 33-43) and 38 dental implants were included. Patients were randomly assigned to two groups: Test ( Ring FGG) and Control (Conventional FGG). Clinical parameters including Bleeding on Probing (BOP), Gingival Index (GI), Plaque Index (PI), Probing Depth (PD), Width of Keratinized Mucosa (KMW), Peri-implant Mucosal Thickness (PMT), and Graft Surface Area (GSA) were recorded at baseline, and at 1, 3, and 12 months postoperatively.

Inclusion Criteria:

• 1. Systemically healthy individuals 2. Age over 18 years 3. Non-smokers 4. No antibiotic therapy for any reason in the past 6 months 5. No previous soft tissue surgery performed in the region of interest 6. KMW≤ 2 mm 7. Presence of inadequate keratinized tissue in the vestibular and/or lingual area of the anterior mandibular implant region 8. Mentally competent to understand the study purpose and procedures explained both verbally and in writing

Exclusion Criteria:

- 1. Presence of peri-implantitis in the implant(s) planned for FGG application (defined as probing depth ≥ 5 mm, pus discharge, mobility, or severe bone loss) 2. Inability to maintain oral hygiene or presence of implant body and/or abutment fractures in the related region 3. Presence of pathological conditions in the palate that prevent harvesting of a free gingival graft 4. History of systemic diseases such as Diabetes Mellitus, Chronic Renal Failure, Cancer, Bleeding Disorders, Connective Tissue Diseases, etc.

5. Use of anticoagulant and/or antiplatelet medications

male and female